The Reno-Protective Effect of Intraoperative Dexmedetomidine Infusion in Elective Coronary Bypass Graft Surgery

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Anantachote Vimuktanandana


Background: Acute kidney injury (AKI) is a common and serious complication after cardiac surgery which increases morbidity and mortality. Dexmedetomidine has significant sympatholytic properties and ameliorating stress response. We hypothesized that dexmedetomidine can prevent acute kidney injury in patients undergoing elective CABG. Methods: This study was double-blinded, randomized controlled trial. Elective CABG patients with normal renal function were allocated to intravenous dexmedetomidine or placebo group. The drugs were bolus 0.5mcg/kg in 20 minutes then 0.4 mcg/kg/hr was infused until the end of the operation. Anesthetic and surgical technique was similar in both groups. Serum creatinine, plasma NGAL and urine NGAL were collected and compared at 0,6,24 hours. P value < 0.05 was considered statistically significant. Results: Total of 20 patients were enrolled and randomized into dexmedetomidine group (n=10) and control group (n=10). There were no differences in patient characteristic data. Serum creatinine and urinary NGAL at 6 and 24 hours were not significantly different between groups. Plasma NGAL in dexmedetomidine group was significantly less than control group at 6 and 24 hours (149.5 vs 291.4; p=0.016 and 118.5 vs 201.5; p=0.004). Moreover, dexmedetomidine group had significantly higher urine output throughout the operation (4.5 vs 2.4 ml/kg/hr.; p=0.011). At 24 hours, we found AKI in 3 patients in the control group but none in the dexmedetomidine group (p=0.06). Conclusion: We demonstrated that dexmedetomidine reduced AKI in elective CABG patients when using plasma NGAL as a biomarker. We also found that dexmedetomidine helps promoting intraoperative urine output.

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