Effect of intraoperative use of dexmedetomidine on anesthetic requirements and time to tracheal extubation in elective adult heart surgery patients. A retrospective cohort study

摘要

Background and Objectives: Scientific literature about the effects of intraoperative use of dexmedetomidine on anesthetic requirements and time to tracheal extubation in elective adult heart surgery patients is limited. Methods: A retrospective cohort study in adult patients who underwent uncomplicated elective heart surgery was performed. 103 adult patients who received intraoperative dexmedetomidine (DEX cohort) were matched with 97 patients who did not receive intraoperative dexmedetomidine (control cohort). Matching by age, gender and type of heart surgery was done. Intraoperative requirements of anesthetics, tracheal extubation in the operating room and time to tracheal extubation in the ICU were extracted from their medical charts. Results: Both cohorts had similar demographic and preoperative characteristics. DEX cohort received smaller intraoperative anesthetic doses of fentanyl (3.2 mg/kg ± 1.3 vs control 12.5 mg/kg ± 5.9, p= 0.0001), thiopental (3.4 mg/kg ± 1.5 vs control 4.0 mg/kg ± 1.6, p= 0.018), and pancuronium (6.5 mg ± 2.3 vs control 8.0 mg ± 1.8, p= 0.0001). Frequency of intraoperative use of thiopental was low in DEX cohort patients compared with control group (81.6 % vs control 97.9%, p= 0.0001), as midazolam (22.3 % vs control 67%, p= 0.0001) and pancuronium (47.6 % vs control 98%, p= 0.0001). Time to tracheal extubation was shorter in DEX cohort (197 ± 118 min vs control 314 ± 265 min, p= 0.002). Tracheal extubation in the operating room was more frequent in the DEX cohort (46.6% vs control 9.3%, p= 0.0001). Postoperative hospital and UCI lengths of stay were similar in both cohorts.Conclusions: Intraoperative use of dexmedetomidine as coadjuvant of fentanyl-isoflurane based anesthesia for elective heart surgery in adult patients could reduce anesthetic requirements and facilitate early postoperative tracheal extubation. Introduction Dexmedetomidine is an ?2-agonist approved in 1999 by FDA for sedation in adult patients in the ICU setting. Previous clinical trials in non-cardiac surgery demonstrate how the use of dexmedetomidine reduces requirements of endovenous and inhalational anesthetic agents, provides intraoperative hemodynamic stability and reduces the requirements of postoperative opioid analgesics (1-6). The use of dexmedetomidine in the ICU , where it could facilitate weaning from mechanical ventilation and improve quality of sedation and pain control for postoperative sedation in patients following cardiac surgery has been described in multiple clinical trials (7-10). However, there is limited information about the intraoperative use of dexmedetomidine in cardiac surgery as a coadjuvant of the anesthetic technique.In 2003, our cardiovascular anesthesia department introduced progressively dexmedetomidine as part of the anesthetic technique in elective adult heart surgery. Based on this initial experience we designed a retrospective cohort study to describe the effects of intraoperative use of dexmedetomidine on anesthetic requirements, postoperative analgesic and sedative requirements, and the time to tracheal extubation. ICU length of stay and postoperative hospital length of stay were also studied. Indirectly, we also studied the effect of dexmedetomidine on postoperative inflammatory response. Methods A retrospective cohort study was approved by Institutional Review Board in Fundación Valle del Lili.From the institutional cardiac surgery database, adult patients, who underwent heart surgery between January 1 2004 and December 31 2006, were identified. These medical records were reviewed by the authors for study eligibility and following inclusion criteria : 1) elective procedure, 2) older than 18 years, 3) left ventricular eyection fraction (LVEF) ≥ 45 %, and 4) no surgical complication leading to reintervention or prolonged mechanical ventilation.Patients Selection Dexmedetomidine cohort: Intraoperative use of dexmedetomidine was identified in 103 patients who meet the inclusion criteria (DEX