Abstract:

AIM: To investigate the effects of desflurane combined with dexmedetomidine on stress response, inflammatory response and myocardium in patients undergoing coronary artery bypass grafting (OPCABG).  METHODS: Sixty-eight patients undergoing OPCABG were randomly divided into observation group and control group according to the random number table method, with 34 cases in each group. Both groups were given midazolam 0.1-0.2 mg/kg, etomidate 0.15-0.3 mg/kg, sufentanil 2 μg/kg and vecuronium 0.1 mg/kg intravenous anesthesia induction. The observation group received intravenous dexmedetomidine 0.1-0.3 μg·kg^-1·h^-1 and desflurane with the lowest effective concentration (MAC) of 0.7-1.5, while the control group was given intravenous dexmedetomidine 0.5 μg·kg^-1·h^-1 to maintain anesthesia. The changes of cardiac index (CI), heart rate (HR), blood pressure (ABP), central venous pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary arterial pressure (PAWP), plasma cTnI and the levels of creatine kinase isoenzyme（CK-MB）, COR, β-EP, CRP, IL-2 and interleukin 6 (IL-6) concentrations, adverse reactions and morphine use were compared between two groups. RESULTS: The CI of observation group at 0.5 h and1 h after bypass were significantly higher than that at 0.5 h after anesthesia; also, CI of observation group at 0.5 h was significantly higher than that of the control group; CI of control group at 1 h was significantly higher than that at 0.5 after anesthesia.HR in the observation group was significantly lower than that of the control group at 0.5 h after induction and HR was significantly higher at other time points than that at 0.5 h after anesthesia (P＜0.05). No significant difference was observed between other indicators (P＞0.05). Levels of cTn I and CK-MB in both groups continued to increase at 6, 12 and 24 h after operation, peaked at 24 h and decreased at 36 h after operation, both indicators were higher than those before operation; levels of cTnI and CK-MB at 12 h after operation in the observation group were significantly lower than those in the control group (P＜0.05).COR during the T1-4 period were significantly lower than that during T0 in the both groups; COR of the observation group during T2-4 period was significantly lower than that of the control group. β-EP and CRP during the T1-4 period were significantly lower than that during T0 in the both groups; β-EP and CRP of the observation group during T2-4 period was significantly lower than that of the control group. Levels of IL-2 in observation group were significantly higher than those in control group. Levels IL-6 during T1-4 in both groups were significantly lower than those during T0 period, and those of the observation group at T3 was significantly higher than that in control group (P＜0.05). No adverse reactions such as respiratory depression, bradycardia or hypotension occurred in both groups. Morphine usage in the control group was significantly higher than that in the observation group (χ²=4.570, P＜0.05). CONCLUSION: Desflurane combined with dexmedetomidine can be safely and effectively used in the OPCABG anesthesia process. It can effectively reduce the stress response and inflammatory reaction, reduce the myocardial injury and stabilize the hemodynamic status of patients, which is worthy of promotion.

Key words: dexmedetomidine, desflurane, hemodynamics, coronary artery bypass grafting