Relationship between anesthesia factor and myocardial injury in patients undergoing cardiac surgery with cardiopulmonary bypass: dexmedetomidine combined with sevoflurane anesthesia / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the relationship between the anesthesia factor and myocardial injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eightyeight patients of both sexes,aged 42-71 yr,weighing 59-83 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective coronary artery bypass grafting with CPB,were divided into 4 groups (n =22 each) using a random number tableroutine anesthesia control group (group C),dexmedetomidine-based anesthesia group (group D),sevofluranebased anesthesia group (group S) and dexmedetomidine combined with sevoflurane anesthesia group (group DS).After tracheal intubation,0.2％-2.1％ sevoflurane was inhaled until the beginning of CPB in S and DS groups.In D and DS groups,dexmedetomidine was intravenously infused as a loading dose of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of surgery.Before induction of anesthesia,before CPB,after the end of CPB,immediately after the end of surgery and at 24 h after surgery,venous blood samples were collected for determination of plasma creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) concentrations by immunofluorescence.The restoration of spontaneous heart beat and adverse events such as hypotension,malignant arrhythmia,cardiac arrest and respiratory depression during surgery and within 24 h after surgery were recorded.Results Compared with group C,the plasma concentrations of CK-MB and cTnI were significantly decreased in the other three groups (P＜0.05).The plasma eoncentrations of CK-MB and eTnl were significantly lower in group DS than in S and D groups (P＜0.05).There were no significant differences in the rate of restoration of spontaneous heart beat among the four groups (P＞ 0.05).No adverse events were found during surgery and within 24 h after surgery in the four groups.Conclusion Dexmedetomidine combined with sevoflurane anesthesia is helpful in reducing myocardial injury and provides better efficacy than either alone in the patients undergoing cardiac surgery with CPB and is more suitable for cardiac surgery with CPB.