An Observational Study on Effect of Dexmedetomidine Nebulization on postoperative Quality of Recovery in patients undergoing off-pump Coronary Artery Bypass Grafting

·       Coronary artery bypass graft (CABG) surgery remains a very important procedure for patients with narrowed coronary arteries either as a result of multiple vessel disease or following failed percutaneous intervention. It basically involves replacing the narrowed portions of the vessels with venous or arterial grafts.[1]

 ·       Most of these patients have advanced heart disease (New York Heart Association functional Class III and IV), in addition to some co-existing diseases such as diabetes and chronic renal disease. This makes intensive care after CABG a standard component of the treatment for most of these patients. Factors such as age, gender, hospital admission prior to surgery, the number of grafts and CPB time have variously been identified by many authors as determinants of Intensive Care Unit (ICU) length of stay (LOS) after CABG surgery. [1][2][3]. Long stay in the ICU has been found to result in increased hospital mortality, poor long-term prognosis, high morbidity and consequently increased cost and expenses. [4] .

·       Nebulized dexmedetomidine offers a variable alternative compared to IV dexmedetomidine, owing to drug deposition over a greater surface area [nasal, buccal, respiratory mucosa], resulting in better systemic absorption and prevention of postoperative delirium and agitation in OPCABG patients[8][9]

·       Delirium is experienced in 20% to 40% of the critically ill and up to 80% of mechanically ventilated patients [1–4]. It is a confusional state that has been described as a transient global disorder of cognition, awareness, and attention. It is associated with prolonged hospital length of stay and time on MV, deterioration in cognition, and increased morbidity and mortality causing additional health-care expenses [4][5]. Its pathophysiological mechanisms are highly heterogeneous—as perceived by the high number of risk factors —and have yet to be fully understood.

Quality of recovery after anaesthesia is an important measure of the early postoperative health status of patients. We attempted to develop a valid and reliable measure of quality of recovery after anaesthesia and surgery.[6]

·       We will conduct a study of OPCABG procedures done at the Fortis hospital, Bannerghatta, Bangalore, India over a 1 year period to determine the efficacy of dexmedetomidine nebulization in quality of recovery of these patients.