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Thorac Cardiovasc Surg 2019; 67(06): 450-457
DOI: 10.1055/s-0038-1668602
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Fast-Track Management in Off-Pump Coronary Artery Bypass Grafting: Dexmedetomidine Provides Rapid Extubation and Effective Pain Modulation

Alicja Zientara
1   Department of Cardiac Surgery, Stadtspital Triemli, Zürich, Switzerland
,
Sergio Mariotti
2   Department of Anesthesiology and Intensive Care, Stadtspital Triemli, Zurich, ZH, Switzerland
,
Sonja Matter-Ensner
2   Department of Anesthesiology and Intensive Care, Stadtspital Triemli, Zurich, ZH, Switzerland
,
Burkhardt Seifert
3   Department of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
,
Kirk Graves
1   Department of Cardiac Surgery, Stadtspital Triemli, Zürich, Switzerland
,
Omer Dzemali
1   Department of Cardiac Surgery, Stadtspital Triemli, Zürich, Switzerland
,
Michele Genoni
1   Department of Cardiac Surgery, Stadtspital Triemli, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

25 April 2018

18 July 2018

Publication Date:
28 August 2018 (online)

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Abstract

Background Dexmedetomidine (DEX) is a highly selective α-2 agonist with many desirable effects including analgesia, improvement of hemodynamic stability, and potential myocardial and renal protection. The aim of this study was to investigate the effect of DEX on patients undergoing off-pump coronary artery bypass (OPCAB) grafting with regard to less pain medication, earlier extubation, faster transfer to normal ward, and cardiac protection.

Patients and Methods From January 2012 to March 2015, 464 patients receiving OPCAB were included for retrospective analysis. After propensity matching (1:1), two groups (DEX vs. propofol, n = 129) could be compared. Continuous and categorical variables were reported as mean ± standard deviation or percentages, and compared with the chi-square test and the Mann–Whitney's test, respectively.

Results In the DEX group, less use of pain medication in the initial phase at intensive care unit was observed. During the first 2 hours, DEX patients received more nicomorphine (DEX 8 ± 3.2 mg vs. propofol 6 ± 4 mg, p < 0.001), while in the following 2 hours, the pain medication was significantly reduced (DEX 3.2 ± 2.8 mg vs. propofol 4.7 ± 3.3 mg, p < 0.001). Remifentanil was stopped considerably earlier (DEX 238 ± 209 minutes vs. propofol 353 ± 266 minutes, p < 0.001). DEX led to earlier extubation (DEX 208 ± 106 minutes vs. propofol 307 ± 230 minutes, p < 0.001) and less postoperative atrial fibrillation (AF) (p = 0.01).

Conclusion Early postoperative DEX application supports the fast-track strategy in patients after OPCAB through enabling rapid extubation, effective pain control, and reduced occurrence of new-onset AF. We are confident to give precedence to DEX over propofol as the new routine medication during postoperative patient transfer.

Keywords

intensive care - off-pump surgery - ventilation

Note

This study was presented at the annual meeting of the German Society of Thoracic and Cardiovascular Surgery, Leipzig, February14, 2016.


 

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