Document Type : Research articles

Authors

• Abbas Sedighinejad ¹
• Ali Mohammadzadeh Jouryabi ¹
• Vali Imantalabl ¹
• Ali Mirmansouri ¹
• Nassir Nassiri Sheikhani ²
• Zahra Atrkarroushan ³
• Gelareh Biazar ¹
• Yasmin Chaibakhsh ³

¹ Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran

² Department of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran

³ Guilan University of Medical Sciences(GUMS), Rasht, Iran

Abstract

Background: In patients undergoing Cardiopulmonary Bypass (CPB) with extracorporeal circulation, the rapid restoration of blood flow to the ischemic tissue induces cardiac damage termed as myocardial Ischemic Reperfusion (I/R) injury.
Objectives: In the current study, the researchers hypothesized that Dexmedetomidine (DEX) modulates I/R injury in Coronary Artery Bypass Graft Surgery (CABG) with Cardiopulmonary Bypass (CPB). Methods: This randomized, double-blind, clinical trial took place in a university affiliated Hospital, Gilan, Iran. From April 2016 to March 2017, 114 eligible patients undergoing elective and isolated CABG were randomized to receive either DEX infusion 0.3 to 0.5 μg/kg/hour before induction of anesthesia till 12 hours postoperatively (group D) or normal saline as placebo (group C). The
endpoints were used to assess creatinine phosphokinase-MB (CKMB) and cardiac troponin I (CTnI) levels at four measurement time points, including baseline (T0) and 6, 12, 24, and 48 hours after the operation (T0 - T4).
Results: Overall, 114 patients’ data were analyzed; group D (n = 58) and group C (n = 56). No significant differences were found between the two groups, in view of baseline characteristics. Following CPB, a marked increase in CKMB and CTnI plasma levels was observed in both groups compared with baseline (P = 0.0001). Serum CKMB levels increased           from 2.27 ± 0.59 to 7.81 ± 1.39, and 2.22 ± 0.64 to 7.46 ± 1.25 and CTnI levels from 10.22 ± 0.17 to 4.89 ± 1.1, and 0.27 ± 0.28 to 4.5 ± 1.4 in groups C and D, respectively (P = 0.0001). According to CKMB, there was a significant difference between the two groups at T2 (P = 0.002) and T3 (P = 0.0001), and based on CTnI at T2 (P = 0.004) and T3 (P = 0.0001). However, no significant difference was observed at the other measurement point times. No adverse effect was recorded due to this intervention. Conclusions: Perioperative DEX in cardiac surgery appears safe, with properties to alleviate I/R injury. Obviously, future standard trials are required to find optimal intervention strategies.

Keywords

• Bypass
• Cardiac Troponin I
• Cardiopulmonary
• Coronary Artery Bypass
• Dexmedetomidine
• Reperfusion Injury