The Effect of Low Dose Ketamine Infusion versus Low Dose Dexmedetomidine Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery

Abstract Background In cardiac surgery, the extent of systemic inflammatory response is closely Mobile associated with patient’s outcome. A systemic inflammatory response syndrome (SIRS) may develop after operations using cardiopulmonary bypass (CPB). Aim of the Work to evaluate the 01006705713 potential effects of intravenous infusion of ketamine versus dexmedetomidine on attenuation f stress responses during coronary artery bypass grafting (CABG) operation. Patients and Email [email protected] Methods This randomized controlled interventional study was conducted on 90 patients who dinaunderwent elective CABG procedure at Ain Shams University Hospital over 24 months from Jan 2018 to Jan 2020. The patients were divided into 3 groups, 30 patients for each group. Group D: received dexmedetomidine infusion, Group K: received ketamine infusion and Group N (control group): received normal saline. Then following measurements recorded at following time interval before induction of anesthesia (T1), after weaning from CPB (T2), 24 h(T3) and 48 h(T4) after completion of the anastomoses. Mean arterial blood pressure records, heart rate & Inflammatory and stress markers including CRP, cortisol, WBC count, glucose and lactate levels. Results Mean arterial pressure among three groups was not statistically significant. Also serum glucose level was not statistically significant between groups. Serum lactate level didn’t show statistically significant difference between groups. From aspects of inflammatory markers, we got good results which were superior for dexmedetomidine followed by ketamine infusion group suggested by statistically significant, suggesting that dexmedetomidine and ketamine may have a role in attenuation inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery. Conclusion Our study that compared Intravenous infusion of ketamine and dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation suggests that dexmedetomidine was superior to ketamine infusion in attenuation of inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.

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Abstract 328: The Importance of Using of Single Aortic Cross Clamp Technique to Reduce Brain Injury After Coronary Artery Bypass Grafting

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a328 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Donald S Likosky ◽

Lawrence J Dacey ◽

Bruce J Leavitt ◽

Gerald L Sardella ◽

Robert E Helm ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Brain Injury ◽

Coronary Artery Bypass Grafting ◽

Inflammatory Response ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Aortic Cross Clamp ◽

Artery Bypass Grafting

Introduction: Brain injury is a common yet devastating complication of cardiac surgery. Several intra-operative practices have been identified that may reduce emboli and the systemic inflammatory response, two mediators of brain injury. Hypothesis: Practices which reduce emboli and the systemic inflammatory response will reduce brain injury Methods: We enrolled 3,994 patients undergoing coronary artery bypass grafting with or without valve surgery at eight medical centers in northern New England between 2008-2011. All procedures were performed with cardiopulmonary bypass. We studied the effect of intra-operative practices that may reduce mediators of brain injury, including: the use of: tip-to-tip coated circuits, echocardiography (transesophageal or epi-aortic), or the use of a single aortic cross-clamp. Brain injury was defined as the presence of stupor, coma, transient ischemic attack or stroke (defined as any focal neurologic deficit persisting post-operatively for more than 24 hours). Results: Brain injury was present in 7.4% (293/3994) of the patients. Adoption of practices varied, with 19.4% (765/3994) of patients receiving 1 practice, 26.0% (1024/3994) receiving 2 practices, and 34.4% (1356/3994) receiving 3 practices. Breakdown across individual practices were: 60.0% (2368/4014) coated circuits, 76.5% echocardiography (3015/4014), and 38.0% single clamp (1498/4104). Once adjusting for patient and disease characteristics and center, adoption of strategies was associated with a 15% reduced odds of brain injury (OR 0.85, ptrend 0.01). Use of a single clamp was associated with the greatest reduction in brain injury (Adj OR 0.63, p=0.02). Conclusion: While the use of any of three intra-operative practices were protective of brain injury, the use of a single clamp technique was associated with a nearly 40% reduced odds of brain injury after cardiac surgery. This analysis further confirms the benefit of a single aortic clamp approach for reducing neurologic injury.

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