Dexmedetomidine as an anesthetic adjuvant in cardiac surgery: a cohort study

ABSTRACT Objective: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery. Methods: We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group). Results: A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality. Conclusion: Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results.

Reconstrução de veia cava inferior infra-renal com enxerto espiralado de veia safena magna / Replacement of an infrarenal inferior vena cava using a spiral saphenous vein graft

Os autores relatam um caso de substituição de segmento de veia cava infra-renal, lesado por trauma contuso abdominal, utilizando enxerto espiralado de veia safena. A paciente evoluiu com alta hospitalar sem sinais de hipertensão venosa em membros inferiores e com perviedade do enxerto confirmada por duplex scan. Embora a ligadura de veia cava infra-renal possa ser realizada com relativa segurança nestes casos, os autores recomendam, sempre que possível, o reparo do vaso como tentativa de evitar o desenvolvimento de hipertensão venosa crônica em membros inferiores. Procedimentos de reparo complexos devem ser evitados no paciente hemodinamicamente instável, por demandarem tempo cirúrgico prolongado, dando-se prioridade ao conceitode "controle de danos", estabelecido em cirurgia do trauma.