Cardiac and renal protective effects of dexmedetomidine in cardiac surgeries: A randomized controlled trial.
BACKGROUND
Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries.


METHODS
Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0.5 μg/kg/h) until 6 h after surgery, whereas the control group received an equivalent volume of physiological saline. Primary outcome measures included myocardial-specific proteins (troponin-I, creatine kinase-MB), urinary-specific kidney proteins (N-acetyl-beta-D-glucosaminidase, alpha-1-microglobulin, glutathione transferase-pi, glutathione transferase alpha), serum proinflammatory cytokines (tumor necrosis factor alpha and interleukin-1 beta), norepinephrine, and cortisol levels. They were measured within 5 min of starting anesthesia (T0), at the end of surgery (T1), 12 h after surgery (T2), 24 h after surgery (T3), 36 h postoperatively (T4), and 48 h postoperatively (T5). Furthermore, creatinine clearance and serum cystatin C were measured before starting surgery as a baseline, and at days 1, 4, 7 after surgery.


RESULTS
Dexmedetomidine reduced cardiac and renal injury as evidenced by lower concentration of myocardial-specific proteins, kidney-specific urinary proteins, and pro-inflammatory cytokines. Moreover, it caused higher creatinine clearance and lower serum cystatin C.


CONCLUSIONS
Dexmedetomidine provided cardiac and renal protection during cardiac surgery.
Asst. Professor in Anesthesiology Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
A S
AS
Ammar
Asst. Professor in Anesthesiology Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
K M
KM
Mahmoud
Lecturer in Public Health, Statistics and Community Medicine Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
Z A
ZA
Kasemy
Lecturer in Clinical Pathology Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
M A
MA
Helwa
Cardiac injury; cardiac surgeries; dexmedetomidine; renal injury