Kamal Manoj, Agarwal Deepa, Singariya Geeta, Kumari Kamlesh, Paliwal Bharat, Ujwal Shobha
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):255-260. doi: 10.4103/joacp.JOACP_353_18. Epub 2020 Jun 15.
Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery.
Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 μg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 μg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and < 0.05 was considered significant.
The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) (<0.001).
Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.
冠状动脉旁路移植术（CABG）手术涉及多种有害刺激，可引发应激反应，进而增加围手术期心肌缺血的风险。本研究旨在评估右美托咪定对减轻CABG手术中气管插管、皮肤切口和胸骨切开术时血流动力学反应的效果。
60例患者随机分为两组，每组30例。D组患者在10分钟内静脉输注负荷剂量的右美托咪定1μg/kg，随后以0.5μg/kg/h的速度持续输注。P组以相似速度输注生理盐水作为负荷剂量和维持剂量。记录血流动力学参数、硫喷妥钠的总诱导剂量及不良反应。采用SPSS 20.0版进行统计分析。使用卡方检验和方差分析，P<0.05认为差异有统计学意义。
气管插管后（7.04%对15.08%）D组心率增加百分比显著低于P组，皮肤切口后（5.91%对10.11%）及胸骨切开术后（5.33%对11.65%）同样如此。同样，气管插管、皮肤切口和胸骨切开术后，D组收缩压、舒张压和平均血压的升高也显著低于P组。与P组相比，D组硫喷妥钠的平均总量显著降低（1.16mg/kg对2.44mg/kg）（P<0.001）。
右美托咪定可显著减轻CABG手术中气管插管、皮肤切口和胸骨切开术时的血流动力学反应，且无明显不良反应。它还显著降低了诱导所需的硫喷妥钠剂量。
