Coronary Artery Disease Clinical Trial
Official title:
Dexmedetomidine's Cardiac and Cognitive Influence on Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery
The investigators hypothesized that dexmedetomidine as an anesthetic adjunct can be used in the setting of off-pump coronary bypass procedure and can provide benefits to cardiac function and cognitive performance on the ground of the dexmedetomidine's characteristics.
The emergence of off-pump coronary artery bypass grafting (OPCAB) procedure brings up new
challenges to anesthesiologists and urges us to contemplate the choice of anesthetics. In
face of these challenges Dexmedetomdine with multiple unique traits can readily fit into
this situation.
Off-pump coronary artery bypass (OPCAB) procedure is an emerging procedure which might bring
benefit to patients in comparison with conventional CABGs although final words about
outcomes haven't been reached on the basis of recent literature. However, OPCAB technique
definitely requires more involvement of anesthesiologists especially in cases where
hemodynamic compromise is usually inevitable during anastomosis of Lcx or PDA and early
extubation in the OR is expected1. Thus, the investigators are encountered with more
intraoperative challenges caused by OPCAB than routine CABGs. Concerning about challenges
the investigators might take on, the investigators shall not only pay more attention to
surgeons' manipulation but also review anesthetics that the investigators have selected to
find an optimal plan to minimize adverse effects on heart and other important organs. With
this perspective, dexmedetomidine come into our sight with its peculiar traits of
hemodynamic effects and assumed cardiac protective effects.
Dexmedetomidine as a more selective α2-adrenoreceptor agonist than clonidine has gradually
gain popularity in anesthetic and ICU settings for its unique pharmacologic characteristics.
Dexmedetomidine provides sufficient sedative effects with minimal respiratory effect and
then reduces the consumption of other sedative and antinociceptive drugs.Given specific
requirements of OPCAB surgery, dexmedetomidine's may be more suitable in varying aspects.
Firstly, dexmedetomine can dramatically diminish the level of serum catecholamine (CA). As
the investigators know, the diminished level of catecholamine indicates less stress response
to surgical stimuli and lower incidence of cardiac events. Secondly, the relatively slower
HR by dexmedetomidine can decrease oxygen consumption of myocardium and consequently improve
the perfusion of endangered ischemic area. In addition, the decreased HR which is assumably
analogous to effects of esmolol or other β-blockers can reduce the occurrence of tachycardia
and minimize the motion of heart when "bypass" procedure is performed on the target vessels.
Thirdly, it has been reported that dexmedetomidine can alleviate sufferings of renal
function during major thoracic surgery .Thus, it is implied that dexmedetomidine might in
the similar way ameliorate the damage to renal system caused by hours of stress response and
havoc of SIRS ,and then improve clinical prognosis . In view of assumptions the
investigators have proposed on the ground of dexmedetomidine's characteristics and specific
requirements of OPCAB surgery, the investigators are expecting that dexmdetomidine can fit
the situation where patients' limited capacity of coronary artery and sophisticated
pathophysiological courses have to be taken into account.
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