Effect of Dexmedetomidine on Endothelial Glycocalyx in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass.

OBJECTIVE

To evaluate the protective role of dexmedetomidine on endothelial glycocalyx in cardiac surgery patients undergoing cardiopulmonary bypass (CPB).

DESIGN

Randomized controlled trial.

SETTING

Single-center study conducted from June 2022 to December 2022.

PARTICIPANTS

Fifty-eight patients who underwent elective valvular cardiac surgery with CPB.

INTERVENTIONS: Patients were randomly assigned to either the dexmedetomidine group (n = 29) or the saline group (n = 29), with infusion starting 10 minutes before anesthesia induction and continuing throughout the maintenance phase.

MEASUREMENTS AND MAIN

RESULTS

Radial artery blood samples were collected at 4 time points: T1, before anesthesia induction; T2, 5 minutes after aortic unclamping; T3, 1 hour postoperatively; and T4, 24 hours postoperatively. The primary endpoint was plasma syndecan-1 concentration, and secondary endpoints were heparin sulfate and tumor necrosis factor-alpha (TNF-α) levels, and long-term clinical outcomes. Compared with controls, the dexmedetomidine group showed significantly less glycocalyx shedding, an effect that persisted throughout CPB and recovery. TNF-α levels were significantly lower at T2-T3, along with reduced lactate levels on aortic unclamping.

CONCLUSIONS

Dexmedetomidine preserves endothelial glycocalyx integrity and attenuates systemic inflammation in CPB patients.