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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Treatment of delirium in early postoperative cardiosurgical patients. Article

V.E. Rubinchik, I.Yu. Kasherininov, A.E. Bautin

Almazov National Medical Research Centre, St. Petersburg, Russia

For correspondence: Vadim E. Rubinchik — M. D., associate professor, the chief of the ICU#2 of Almazov National Medical Research Centre, St. Petersburg; e-mail: verubinchik@gmail.com

For citation: Rubinchik VE, Kasherininov IYu, Bautin AE. Treatment of delirium in early postoperative cardiosurgical patients. Article. Annals of Critical Care. 2019;3:77–83.

DOI: 10.21320/1818-474X-2019-3-77-83


Abstract

Background. Postoperative delirium is highly relevant in elderly patients who undergo cardiosurgical interventions with cardiopulmonary bypass (CPB), long stay in intensive care unit (ICU), suffering from widespread atherosclerosis and having a wide range of comorbidities.

In the world literature there is a lot of data on the successful use of dexmedetomidine for sedation, prevention and relief of delirium, including patients after open-heart interventions. Comparative evaluation of dexmedetomidine and neuroleptic sedation with “traditional” for Russian Federation management of cardiosurgical patients suffering from postoperative delirium seems to be a relevant clinical and research task.

Objectives. Comparative evaluation of the effectiveness of drug sedation with dexmedetomidine and propofol in cardiosurgical patients with postoperative delirium.

Material and Methods. An open prospective cohort study took place in 2017–2019 and included 42 patients who underwent open-heart intervention with CPB and had delirium in the postoperative period.

Exclusion criteria: severe brachiocephal artery atherosclerosis, acute period or consequences of stroke, signs of acute respiratory failure associated with the pathology of the respiratory system, severe cardiovascular failure, age over 80 years.

Detection and treatment of delirium were performed by an intensivist together with a psychiatrist. Haloperidol was used as the main antipsychotic. Depending on the drug used for medical sedation, the patients were divided into 2 groups: 22 patients underwent medical sedation with propofol, 20 with dexmedetomidine in the form of an extended infusion. According to the results of the study, the length of patients’ stay in the ICU and hospital, the need for vasopressor therapy, mechnical ventilation (MV), and the duration of delirium were analyzed.

Results. In patients of the dexmedetomidine group, compared with the propofol group, the following was observed: less need for vasopressors and the duration of their use, less frequent use of MV (27.2 % versus 10.0 % of cases, p < 0.05), shorter stay in ICU (4.4 ± 1.8 vs 7.2 ± 2.3 days, p < 0.05), and finally, more rapid relief of the delirium itself (34.7 ± 6.8 vs 52.6 ± 8.9 hours, p < 0.05). There was no statistically significant difference between the groups for the length of hospital stay.

Conclusions. In the early postoperative period of open-heart interventions, medical sedation using dexmedetomidine as a component of the delirium therapy seems to be preferable to propofol sedation. Using of dexmedetomidine during study was associated with more rapid relief of the delirium, more favorable hemodynamic profile, less need for MV and duration of MV, as well as shorter duration of stay in the ICU, compared with the use of propofol sedation, which allows us to recommend routine use of dexmedetomidine in the cardiosurgical ICU.

Keywords: cardiosurgery, postoperative period, delirium, sedation, dexmedetomidine.

Received: 26.03.2019

Accepted: 03.09.2019


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Evaluation of brain bioelectrical activity during xenon-oxygen mixture inhalation

V.I. Potievskaya1, F.M. Shvetskiy2, M.B. Potievskiy3

FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation, Moscow

SBIH “Hospital for war veterans №2”, Moscow

FSBEI HE “Lomonosov Moscow State University”, Moscow

For correspondence: Vera I. Potievskaya, Ph.D., M.D., chief researcher «National Medical Research Radiology Center», Russian Federation Ministry of Healthcare; e-mail: vera.pot@mail.ru

For citation: Potievskaya VI, Shvetskiy FM, Potievskiy MB. Evaluation of brain bioelectrical activity during xenon-oxygen mixture inhalation. Alexander Saltanov Intensive Care Herald. 2019;1:94–9.

DOI: 10.21320/1818-474X-2019-1-94-99


Xenon is an inert gas used like inhalational anesthetic during different surgeries, including high-risk operations and for pain treatment caused by different factors. If concentration of the gas is less than 50 %, or the duration of the procedure is very short, no consciousness depression occurs. 20 healthy persons from 22 to 30 years old were undergone xenon/oxygen inhalation with concentration 70/30 % respectively for 3 minutes. Electroencephalography (EEG) was recorded before, during and 30 minutes later the procedure. For the data processing spectral analysis was used. Statistical analysis was performed by Wilcoxon and Page tests. As a result, significant increase in slow wave activity and reduction in alpha-rhythm activity were observed during and after the procedure as well as repartition of activity zones in brain similar to physiological sleep. This fact may be used in conduction of treatment and diagnostics procedures.

Keywords: xenon, inhalational anesthetics, mask inhalations of xenon-oxygen mixture, electroencephalography, sedation

Received: 07.10.2018


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