Sarat Babu Chevuri1, Mazharulla Khan2, Jayashree3
Dexmedetomidine has anxiolytic, sedative and analgesic properties, which is widely used as an adjuvant during general anaesthesia. Use of dexmedetomidine as an anaesthetic adjuvant during cardiac surgery decreased the incidence of delirium, possibly by sparing the consumption of general anaesthetics. Evidence in this aspect was still lacking.
The aim of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in post-cardiac surgery patients.
MATERIALS AND METHODS
A prospective, randomised, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Sixty-four patients who underwent elective cardiac surgery under general anaesthesia were shifted to intensive care unit (ICU) and randomly divided into two groups. Group A (n= 32) received a 12 h infusion of normal saline and Group B (n= 32) received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with intravenous bolus of fentanyl. Total fentanyl consumption, haemodynamic monitoring, Visual Analogue Scale (VAS) pain ratings and Ramsay Sedation Scale were charted every 6th hour for 24 h postoperatively and followed up till recovery from ICU. Student’s t-test, Chi-square/ Fisher’s exact test has been used to find the significance of study parameters between the groups.
Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001). Total fentanyl consumption in dexmedetomidine group was (118.13 ± 35.78 μg) than in saline group (190.56 ± 36.99 μg) with P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001 and P = 0.046, respectively). Incidence of delirium was less in dexmedetomidine group (P = 0.086 +). Haemodynamic parameters were statistically insignificant.
Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable haemodynamic effects in the cardiac surgery patients.