Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery compared to propofol: a randomized controlled trial
DEXは心臓術後のAfを減らす。
DEXは0.2–1.5 μg/kg/hとMAX多め。
使用量は0.68 (0.48 to 0.82)なので日本のMAXぐらいを使用している。
Discussionから
Several potential factors could contribute to the effect of dexmedetomidine on preventing new-onset postoperative AF. First, dexmedetomidine could reduce myocardial ischemia-reperfusion injury and improve the perfusion of the myocardium in patients undergoing cardiac surgery [16, 36]. Second, the inflammatory response induced by cardiac surgery and bypass can alter atrial electrophysiology and structural substrates, leading to increased vulnerability to AF [14, 37]. Dexmedetomidine has been shown to inhibit the inflammatory response in animal models [38, 39] and in clinical trials [40, 41]. Tasdogan et al. [41] found that postoperative patients who received dexmedetomidine had significantly lower levels of tumor necrosis factor-alpha, interleukin-1 and interleukin-6 than those who received propofol. Third, increased adrenergic tone plays a role in the development of postoperative AF [42]. Dexmedetomidine can decrease catecholamines [43] and inhibit the arrhythmogenic effect of epinephrine [44]. Fourth, dexmedetomidine can enhance vagal activity, leading to alterations in Ca2+ currents across the myocyte cell membrane, which in turn could result in prolonged repolarization and an increased effective refractory period [17]. Based on the combination of organ-protective, anti-inflammatory, sympatholytic and parasympathomimetic effects, it is not surprising that the use of dexmedetomidine during the early postoperative period could be beneficial in preventing AF after cardiac surgery.
