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

Abstract

Background: Acute kidney injury (AKI) is a common and serious complication after cardiac surgery which increase morbidity and mortality. Dexmedetomidinehas significant sympatholytic properties and ameliorating stress response. We hypothesized that dexme-detomidinecan 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 todexmedetomidine (dexmed) or placebo group. The drugs were bolus at 0.5mcg/kg in 20 minutes and infused at 0.4 mcg/kg/hruntil 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.

Results: Total of 20 patients were enrolled and randomized into dexmed 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 dexmed 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, dexmed 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 butnone in the dexmedgroup(p = 0.06).

Conclusion: We demonstrated that dexmedetomidine reduced AKI in elective CABG patients when using NGAL as a biomarker.We also found that dexmedetomidine helps promoting urine output.