A comparison of the infusion of dexmedetomidine versus remifentanil in patients undergoing off-pump coronary artery bypass graft: A randomized trial

Objective: To compare the infusion of dexmedetomidine (Group DEX) and remifentanil (Group REMI) during off-pump coronary artery bypass graft (OPCAB) regarding cardioprotective effect, hemodynamics and incidence of hypokalemia and arrhythmia. Methods: During OPCAB, Group DEX (n=23) received an infusion of dexmedetomidine 0.1-0.7 μg/kg/hr; Group REMI (n=24) received an infusion of remifentanil 0.01-0.5 μg/kg/min; the control group (n=25) received none. We measured serum creatinine kinase-myocardial band and cardiac troponin I (cTnI) concentration before and immediately after the surgery, postoperative day (POD)#1 and #2. Serum potassium concentration, incidence of hypokalemia and arrhythmia and hemodynamic variables were measured. Results: The concentration of cTnI were significantly lower in the Group DEX and REMI than the control group on POD#1 and #2 [cTnI on POD#1: 1.86 ng/ml (0.76-3.84) vs. 2.62 ng/ml (0.98-4.99) vs. 4.33 ng/ml (2.52-7.98), in Group DEX, REMI and control, respectively, p=0.001]. Other variables were not different among groups. Conclusions: Dexmedetomidine or remifentanil similarly reduced postoperative myocardial injury marker levels compared with control group. There was no difference between their infusion in parameters measured in this study. Dexmedetomidine appears to be a safe and effective alternative to remifentanil during OPCAB.