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Researchers have found that intraoperative infusion of dexmedetomidine is highly effective in managing perioperative blood glucose levels and reducing insulin requirements in diabetic patients undergoing cardiac surgery. This study was recently published in the journal Annals of Cardiac Anesthesia. Panidapu N. and colleagues conducted a prospective observational study to investigate the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetic patients undergoing cardiac surgery. This study aimed to assess whether DEX infusion could improve glycemic control and reduce insulin requirements in this patient population.
Diabetes mellitus (DM) significantly increases the risk of cardiovascular complications in patients undergoing coronary artery bypass (CABG) surgery. Perioperative hyperglycemia during cardiac procedures has been linked to adverse outcomes, exacerbated by surgical trauma and cardiopulmonary bypass-induced inflammation. Dexmedetomidine (DEX), a potent α2 adrenoreceptor agonist, is favoured in cardiac surgery for its ability to modulate stress responses and inflammation without adverse cardiovascular effects. DEX's role in maintaining hemodynamic stability, reducing sedative and opioid needs, and potentially lowering mortality rates post-CABG.
The study included 100 adult diabetic patients undergoing cardiac surgery with cardiopulmonary bypass, divided into two groups: group D receiving DEX infusion and group C receiving normal saline infusion. Various parameters including blood glucose levels, heart rate, mean arterial pressure, serum potassium levels, insulin requirements, duration of mechanical ventilation, and incidence of complications such as arrhythmias and delirium were monitored and compared between the two groups.
The study findings were as follows:
DEX infusion significantly reduced the mean dose of insulin required compared to saline infusion (36.03 ± 22.71 IU vs 47.82 ± 30.19 IU, P = 0.0297).
The incidence of arrhythmias was lower in the DEX group compared to the saline group (20% vs 46%, P = 0.0059).
Similarly, the incidence of delirium was significantly lower in the DEX group (6% vs 20%, P = 0.0384).
No significant differences were observed in other clinical parameters such as duration of mechanical ventilation and severity of illness scores (VIS).
This approach not only helps in glycemic control but also contributes to a lower incidence of postoperative complications such as arrhythmias and delirium. The findings underscore the potential benefits of DEX infusion in optimizing outcomes in diabetic patients undergoing cardiac procedures.
Reference:
Panidapu, N., Babu, S., Gadhinglajkar, S. V., Thomas, D., Aspari, A. M., & Sen, B. (2024). Effects of dexmedetomidine on perioperative glycemic control in adult diabetic patients undergoing cardiac surgery. Annals of Cardiac Anaesthesia, 27(3), 228–234. https://doi.org/10.4103/aca.aca_209_23