The Effect of Low Dose Ketamine Infusion Versus Low Dose Dexmedetomidine Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery

Abstract

: In cardiac surgery, the extent of systemic inflammatory response is closely associated with patient’s outcome. A systemic inflammatory response syndrome (SIRS) may develop after operations using cardiopulmonary bypass (CPB). Aim of the Work: to evaluate the potential effects of intravenous infusion of ketamine versus dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation. Patients and Methods: This randomized controlled interventional study was conducted on 90 patients who underwent elective CABG procedure at Ain Shams University Hospital over 24 months from Jan 2018 to Jan 2020. The patients were divided into 3 groups, 30 patients for each group. Group D: received dexmedetomidine infusion, Group K: received ketamine infusion and Group N (control group): received normal saline. Then following measurements recorded at following time interval before induction of anesthesia (T1), after weaning from CPB (T2), 24 h(T3) and 48 h(T4) after completion of the anastomoses. Mean arterial blood pressure records, heart rate & Inflammatory and stress markers including CRP, cortisol, WBC count, glucose and lactate levels. Results: Mean arterial pressure among three groups was not statistically significant. Also serum glucose level was not statistically significant between groups. Serum lactate level didn’t show statistically significant difference between groups. From aspects of inflammatory markers, we got good results which were superior for dexmedetomidine followed by ketamine infusion group suggested by statistically significant, suggesting that dexmedetomidine and ketamine may have a role in attenuation inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery. Conclusion: Our study that compared Intravenous infusion of ketamine and dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation suggests that dexmedetomidine was superior to ketamine infusion in attenuation of inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.