Introduction
Dexmedetomidine is an alpha 2 agonist drug with several theoretical benefits supported
in the literature for cardiac surgery including a decrease of mortality (1, 2); however,
many anesthesiologists restrict its use due to side effects such as disturbances of
the cardiac conduction system. Therefore, it is important to describe the rhythm alterations
associated with the use of dexmedetomidine in the postoperative period of cardiac
surgery, and its impact in the postoperative course of this patient population. The
following study pretend to describe the frequency of appearance of Atrial Ventricular
Blocks related to the intraoperative use of dexmedetomidine in patients undergoing
cardiovascular surgery.
Methods
After IERB approval of a cross sectional descriptive study. All patients undergoing
cardiac surgery under general anesthesia with dexmedetomidine 0.5mcg/kg/h from anesthesia
induction to the case end, that were done between 2015 and 2019 at the center were
included. Most data were taken from anesthesia and intensive care unit medical records.
Standard demographic variables were collected, frequency measures were established
for relevant events such as bradyarrhythmias, and their frequency was described according
to severity and need for intraoperative and postoperative intervention.
Results
148 patients who underwent simple or combined surgical procedures were included in
the study; the prevalence of atrioventricular blocks was 6%, according to it severity,
first degree blocks were reported in 2.7%, second degree blocks were reported in 0.6%
and complete blocks were reported in 2,7%. Bradyarrhythmias associated with the use
of dexmedetomidine varies between 24.2% - 28.2% (period) depending on the time of
diagnosis (Table 1). According to its severity, sinus bradycardia varies between 20.1%
- 24.32%, and nodal rhythm 0.6% - 1.2%. 25.6% of the patients required transient postoperative
pacemakers, 1.2% of the patients required a permanent pacemaker (Chart 1). The most
frequent tachyarrhythmia was atrial fibrillation in 14.8%. An overall mortality of
2% was reported.
Discussion
The use of dexmedetomidine predisposes to an increase in the presentation of sinus
bradycardia in the immediate postoperative period of cardiovascular surgery compared
to that reported in the literature, without increasing the prevalence of atrioventricular
blocks.
There is a greater tendency to use an epicardial pacemaker during the intraoperative
period, which for the most part was not necessary in the immediate postoperative period.
There is a decreasing trend in the presentation of atrial fibrillation as described
in previous studies. There is no increase in the mortality of these patients compared
to local and international reports.
Prospective studies are required to verify the exploratory findings of this study
and judge its benefits against the development of bradyarrhythmias in this patient
population.
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© 2021 Published by Elsevier Inc.
