Dexmedetomidine as a Heart Rate Control for Off-Pump Coronary Artery Bypass Surgery

Introduction: The traditional surgical approach is performed under cardiac arrest with cardiopulmonary bypass (CPB), which has the potential to result in myocardial injuries. In 1990s, when researchers developed efficient mechanical stabilizer devices, Off-pump coronary artery bypass (OPCAB) gained more widespread interest, as it's associated with many significant benefits. Avoidance of tachycardia is a goal for anesthetic management during OPCAB surgery. A short-acting Beta-blocker is needed for lowering excessive increases in heart rate. However, in some hospitals these drugs were not available. Case: A 53-yr-old, 73 kg man with a three-vessel coronary arterial disease with left main disease was scheduled for elective OPCAB surgery. Patient has a medical history of heart attack and hypertension. Preoperative echocardiography shows reduced LV systolic function, diastolic dysfunction grade I, with LVEF 47%. Throughout the hour after induction, HR increased in a constant manner to a persistent of 85-90 bpm despite additional fentanyl given. We didn't have any intravenous beta blocker drug and therefore we started dexmedetomidine. HR decreased to 55-60 bpm and remained at that value throughout the surgical procedure. Patient extubated in OR and transferred to ICU. After 6 days, he was discharged from the hospital without any complications. Conclusion: Perioperative administration of Dexmedetomidine is an effective adjuvant to general anaesthesia, attenuates the stress response to intubation, provides minimal heart rate variations, enabling smooth extubation, also provides adequate sedation in the post-operative period.