Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study
ABSTRACT Objective: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surge...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cirurgia Cardiovascular
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| Series: | Brazilian Journal of Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382016000300213&lng=en&tlng=en |
| _version_ | 1828348860606447616 |
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| author | Paulo Gabriel Melo Brandão Francisco Ricardo Lobo Serginando Laudenir Ramin Yasser Sakr Mauricio Nassau Machado Suzana Margareth Lobo |
| author_facet | Paulo Gabriel Melo Brandão Francisco Ricardo Lobo Serginando Laudenir Ramin Yasser Sakr Mauricio Nassau Machado Suzana Margareth Lobo |
| author_sort | Paulo Gabriel Melo Brandão |
| collection | DOAJ |
| description | ABSTRACT Objective: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery. Methods: We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group). Results: A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality. Conclusion: Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results. |
| first_indexed | 2024-04-14T01:01:13Z |
| format | Article |
| id | doaj.art-2ae8ba8e573240ed82281fa57a527015 |
| institution | Directory Open Access Journal |
| issn | 1678-9741 |
| language | English |
| last_indexed | 2024-04-14T01:01:13Z |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| record_format | Article |
| series | Brazilian Journal of Cardiovascular Surgery |
| spelling | doaj.art-2ae8ba8e573240ed82281fa57a5270152022-12-22T02:21:25ZengSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery1678-974131321321810.5935/1678-9741.20160043S0102-76382016000300213Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort StudyPaulo Gabriel Melo BrandãoFrancisco Ricardo LoboSerginando Laudenir RaminYasser SakrMauricio Nassau MachadoSuzana Margareth LoboABSTRACT Objective: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery. Methods: We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group). Results: A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality. Conclusion: Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382016000300213&lng=en&tlng=enDexmedetomidineCardiovascular Surgical ProceduresAdjuvantsAnesthesia |
| spellingShingle | Paulo Gabriel Melo Brandão Francisco Ricardo Lobo Serginando Laudenir Ramin Yasser Sakr Mauricio Nassau Machado Suzana Margareth Lobo Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study Brazilian Journal of Cardiovascular Surgery Dexmedetomidine Cardiovascular Surgical Procedures Adjuvants Anesthesia |
| title | Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study |
| title_full | Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study |
| title_fullStr | Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study |
| title_full_unstemmed | Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study |
| title_short | Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study |
| title_sort | dexmedetomidine as an anesthetic adjuvant in cardiac surgery a cohort study |
| topic | Dexmedetomidine Cardiovascular Surgical Procedures Adjuvants Anesthesia |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382016000300213&lng=en&tlng=en |
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