ABSTRACT 76

ULTRA-FAST-TRACK OFF-PUMP CORONARY ARTERY BYPASS WITH DEXMEDETOMIDINE

G. Bradley Smith, MD; Annette Schneider, RN; Walter Knoll, DO; St. Joseph’s Medical Center, Bloomington, Illinois

PURPOSE:  To study the use of dexmedetomidine to improve pain control, provide sedation, and facilitate immediate extubation after OPCAB.

METHODS:  This was an observational study of 58 consecutive OPCAB patients.  A group of 29 patients was compared to the next 29, who received dexmedetomidine.  Dexmedetomidine (0.2 mcg/kg/hr) was initiated at sternal closure and extended approximately 6 hours postoperatively.  All patients received 0.25 % bupivacaine intercostal nerve block.  Patients in both groups were extubated immediately.  Parameters studied included hemodynamic and respiratory effects; pain, sedation, and agitation scores; and analgesic use.

SUMMARY:  Patients who received dexmedetomidine showed lower early pain scores (2 vs. 8) while receiving less morphine (6 mg vs. 10.5 mg).  Dexmedetomidine patients were more cooperative and oriented (Ramsay sedation score 2 vs. 3) and significantly less agitated (0 vs. 48 %).  Hemodynamically, a 10% decrease in BP and 5% decrease in heart rate were noted.  Respiratory rates, pH, and pCO₂ were unchanged.

CONCLUSIONS:  Dexmedetomidine provided clinically effective sedation, improved analgesia and patient management.  Hemodynamic changes were mild and predictable without respiratory depression.  Dexmedetomidine significantly facilitates routine immediate extubation in the OPCAB patient.