Dexmedetomidine in Fast-Track Cardiac Care for Patients Undergoing Coronary Artery Bypass Graft Surgery
Abstract
Background: Dexmedetomidine offers established cardioprotective benefits, yet its specific impact on ventilation weaning and broader recovery metrics in cardiac surgery warrants a clearer definition.
Methods: We enrolled 100 elective CABG patients in a double-blind randomized trial. Subjects received either a dexmedetomidine regimen (1 µg/kg loading dose, 0.3 µg/kg/h maintenance) or standard care. The study prioritized mechanical ventilation duration as the primary endpoint. We further analyzed cardiac injury markers alongside interleukin-6 levels and length of stay.
Results: The median duration of mechanical ventilation was shorter in the dexmedetomidine group (210 vs. 310 minutes; p=0.004). This recovery benefit also found its way to biological indices, with the intervention group showing lower median amounts of CK-MB (65.00 vs 129.00 U/L; p<0.001), troponin I (0.07 vs 4.04 ng/mL; p<0.001) and five pack interleukin-6 (40.00 vs 70.00 pg/mL; p=0·004). As a result, patients had shorter times in the ICU (23.0 ± 24.9 vs. 32.25 ± 38.3 hours; p=0.023) and hospital (9 ± 5.2 vs 11±7 days; p<0.001). However, the drug disturbed hemodynamics stability with higher rates of hypotension (44% vs 22%; p=0.019), bradycardia (62% vs 24%; p<0.001) and need for temporary pacing (50% vs 16%; p<0.001).
Conclusion: Administering dexmedetomidine accelerates extubation and attenuates myocardial injury. These benefits justify its use, provided the anesthesia team proactively manages the accompanying hemodynamic instability.
[1] Ji F, Li Z, Nguyen H, Young N, Shi P, Fleming N, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. 2013; 127(15):1576-84.
[2] Safaric Oremus Z, Bradic N, Gospic I, Presecki I, Sakan S, Sojcic N, et al. Effect of Dexmedetomidine on Cardiopulmonary Bypass Induced Inflammatory Response in Patients Undergoing Aortic Valve Replacement. Life. 2025; 15(4):524.
[3] Fan Y, Chen B, Fang F, et al. Effect of Dexmedetomidine on Endothelial Glycocalyx in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2026; 40(3):805-13.
[4] Caetano da Silva L, Tapioca V, Viana P, Pereira EM, Gibicoski T, Amaral S. Dexmedetomidine for delirium prevention after cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2025; 44(5):101578.
[5] Zhong Y, Ren Z, Gao J, He X, Li Q. Dexmedetomidine for the prevention of postoperative delirium in patients undergoing cardiac surgery: a systematic review and meta-analysis with trial sequential analysis. BMC Anesthesiol. 2025; 25(1):408.
[6] Wang G, Niu J, Li Z, Lv H, Cai H. The efficacy and safety of dexmedetomidine in cardiac surgery patients: A systematic review and meta-analysis. PLoS One. 2018; 13(9):e0202620.
[7] Kerroum A, Rosner L, Scala E, Kirsch M, Tozzi P, Courbon C, et al. Intraoperative Dexmedetomidine Use for Enhanced Recovery after Surgery (ERAS) in Cardiac Surgery-Single Center Retrospective Observational Cohort Study. Medicina (Kaunas). 2024; 60(7):1036.
[8] He H, Liu P, Li P. Dexmedetomidine Ameliorates Cardiac Ischemia/Reperfusion Injury by Enhancing Autophagy Through Activation of the AMPK/SIRT3 Pathway. Drug Des Devel Ther. 2023; 17:3205-18.
[9] Chen M, Li X, Mu G. Myocardial protective and anti-inflammatory effects of dexmedetomidine in patients undergoing cardiovascular surgery with cardiopulmonary bypass: a systematic review and meta-analysis. J Anesth. 2022; 36(1):5-16.
[10] Zhou H, Zhou D, Lu J, Wu C, Zhu Z. Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on Cardiac Injuries and the Inflammatory Response in Valve Replacement Surgery With a Sevoflurane Postconditioning Protocol: A Pilot Study. J Cardiovasc Pharmacol. 2019; 74(2):91-7.
[11] Elgebaly AS, Fathy SM, Sallam AA, Elbarbary Y. Cardioprotective effects of propofol-dexmedetomidine in open-heart surgery: A prospective double-blind study. Ann Card Anaesth. 2020; 23(2):134-41.
[12] Park JB, Bang SH, Chee HK, Kim JS, Lee SA, Shin JK. Efficacy and Safety of Dexmedetomidine for Postoperative Delirium in Adult Cardiac Surgery on Cardiopulmonary Bypass. Korean J Thorac Cardiovasc Surg. 2014; 47(3):249-54.
[13] Morris R, Kuppa SA, Zhu X, Bu K, Han W, Cheng F. The Association Between Dexmedetomidine and Bradycardia: An Analysis of FDA Adverse Event Reporting System (FAERS) Data and Transcriptomic Profiles. Genes (Basel). 2025; 16(6):615.
[14] Cheng H, Li Z, Young N, Boyd D, Atkins Z, Ji F, et al. The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients. J Cardiothorac Vasc Anesth. 2016; 30(6):1502-8.
[15] Ren J, Zhang H, Huang L, Liu Y, Liu F, Dong Z. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med. 2013; 6(2):497-502.
[16] Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol. 2013; 29(2):162-7.
[17] Kesumarini D, Widyastuti Y, Boom CE, Dinarti LK. Dexmedetomidine as a myocardial protector in pediatric heart surgery using cardiopulmonary bypass: a systematic review. Ann Med Surg (Lond). 2023; 85(10):5075-84.
[18] Chi X, Liao M, Chen X, Zhao Y, Yang L, Luo A, et al. Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth. 2016; 30(1):44-50.
[19] Zdravković R, Vicković S, Preveden M, Drobnjak V, Lukić-Šarkanović M, Miljević IB, et al. Effect of Continuous Intraoperative Dexmedetomidine on Interleukin-6 and Other Inflammatory Markers After Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial. Medicina (Kaunas). 2025; 61(5):787.
[20] She H, Hu Y, Zhao G, Du Y, Wu Y, Chen W, et al. Dexmedetomidine Ameliorates Myocardial Ischemia-Reperfusion Injury by Inhibiting MDH2 Lactylation via Regulating Metabolic Reprogramming. Adv Sci (Weinh). 2024; 11(48):e2409499.
[21] Fan ZW, Li SL, Tang YX, Qiang WM, Wu YT, Ge JY, et al. Effect of Low-Dose Dexmedetomidine as an Anesthetic Adjuvant on Intraoperative Hemodynamics and Prognosis in Patients Undergoing Cardiac Surgery. Cardiovasc Drugs Ther. 2026; 40(2):621-30.
[22] Sedighinejad A, Mohammadzadeh Jouryabi A, Imantalabl V, Mirmansouri A, Nassiri Sheikhani N, Atrkarroushan Z, et al. Efficacy of Dexmedetomidine in Coronary Artery Bypass Graft Surgery under Cardiopulmonary Bypass: A Randomized, Double-Blind Clinical Trial. Iran Red Crescent Med J. 2024; 20(8):1-7.
[23] Totonchi Z, Rezvani H, Ghorbanloo M, Yazdanian F, Mahdavi M, Babaali N, et al. Effect of dexmedetomidine infusion on hemodynamics and stress responses in pediatric cardiac surgery: A randomized trial. Res Cardiovasc Med. 2017; 6(18):7.
[24] Poon WH, Ling RR, Yang IX, Luo H, Kofidis T, MacLaren G, et al. Dexmedetomidine for adult cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia. 2023; 78(3):371-80.
[25] Ysenbaardt B, Nauwynck M, Mulier J. The effect of perioperative use of dexmedetomidine on time to extubation and ICU stay after coronary artery bypass graft surgery: a single-center retrospective cohort study. Acta Anaesthesiol Belg. 2022; 73:135-9.
[26] Ding Y, Wang X, Li X, He J, Teng X, Chen G. Safety and adverse events associated with dexmedetomidine for sedation in adult ICU patients: a systematic review and meta-analysis. Front Med (Lausanne). 2025; 12:1677955.
[27] Martinez L, Ekman E, Nakhla N. Perioperative Opioid-sparing Strategies: Utility of Conventional NSAIDs in Adults. Clin Ther. 2019; 41(12):2612-8.
[28] Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019; 123(6):777-94.
[29] Singh A, Garg V, Mehta Y, Bhan A, Trehan N. Perioperative dexmedetomidine reduces delirium after coronary artery bypass graft surgery: A prospective, single-blind, observational study. Ann Card Anaesth. 2022; 25(4):490-7.
[30] Mishra SC, Chowdhury S. Effects of preoperative dexmedetomidine on the occurrence of postoperative delirium in adult cardiac surgery patients. Int J Res Med Sci. 2023; 11(6):2191-5.
[31] Chima AM, Mahmoud MA, Narayanasamy S. What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care? Adv Anesth. 2022; 40(1):111-30.
[32] Soltani G, Jahanbakhsh S, Tashnizi MA, Fathi M, Amini S, Zirak N, et al. Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial. Electron Physician. 2017; 9(10):5578-87.
[33] Mohammed Jabbar Hatemi B, Enayati A, Ghorbani S, Tahmasebi F, Abo Aljadayel H, Jabbari A, et al. Double-Blind, Randomized, Controlled Pilot Trial to Specify Collateral Effect and Safety of Perioperative Dexmedetomidine in Patients Undergoing Open Heart Surgery. Anesth Pain Med. 2025; 15(1):e157117.
[34] Wang W, Liu J, Ye H, Wang M, Wang T. Effect of Dexmedetomidine on Tachyarrhythmias After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol. 2022; 79(3):315-24.
[35] Heybati K, Zhou F, Ali S, Deng J, Mohananey D, Villablanca P, et al. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2022; 129(4):515-26.
[36] El-Safty OM, El-Deek M, Ibrahim DA, Fahim M, Khaled Shaker M, Khaled M, et al. Evaluation of The Safety and Efficacy of Dexmedetomidine as an Anesthetic Adjuvant in Coronary Artery Bypass Grafting Surgeries. Egypt J Hosp Med. 2024; 96(1):3305-13.
[37] Zientara A, Mariotti S, Matter-Ensner S, Seifert B, Graves K, Dzemali O, et al. Fast-Track Management in Off-Pump Coronary Artery Bypass Grafting: Dexmedetomidine Provides Rapid Extubation and Effective Pain Modulation. Thorac Cardiovasc Surg. 2019; 67(6):450-7.
[38] Massoumi G, Mansouri M, Khamesipour S. Comparison of the incidence and severity of delirium and biochemical factors after coronary artery bypass grafting with dexmedetomidine: A randomized double-blind placebo-controlled clinical trial study. ARYA Atheroscler. 2019; 15(1):14-21.
[39] Lei C, Zheng Z, Han J, Wang L, Zhai W, Li C, et al. Effects of Dexmedetomidine on Outcomes After Cardiac Surgery (DOCS): a randomised double-blind, placebo-controlled trial. Br J Anaesth. 2026; 136(1):55-64.
[2] Safaric Oremus Z, Bradic N, Gospic I, Presecki I, Sakan S, Sojcic N, et al. Effect of Dexmedetomidine on Cardiopulmonary Bypass Induced Inflammatory Response in Patients Undergoing Aortic Valve Replacement. Life. 2025; 15(4):524.
[3] Fan Y, Chen B, Fang F, et al. Effect of Dexmedetomidine on Endothelial Glycocalyx in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2026; 40(3):805-13.
[4] Caetano da Silva L, Tapioca V, Viana P, Pereira EM, Gibicoski T, Amaral S. Dexmedetomidine for delirium prevention after cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2025; 44(5):101578.
[5] Zhong Y, Ren Z, Gao J, He X, Li Q. Dexmedetomidine for the prevention of postoperative delirium in patients undergoing cardiac surgery: a systematic review and meta-analysis with trial sequential analysis. BMC Anesthesiol. 2025; 25(1):408.
[6] Wang G, Niu J, Li Z, Lv H, Cai H. The efficacy and safety of dexmedetomidine in cardiac surgery patients: A systematic review and meta-analysis. PLoS One. 2018; 13(9):e0202620.
[7] Kerroum A, Rosner L, Scala E, Kirsch M, Tozzi P, Courbon C, et al. Intraoperative Dexmedetomidine Use for Enhanced Recovery after Surgery (ERAS) in Cardiac Surgery-Single Center Retrospective Observational Cohort Study. Medicina (Kaunas). 2024; 60(7):1036.
[8] He H, Liu P, Li P. Dexmedetomidine Ameliorates Cardiac Ischemia/Reperfusion Injury by Enhancing Autophagy Through Activation of the AMPK/SIRT3 Pathway. Drug Des Devel Ther. 2023; 17:3205-18.
[9] Chen M, Li X, Mu G. Myocardial protective and anti-inflammatory effects of dexmedetomidine in patients undergoing cardiovascular surgery with cardiopulmonary bypass: a systematic review and meta-analysis. J Anesth. 2022; 36(1):5-16.
[10] Zhou H, Zhou D, Lu J, Wu C, Zhu Z. Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on Cardiac Injuries and the Inflammatory Response in Valve Replacement Surgery With a Sevoflurane Postconditioning Protocol: A Pilot Study. J Cardiovasc Pharmacol. 2019; 74(2):91-7.
[11] Elgebaly AS, Fathy SM, Sallam AA, Elbarbary Y. Cardioprotective effects of propofol-dexmedetomidine in open-heart surgery: A prospective double-blind study. Ann Card Anaesth. 2020; 23(2):134-41.
[12] Park JB, Bang SH, Chee HK, Kim JS, Lee SA, Shin JK. Efficacy and Safety of Dexmedetomidine for Postoperative Delirium in Adult Cardiac Surgery on Cardiopulmonary Bypass. Korean J Thorac Cardiovasc Surg. 2014; 47(3):249-54.
[13] Morris R, Kuppa SA, Zhu X, Bu K, Han W, Cheng F. The Association Between Dexmedetomidine and Bradycardia: An Analysis of FDA Adverse Event Reporting System (FAERS) Data and Transcriptomic Profiles. Genes (Basel). 2025; 16(6):615.
[14] Cheng H, Li Z, Young N, Boyd D, Atkins Z, Ji F, et al. The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients. J Cardiothorac Vasc Anesth. 2016; 30(6):1502-8.
[15] Ren J, Zhang H, Huang L, Liu Y, Liu F, Dong Z. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med. 2013; 6(2):497-502.
[16] Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol. 2013; 29(2):162-7.
[17] Kesumarini D, Widyastuti Y, Boom CE, Dinarti LK. Dexmedetomidine as a myocardial protector in pediatric heart surgery using cardiopulmonary bypass: a systematic review. Ann Med Surg (Lond). 2023; 85(10):5075-84.
[18] Chi X, Liao M, Chen X, Zhao Y, Yang L, Luo A, et al. Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth. 2016; 30(1):44-50.
[19] Zdravković R, Vicković S, Preveden M, Drobnjak V, Lukić-Šarkanović M, Miljević IB, et al. Effect of Continuous Intraoperative Dexmedetomidine on Interleukin-6 and Other Inflammatory Markers After Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial. Medicina (Kaunas). 2025; 61(5):787.
[20] She H, Hu Y, Zhao G, Du Y, Wu Y, Chen W, et al. Dexmedetomidine Ameliorates Myocardial Ischemia-Reperfusion Injury by Inhibiting MDH2 Lactylation via Regulating Metabolic Reprogramming. Adv Sci (Weinh). 2024; 11(48):e2409499.
[21] Fan ZW, Li SL, Tang YX, Qiang WM, Wu YT, Ge JY, et al. Effect of Low-Dose Dexmedetomidine as an Anesthetic Adjuvant on Intraoperative Hemodynamics and Prognosis in Patients Undergoing Cardiac Surgery. Cardiovasc Drugs Ther. 2026; 40(2):621-30.
[22] Sedighinejad A, Mohammadzadeh Jouryabi A, Imantalabl V, Mirmansouri A, Nassiri Sheikhani N, Atrkarroushan Z, et al. Efficacy of Dexmedetomidine in Coronary Artery Bypass Graft Surgery under Cardiopulmonary Bypass: A Randomized, Double-Blind Clinical Trial. Iran Red Crescent Med J. 2024; 20(8):1-7.
[23] Totonchi Z, Rezvani H, Ghorbanloo M, Yazdanian F, Mahdavi M, Babaali N, et al. Effect of dexmedetomidine infusion on hemodynamics and stress responses in pediatric cardiac surgery: A randomized trial. Res Cardiovasc Med. 2017; 6(18):7.
[24] Poon WH, Ling RR, Yang IX, Luo H, Kofidis T, MacLaren G, et al. Dexmedetomidine for adult cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia. 2023; 78(3):371-80.
[25] Ysenbaardt B, Nauwynck M, Mulier J. The effect of perioperative use of dexmedetomidine on time to extubation and ICU stay after coronary artery bypass graft surgery: a single-center retrospective cohort study. Acta Anaesthesiol Belg. 2022; 73:135-9.
[26] Ding Y, Wang X, Li X, He J, Teng X, Chen G. Safety and adverse events associated with dexmedetomidine for sedation in adult ICU patients: a systematic review and meta-analysis. Front Med (Lausanne). 2025; 12:1677955.
[27] Martinez L, Ekman E, Nakhla N. Perioperative Opioid-sparing Strategies: Utility of Conventional NSAIDs in Adults. Clin Ther. 2019; 41(12):2612-8.
[28] Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019; 123(6):777-94.
[29] Singh A, Garg V, Mehta Y, Bhan A, Trehan N. Perioperative dexmedetomidine reduces delirium after coronary artery bypass graft surgery: A prospective, single-blind, observational study. Ann Card Anaesth. 2022; 25(4):490-7.
[30] Mishra SC, Chowdhury S. Effects of preoperative dexmedetomidine on the occurrence of postoperative delirium in adult cardiac surgery patients. Int J Res Med Sci. 2023; 11(6):2191-5.
[31] Chima AM, Mahmoud MA, Narayanasamy S. What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care? Adv Anesth. 2022; 40(1):111-30.
[32] Soltani G, Jahanbakhsh S, Tashnizi MA, Fathi M, Amini S, Zirak N, et al. Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial. Electron Physician. 2017; 9(10):5578-87.
[33] Mohammed Jabbar Hatemi B, Enayati A, Ghorbani S, Tahmasebi F, Abo Aljadayel H, Jabbari A, et al. Double-Blind, Randomized, Controlled Pilot Trial to Specify Collateral Effect and Safety of Perioperative Dexmedetomidine in Patients Undergoing Open Heart Surgery. Anesth Pain Med. 2025; 15(1):e157117.
[34] Wang W, Liu J, Ye H, Wang M, Wang T. Effect of Dexmedetomidine on Tachyarrhythmias After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol. 2022; 79(3):315-24.
[35] Heybati K, Zhou F, Ali S, Deng J, Mohananey D, Villablanca P, et al. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2022; 129(4):515-26.
[36] El-Safty OM, El-Deek M, Ibrahim DA, Fahim M, Khaled Shaker M, Khaled M, et al. Evaluation of The Safety and Efficacy of Dexmedetomidine as an Anesthetic Adjuvant in Coronary Artery Bypass Grafting Surgeries. Egypt J Hosp Med. 2024; 96(1):3305-13.
[37] Zientara A, Mariotti S, Matter-Ensner S, Seifert B, Graves K, Dzemali O, et al. Fast-Track Management in Off-Pump Coronary Artery Bypass Grafting: Dexmedetomidine Provides Rapid Extubation and Effective Pain Modulation. Thorac Cardiovasc Surg. 2019; 67(6):450-7.
[38] Massoumi G, Mansouri M, Khamesipour S. Comparison of the incidence and severity of delirium and biochemical factors after coronary artery bypass grafting with dexmedetomidine: A randomized double-blind placebo-controlled clinical trial study. ARYA Atheroscler. 2019; 15(1):14-21.
[39] Lei C, Zheng Z, Han J, Wang L, Zhai W, Li C, et al. Effects of Dexmedetomidine on Outcomes After Cardiac Surgery (DOCS): a randomised double-blind, placebo-controlled trial. Br J Anaesth. 2026; 136(1):55-64.
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How to Cite
1.
Baniani M, Dabbagh A, Ashari A, Al-Juaifari MBS, Abtahi D. Dexmedetomidine in Fast-Track Cardiac Care for Patients Undergoing Coronary Artery Bypass Graft Surgery. Arch Anesth & Crit Care. 2026;.
