ผลของยา Dexmedetomidine ต่อการตอบสนองของอัตราการเต้นของหัวใจและความดันโลหิต สำหรับการระงับความรู้สึกผ่าตัดบายพาสเส้นเลือดหัวใจ: การศึกษาแบบสุ่มมีกลุ่มควบคุมปกปิดสองทาง

Padet  Boonmark; Jiraporn  Phuksuetrong

Authors

Padet Boonmark Sawanpracharak Hospital
Jiraporn Phuksuetrong Sawanpracharak Hospital

Keywords:

Dexmedetomidine, intubation, skin incision, sternotomy

Abstract

Objective: The present study was conducted to evaluate the effect of dexmedetomidine on the heart rate and blood pressure response to intubation, skin incision, sternotomy and doses of nicardipine before aortic cannulation in coronary artery bypass graft surgery.

Material and methods: This was a prospective randomized controlled trial study. We enrolled patients between aged 40 and 75, ASA physical status II-III who had coronary artery bypass graft surgery (CABG) scheduled at Sawanpracharak hospital between May 2023 and December 2023. There were sixty patients in total. These patients were randomized into two groups of 30 each. In dexmedetomidine group, patients received dexmedetomidine 1 mcg/kg loading over 10 minutes, followed by continuous infusion of 0.5 mcg/kg/hr. In control group, normal saline was infused as loading and maintenance dose at similar rate. HR, SBP, DBP, MAP, dose of nicardipine to keep SBP 80-90 mmHg before aortic cannulation, and adverse effects were recorded. We compared and evaluated the efficacy of dexmedetomidine in attenuation of hemodynamic response after intubation, skin incision, sternotomy, and doses of nicardipine to keep SBP 80-90 mmHg before aortic cannulation.

Result: The heart rate was significantly lower in dexmedetomidine group than control group at all time points; at 1 minute (66±12.2 vs 88±19.4), 3 minute (63±10.8 vs 81±18.4) 5 minute (61±10.2 vs 77±16.1) after intubation, at 1 minute (63±11.2 vs 85±17.3) , 3 minutes (63±12.1 vs 81±16.3), 5 minutes (63±10.0 vs 77±17.4) after skin incision, and at 1 minute (66±12.1 vs 81±18.5), 3 minute ( 65±12.0 vs 76±18.5), 5 minutes (65±11.1 vs 76±15.8) after sternotomy (p-value<0.01). SBP, DBP, MAP do not significantly differ in both groups. There was a significantly lower dose of nicardipine in dexmedetomidine group in comparison to control group (0.50±0.2 mg vs 0.27±0.1 mg) (p-value<0.01) to keep SBP 80-90 mmHg before aortic cannulation.

Conclusion: Dexmedetomidine resulted in decrease heart rate in response to intubation, skin incision, and sternotomy in CABG surgery, but had no effect on blood pressure compared to the control group. It also reduced the dose of nicardipine required to keep SBP 80-90 mmHg before aortic cannulation.

Keywords: Dexmedetomidine, intubation, skin incision, sternotomy

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