Study on Role Of Dexmetedomine Infusion In Early Extubation After Coronary Artery Bypass Grafting

Abstract

Background: Postoperative pain has negative consequences on patients’ outcomes after cardiac surgery. Routine management with opioid and or non-steroidal anti-inflammatory medications has several disadvantages. Opioids have several undesirable side effects, including nausea, vomiting, decreased gastrointestinal motility, respiratory depression, drowsiness, and hemodynamic effect with large doses. Moreover, non-opioids analgesics, such as non-steroidal anti-inflammatory drugs
and acetaminophen, may be a useful complement to opioids for postoperative pain relief. Dexmedetomidine (DEX) is a highly selective α2 receptor agonist that provides better sedation, analgesic, and anxiolytic effect. This property is considered unique among sedatives used for intensive care units generally. Objectives: The present study was undertaken to determine the role of an early administration of dexmedetomidine in decreasing opioid use post-cardiac surgery and its effects on the quality of
postoperative recovery in patients after coronary artery bypass grafting. Methodology: The present study included a total of 120 patients who underwent CABG at our tertiary care hospital. These Patients were randomly allocated into two groups, Group A included 60 patients who received postoperative DEX infusion for sedation and Group B included 60 patients who did not receive DEX infusion. All patients were intubated, ventilated, and sedated by propofol intravenous (IV) infusion 25–50 μg/kg/min. On admission to CSICU, vital signs were recorded, and group A patients were started on DEX IV infusion 0.2–0.4 μg/kg/h. while patients in group B were maintained only on propofol infusion. Vital signs, including heart rate (HR), oxygen saturation, and end-tidal carbon dioxide, were continuously monitored, and blood pressure was monitored both invasively and non-invasively. Results: The present study included a total of 120 patients who underwent CABG at our tertiary care hospital. These Patients were randomly allocated into two groups, Group A included 60 patients who received postoperative DEX infusion for sedation and Group B included 60 patients who did not receive DEX infusion. The results of our study indicate that the pain scores gradually improved in Group A as compared to Group B, which means that early DEX infusion following CABG operations was associated with reduction in morphine usage, decrease in pain severity and improvement in sedation which encouraged early extubation as seen in table 2 and 3. Conclusion: The findings of our study indicate that administration of dexmedetomidine in the early postoperative period can be safe. It may reduce the use of opioids, has sedative, analgesics,
and sympatholytic effects that could play a useful role during the management of coronary artery bypass patients, and may improve postoperative recovery.