title: Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study.
abstract: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery.
  
  
  
  We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group).
  
  
  
  A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality.
  
  
  
  Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results.
authors.affiliation: Division of Critical Care Medicine, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Paulo Gabriel Melo
authors.initials: PG
authors.lastname: Brandão
authors.affiliation: Division of Anesthesiology, Department of Surgery, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Francisco Ricardo
authors.initials: FR
authors.lastname: Lobo
authors.affiliation: Division of Anesthesiology, Department of Surgery, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Serginando Laudenir
authors.initials: SL
authors.lastname: Ramin
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.affiliation: Division of Cardiology. Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Mauricio Nassau
authors.initials: MN
authors.lastname: Machado
authors.affiliation: Division of Critical Care Medicine, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Suzana Margareth
authors.initials: SM
authors.lastname: Lobo
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000401:mortality*; D011184:Postoperative Period; D018341:Receptors, Adrenergic, alpha-2 / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000759:Adjuvants, Anesthesia; D018341:Receptors, Adrenergic, alpha-2; D020927:Dexmedetomidine