{"title":"Effect of Low-Dose Dexmedetomidine as an Anesthetic Adjuvant on Intraoperative Hemodynamics and Prognosis in Patients Undergoing Cardiac Surgery.","authors":"Zhi-Wei Fan, Shi-Liang Li, Yu-Xian Tang, Wei-Min Qiang, Yu-Ting Wu, Jun-Yuan Ge, Lin-Wei Chen, Kun-Sheng Li","doi":"10.1007/s10557-025-07713-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Dexmedetomidine, as an anesthetic adjuvant, has a guideline-recommended dose of 0.2-0.7 µg/kg/h. We sought to compare the intraoperative hemodynamic and prognostic performance of cardiac surgical patients receiving the guideline-recommended dose of dexmedetomidine to those receiving a dose lower than the guideline.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 871 patients who were maintained under anesthesia with dexmedetomidine during cardiac surgery, of whom 414 patients received the guideline-recommended dose as a control group and 457 below the guideline-recommended dose as a low-dose group. A cohort of patients in the low-dose and control group (155 vs 155) was created by propensity score matching. The primary outcome was a composite of adverse outcomes, including bradycardia, atrial fibrillation, and hypotension. Secondary outcomes assessed included delirium, analgesic medication use, cardiac intensive care unit (CICU) length of stay, and duration of mechanical ventilation.</p><p><strong>Results: </strong>After propensity matching, the maximum heart rate difference, maximum systolic blood pressure difference, maximum diastolic blood pressure value, and maximum mean arterial pressure difference before and after cardiopulmonary bypass and after cessation of pumping were significantly different in the low-dose group compared with the control group (P < 0.01). Compared with the control group, the low-dose group had a higher incidence of postoperative atrial fibrillation (34.8% vs. 23.9%, P = 0.034), and the length of stay in the cardiac intensive care unit (median 4 days, quartiles 3-5 days vs. median 3 days, quartiles 3-4 days, P < 0.001) was significantly longer.</p><p><strong>Conclusion: </strong>Compared with lower dose, receiving dexmedetomidine pumped at the guideline-recommended dose in anesthetic assistance for cardiac surgery resulted in smoother intraoperative hemodynamic performance and an improvement in the incidence of postoperative atrial fibrillation, shorter stay in the cardiac intensive care unit, and better prognostic performance.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Drugs and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10557-025-07713-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Dexmedetomidine, as an anesthetic adjuvant, has a guideline-recommended dose of 0.2-0.7 µg/kg/h. We sought to compare the intraoperative hemodynamic and prognostic performance of cardiac surgical patients receiving the guideline-recommended dose of dexmedetomidine to those receiving a dose lower than the guideline.
Methods: A retrospective cohort study was conducted on 871 patients who were maintained under anesthesia with dexmedetomidine during cardiac surgery, of whom 414 patients received the guideline-recommended dose as a control group and 457 below the guideline-recommended dose as a low-dose group. A cohort of patients in the low-dose and control group (155 vs 155) was created by propensity score matching. The primary outcome was a composite of adverse outcomes, including bradycardia, atrial fibrillation, and hypotension. Secondary outcomes assessed included delirium, analgesic medication use, cardiac intensive care unit (CICU) length of stay, and duration of mechanical ventilation.
Results: After propensity matching, the maximum heart rate difference, maximum systolic blood pressure difference, maximum diastolic blood pressure value, and maximum mean arterial pressure difference before and after cardiopulmonary bypass and after cessation of pumping were significantly different in the low-dose group compared with the control group (P < 0.01). Compared with the control group, the low-dose group had a higher incidence of postoperative atrial fibrillation (34.8% vs. 23.9%, P = 0.034), and the length of stay in the cardiac intensive care unit (median 4 days, quartiles 3-5 days vs. median 3 days, quartiles 3-4 days, P < 0.001) was significantly longer.
Conclusion: Compared with lower dose, receiving dexmedetomidine pumped at the guideline-recommended dose in anesthetic assistance for cardiac surgery resulted in smoother intraoperative hemodynamic performance and an improvement in the incidence of postoperative atrial fibrillation, shorter stay in the cardiac intensive care unit, and better prognostic performance.
目的：右美托咪定作为麻醉辅助剂，指南推荐剂量为0.2-0.7µg/kg/h。我们试图比较接受指南推荐剂量的右美托咪定和接受低于指南剂量的右美托咪定的心脏手术患者的术中血流动力学和预后表现。方法：对871例心脏手术中右美托咪定麻醉维持的患者进行回顾性队列研究，其中414例患者接受指南推荐剂量作为对照组，457例患者低于指南推荐剂量作为低剂量组。通过倾向评分匹配，建立了低剂量组和对照组（155 vs 155）的患者队列。主要结局是不良结局的综合，包括心动过缓、心房颤动和低血压。评估的次要结局包括谵妄、镇痛药物使用、心脏重症监护病房（CICU）住院时间和机械通气持续时间。结果：倾向匹配后，低剂量组体外循环前后及停泵后的最大心率差、最大收缩压差、最大舒张压值、最大平均动脉压差与对照组比较差异均有统计学意义(P)。与低剂量相比，在心脏手术麻醉辅助中接受指南推荐剂量的右美托咪定，术中血流动力学表现更平稳，术后房颤发生率有所改善，在心脏重症监护病房的住院时间更短，预后更好。
期刊介绍：
Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field.
Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients.
Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.
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