Dexmedetomidine sedation experience in hybrid cardiac operations. Article

K.A. Gruzdev, A.A. Margolina, E.A. Tabak’yan, M.G. Lepilin

National medical research centre of cardiology, Moscow, Russia

For correspondence: Kirill A. Gruzdev — M. D., specialist in anesthesiology and intensive care medicine, department of anesthesiology and intensive care medicine National medical research centre of cardiology, Moscow; e-mail: kirillgruzdev@gmail.com

For citation: Gruzdev KA, Margolina AA, Tabak’yan EA, Lepilin MG. Dexmedetomidine sedation experience in hybrid cardiac operations. Article. Annals of Critical Care. 2019;3:69–76.

DOI: 10.21320/1818-474X-2019-3-69-76


Abstract

Background. Dexmedetomidine sedation can appear effective anesthesiological management in hybrid cardiac operations.

Objectives. To examine the safety use of dexmedetomidine sedation in hybrid cardiac operations.

Material and Methods. This study includes 132 patients, who underwent hybrid cardiac operations. Patients were randomized into dexmedetomidine (DEX) and general anesthesia (GA) use groups. We evaluated hemodynamics, gas exchange measurements, postoperative complications as primary outcomes of the study.

Results. In DEX group greater hemodynamics stability occured, which reflected in higher systolic (p < 0,0001) and mean arterial pressure (p = 0,019) compared to GA. Significantly lower usage of cathecholamines was defined in DEX versus GA (p = 0,033). The depth of sedation in DEX seemed to be adequate in assessing with RASS and Ramsay score. In DEX we observed highest value of carbon dioxide in arterial blood gas versus GA (47.0 vs 39.0, respectively), with no significant difference in oxygen concentration. Frequency of COPD was significantly higher in DEX group. Higher incidence of postoperative delirium (p = 0,041) was noted in GA (15 %) versus DEX (3,5 %). There was no significant difference in frequency of AKI, renal replacement therapy, stroke, respiratory complications in observed groups. In DEX group GFR values appeared much better than in GA group (p = 0,02).

Conclusions. In hybrid cardiac operations sedation with dexmedetomidine provides hemodynamics stability. Dexmedetomidine set up good anesthesia conditions with adequate gas exchange parameters, that is usefull in patients with COLD. Applying dexmedetomidine, the frequency of postoperative delirium may be reduced. Dexmedetomidine can improve glomerular filtration rate values.

Keywords: dexmedetomidine, sedation, transcatheter aortic valve implantation, delirium.

Received: 28.03.2019

Accepted: 03.09.2019


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