Comparison Between Lidocaine, Dexmedetomidine, and Their Combined Infusion in Subjects Undergoing Coronary Artery Bypass Graft

Not Applicable

Completed

Conditions: Dexmedetomidine
Lidocaine
Myocardial Injury
Blood Electrolyte Balance
Coronary Artery Bypass Graft
Arrhythmia
Unstable Angina

Brief Summary: The aim of the present study is to compare the antiarrhythmic and myocardial protective effect between lidocaine, dexmedetomidine, and their combined infusion in subjects undergoing coronary artery bypass graft.

Detailed Description: Lidocaine has been reported to have an antiarrhythmic and myocardial protective effect. A previous study has reported that low-dose lidocaine infusion can decrease the incidence of ventricular fibrillation and tachycardia during the first 24 hours after coronary artery bypass graft (CABG). A recent study also reported that the lidocaine infusion during CABG could decrease the myocardial injury by measuring the CK-MB and Troponin-I blood level.

Dexmedetomidine is an alpha-2 agonist and reduces the sympathetic tone and neuroendocrine stress response. Dexmedetomidine was reported to have a cardioprotective effect by a previous animal study. However, there was no clinical study evaluating the cardioprotective effect of dexmedetomidine.

Therefore, we are trying to evaluate and compare the antiarrhythmic and myocardial protective effect between lidocaine, dexmedetomidine, and their combined infusion in subjects undergoing coronary artery bypass graft.

Recruitment & Eligibility

Inclusion Criteria

Those undergoing off-pump coronary artery bypass graft during the study period in Samsung Medical Center

Exclusion Criteria

Any patients with plasma aldosterone, or glucocorticoid disorder including primary hyperaldosteronism, renovascular hypertension, rennin-secreting tumor, salt-wasting renal disease, Cushing syndrome
Patients with recent exogenous steroid administration or previous diuretics therapy
Patients with recent myocardial infarction
Those undergoing unplanned cardiopulmonary bypass during the surgery

Arm && Interventions

Group	Intervention	Description
Lidocaine group	Lidocaine infusion	a bolus dose of lidocaine 1.5 mg/kg after anesthetic induction with following lidocaine infusion with 2 mg/kg/hr during the surgery and same dose during postoperative 24 hour in ICU.
Combined infusion group	Lidocaine infusion	Combined lidocaine and dexmedetomidine infusion with the dose specified in single infusion group
Combined infusion group	Dexmedetomidine infusion	Combined lidocaine and dexmedetomidine infusion with the dose specified in single infusion group
Dexmedetomidine group	Dexmedetomidine infusion	Dexmedetomidine infusion during anesthetic induction with 0.2 mcg/kg/hr followed by 0.3 \~ 0.7 mcg/kg/hr during the surgery

Primary Outcome Measures

Name	Time	Method
Myocardial injury marker	postoperative ICU day 3	Myocardial injury marker - CK-MB, and Troponin(i) blood level

Secondary Outcome Measures

Name	Time	Method
Postoperative ICU stay, Hospital stay, Extubation time	1 day after hospital discharge	Postoperative ICU stay, Hospital stay
The incidence of hypokalemia	1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, , postoperative ICU day 1, 2, 3	The incidence of hypokalemia
The blood sodium, potassium, calcium level	1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, postoperative ICU day 1, 2, 3	The blood sodium, potassium, calcium level
The incidence of arrhythmia during and after the surgery	1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, postoperative ICU day 1, 2, 3	The incidence of arrhythmia during and after the surgery: Ventricular premature beat,Atrial premature complex, Bigeminy, Trigeminy, Atrial fibrillation, Ventricular tachycardia, Ventricular fibrillation, Atrio-Ventricular block, PSVT, Junctional rhythm, External pacing
Inotropics use during and after the surgery	1 day before surgery day, at the start of anesthetic induction, 2 hour, 4 hour after anesthetic induction, , postoperative ICU day 1, 2, 3	Inotropics and other drug use during and after the surgery: Dopamine, NTG, dobutamine, milrinone, epinephrine, norepinephrine, amiodarone, diltiazem, remifentanil, esmolol, labetalol, nicardipine, Lasix, phenylephrine, lidocaine, sufentanil