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ORIGINAL ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 312-320

Cardiac preconditioning effect of ketamine–dexmedetomidine versus fentanyl–propofol during arrested heart revascularization


1 Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
4 Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
5 Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Correspondence Address:
Dr. Mohammed Adel Hegazy
Department of Anesthesia and Intensive Care, Mansoura University Hospitals, F1, 60, El Gomhoria Street, Qism 2, Mansoura 35516, Dakahleya Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aer.AER_55_20

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Background: Myocardial damage due to ischemia and reperfusion is still unavoidable during coronary surgery. Anesthetic agents have myocardial preconditioning effect. Ketamine has sympathomimetic effect, while dexmedetomidine has a sympatholytic effect in addition to anesthetic, analgesic, and anti-inflammatory properties of both the drugs. This study was carried out to compare ketamine–dexmedetomidine (KD) combination with fentanyl–propofol (FP) combination on the release of cardiac troponin T (cTnT) and outcome after coronary artery bypass graft. Patients and Methods: Ninety adult patients who underwent coronary artery bypass grafting (CABG) were assigned to receive either KD base anesthesia (KD group) or FP anesthesia (FP group). Trends of high-sensitive cTnT, CK-MB, and serum cortisol were followed in the first postoperative 24 h. Other outcomes were vital signs, weaning from cardiopulmonary bypass, tracheal extubation time, and echocardiographic findings. Results: There was a significant lower release of cTnT in KD group than FP group during its peak values at 6 h after aortic unclamping (92.01 ± 7.332 in KD versus 96.73 ± 12.532 ng.L−1 P = 0.032). significant lower levels of serum cortisol levels were noted KD group than in FP group at 6 and 12 h after aortic unclamping P < 0.001. As regard tracheal extubation time, patients assigned to KD group extubated earlier than whom in FP group 202.22 ± 28.674 versus 304.67 ± 40.598 min respectively P < 0.001. Conclusion: The use of KD during on-pump CABG confers better myocardial protective and anti-inflammatory effect than fentanyl propofol.


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