Dexmedetomidine Provides Effective Pain Modulation and Rapid Extubation during Perioperative Fast-track Management in Patients after Off-pump Coronary Artery Bypass Grafting

Objectives: Dexmedetomidine (DEX) is a highly selective α-2 agonist with 10-fold greater α-2 to α-1 receptor selectivity than clonidine. Many desirable effects of DEX, including analgesia, anxiolysis, hemodynamic stability, and potential myocardial and renal protection have been proven. The aim of this study is to investigate the effect of DEX on patients undergoing off-pump coronary artery bypass grafting (OPCAB).

Methods: 464 OPCAB patients were included for retrospective analysis of early postoperative outcome. After propensity matching (1:1), including cardiovascular risk factors, baseline laboratory values and operative strategy, two groups (DEX vs disoprivan (DISO), n = 129) were compared. DEX patients received immediately after chest closure an infusion of DEX (1µg/kg/h) while disoprivan was reduced and stopped in the OR. DISO patients were transferred with disoprivan to the ICU, routinely. Continuous and categorical variables were reported as mean ±  SD or percentages, and compared with the Mann-Whitney test and the chi-square test.

Results: In the DEX group less use of pain medication in the initial phase was observed. During the first 2 hours, DEX patients received more intravenous nicomorphine (MO) (DEX 8 ± 3.2mg vs DISO 6 ± 4mg, p< 0.001), while in the following 2 hours MO was significantly reduced (DEX 3.2 ± 2.8mg vs DISO 4.7 ± 3.3mg, p< 0.001). After 12 hours there was no difference in both groups, although remifentanil was stopped considerably earlier in the DEX group (DEX 238 ± 209min vs DISO 353 ± 266min, p< 0.001). Additionally, DEX led to earlier extubation (DEX 208 ± 106min vs, DISO 307 ± 230min, p< 0.001). Atrial fibrillation occurred significantly rarer after DEX application (p = 0.01). Delirium occurred only once in the DEX group and five times in the DISO group, which was not significant (p = 0.098). There were no differences between both groups in postoperative CK, CKMB or Troponin T and in Creatinine.

Fig. 1 Analgesia_extubation.

Conclusion: Early postoperative application of DEX supports the fast-track strategy in OPCAB patients by rapid extubation, less need of pain medication, rarer occurrence of atrial fibrillation and a tendency to less delirium.