Open Heart Surgery with Cardiopulmonary Bypass using Dexmedetomidine-based Monitored Anesthesia Care without Endotracheal intubation Improves Postoperative Recovery

Background Studies have demonstrated the feasibility of performing awake cardiac surgery (ACS) in non‐intubated patients with consciousness and spontaneous breathing using epidural anesthesia. However, major concerns about severe complications of epidural anesthesia, such as epidural hematoma, have seriously hampered the development of ACS. Monitored anesthesia care (MAC) is a planned procedure during which the patients undergo local anesthesia together with sedation and analgesia. Dexmedetomidine (Dex), a highly selective α‐2 agonist, can facilitate fast recovery in patient undergoing cardiac surgery. We aimed to evaluate the feasibility and safety of Dex‐based MAC without intubation and the potential of achieving enhanced recovery after surgery (ERAS). Methods With patients’ consent, 11 patients scheduled to undergo cardiac surgeries under cardiopulmonary bypass (CPB) were arranged for MAC. Surgery was performed with a conventional median sternotomy. MAC composed of continuous Dex infusion (0.2 – 0.5 g/kg/hour) supplemented with low‐dose remifentanil/sufentanil, regional anesthesia and electroacupuncture was applied to satisfy the need for analgesia and sedation during cardiac surgery while avoid significant respiratory depression. 11 patients who routinely underwent general anesthesia (GA) that matched for age, gender and types of operation were used as controls. Intraoperative respiration and hemodynamics, postoperative vasoactive‐inotropic score (VIS), serum troponin I, complications and recovery after surgery were evaluated. Results 11 cardiac surgeries including mitral valve replacements, valvoplasty, valve replacement plus valvoplasty, resection of atrial myxoma, and repair of atrial septal defect, were uneventfully accomplished under MAC. None of them required conversion to GA. The whole process of surgery was accompanied by adequate spontaneous breathing, stable hemodynamics, satisfactory surgical conditions, good patient satisfaction and no anesthesia awareness. Compared with GA group, intraoperative dosage of opioids and general anesthetics, VIS at 6 hours after entry into intensive care unit (ICU), serum cardiac troponin I concentrations, the time to drink and duration of ICU stay were significantly reduced in the MAC group (all p<0.05). Conclusion The minimally invasive Dex‐based MAC for heart surgery with CPB is safe and feasible. Moreover, it shows the potential of cardioprotection and enhanced recovery after surgery. Support or Funding Information Study supported in part by a NSFC grant(81774108)