Hegazy MA, Hegazi RA, Hendawy SR, Hussein MS, Abdellateef A, Awad G, Abdeldayem OT. Cardiac Preconditioning Effect of Ketamine-Dexmedetomidine versus Fentanyl-Propofol during Arrested Heart Revascularization.
Anesth Essays Res 2020;
14:312-320. [PMID:
33487835 PMCID:
PMC7819405 DOI:
10.4103/aer.aer_55_20]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background
Myocardial damage due to ischemia and reperfusion is still unavoidable during coronary surgery. Anesthetic agents have myocardial preconditioning effect. Ketamine has sympathomimetic effect, while dexmedetomidine has a sympatholytic effect in addition to anesthetic, analgesic, and anti-inflammatory properties of both the drugs. This study was carried out to compare ketamine-dexmedetomidine (KD) combination with fentanyl-propofol (FP) combination on the release of cardiac troponin T (cTnT) and outcome after coronary artery bypass graft.
Patients and Methods
Ninety adult patients who underwent coronary artery bypass grafting (CABG) were assigned to receive either KD base anesthesia (KD group) or FP anesthesia (FP group). Trends of high-sensitive cTnT, CK-MB, and serum cortisol were followed in the first postoperative 24 h. Other outcomes were vital signs, weaning from cardiopulmonary bypass, tracheal extubation time, and echocardiographic findings.
Results
There was a significant lower release of cTnT in KD group than FP group during its peak values at 6 h after aortic unclamping (92.01 ± 7.332 in KD versus 96.73 ± 12.532 ng.L-1 P = 0.032). significant lower levels of serum cortisol levels were noted KD group than in FP group at 6 and 12 h after aortic unclamping P < 0.001. As regard tracheal extubation time, patients assigned to KD group extubated earlier than whom in FP group 202.22 ± 28.674 versus 304.67 ± 40.598 min respectively P < 0.001.
Conclusion
The use of KD during on-pump CABG confers better myocardial protective and anti-inflammatory effect than fentanyl propofol.
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