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Response to the Letter to the Editor by Yang et al
Author’s Accepted Manuscript Response to the Letter to the Editor by Dr Fu-Shan Xu Xiaohui Chi, Hui Yang
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1053-0770(16)30370-6 http://dx.doi.org/10.1053/j.jvca.2016.08.034 YJCAN3820
To appear in: Journal of Cardiothoracic and Vascular Anesthesia Cite this article as: Xiaohui Chi and Hui Yang, Response to the Letter to the Editor by Dr Fu-Shan Xu, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2016.08.034 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Response to the Letter to the Editor by Dr Fu-Shan Xu Authors: Xiaohui Chi M.D.,
Hui Yang M.D Ph.D.*
Address: Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Road, Wuhan, Hubei 430030, China *Corresponding author: Hui Yang M.D Ph.D. E-mail address: [email protected] Tel: +8627-83663173, Fax: +8627-83662853. To the Editor: We thank Drs Gui-Zhen Yang and Fu-Shan Xue for their interest in our recent study.1 We reviewed Dr. Fu-Shan Xue's comments and offer the following reply. The authors expressed concern that our study only measured serum cardiac troponin I (cTnI) level at 24 hours and 48 hours after surgery, but not it at the end of surgery. This time window was chosen since it takes 24 h for cTnI to reach its peak serum level.2 C Blhillis measured serum cTnI level at 2 and 24 hours. cTnI levels are frequently elevated after cardiac surgery. However, only cTnI levels at 24 hours remain independent predictors of short, medium, and long-term outcome.3 In addition, highest postoperative peak release of cTnI significantly affects mid-term survival after OPCAB.4 The myocardial damage biomarkers, serum cTnI and CK-MB, were reduced after continuous administration of
dexmedetomidine in our study, despite that the mechanism was not identified. The authors recommended that dosage regimen of dexmedetomidine should assure adrenergic blockade at least for 72 hours postoperatively and preferably longer. But it may be inappropriate. The United States Federal Drug Administration has advised that dexmedetomidine is only used for short-term sedation (<24 h) because of adverse effects such as tachyphylaxis, complications of respiratory failure, and acute respiratory distress syndrome.5 It also should be noted that longtime administration of dexmedetomidine increased the propensity toward hypotension which may against organ perfusion. Meanwhile, administration of dexmedetomidine will prolong both extubation time and length of ICU stay and increase the total cost of hospitalization.1 Thus we need to weigh
the
pros
and
cons
before
a
definite
conclusion
of
dexmedetomidine cardioprotection has been reached. We agree with the authors that the large-scale clinical trials and long-term follow-up are required to substantiate whether the high-dose dexmedetomidine benefit postoperative cardiovascular morbidity and mortality. We are participating in a perspective multicenter randomized double blind and parallel control study in China with respect to dexmedetomidine and outcomes of cardiac surgery.
References 1. Chi X, Liao M, Chen X, et al: Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 30: 44-50, 2016 2. Peivandi A A, Dahm M, Opfermann U T, et al: Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction. Herz 29:658-664, 2004 3. Croal B L, Hillis G S, Gibson P H, et al: Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation 114: 1468-1475, 2006 4. Paparella D, Cappabianca G, Malvindi P, et al: Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg 32: 481-487, 2007 5.US Food and Drug Administration. Safety information: Precedex (dexmedetomidine
hypochloride).
Available
from
http://www.fdagov/Safety/ MedWatch/SafetyInformation/ucm233675.htm (accessed 29 January 2013)
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1053-0770(16)30370-6 http://dx.doi.org/10.1053/j.jvca.2016.08.034 YJCAN3820
To appear in: Journal of Cardiothoracic and Vascular Anesthesia Cite this article as: Xiaohui Chi and Hui Yang, Response to the Letter to the Editor by Dr Fu-Shan Xu, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2016.08.034 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Response to the Letter to the Editor by Dr Fu-Shan Xu Authors: Xiaohui Chi M.D.,
Hui Yang M.D Ph.D.*
Address: Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Road, Wuhan, Hubei 430030, China *Corresponding author: Hui Yang M.D Ph.D. E-mail address: [email protected] Tel: +8627-83663173, Fax: +8627-83662853. To the Editor: We thank Drs Gui-Zhen Yang and Fu-Shan Xue for their interest in our recent study.1 We reviewed Dr. Fu-Shan Xue's comments and offer the following reply. The authors expressed concern that our study only measured serum cardiac troponin I (cTnI) level at 24 hours and 48 hours after surgery, but not it at the end of surgery. This time window was chosen since it takes 24 h for cTnI to reach its peak serum level.2 C Blhillis measured serum cTnI level at 2 and 24 hours. cTnI levels are frequently elevated after cardiac surgery. However, only cTnI levels at 24 hours remain independent predictors of short, medium, and long-term outcome.3 In addition, highest postoperative peak release of cTnI significantly affects mid-term survival after OPCAB.4 The myocardial damage biomarkers, serum cTnI and CK-MB, were reduced after continuous administration of
dexmedetomidine in our study, despite that the mechanism was not identified. The authors recommended that dosage regimen of dexmedetomidine should assure adrenergic blockade at least for 72 hours postoperatively and preferably longer. But it may be inappropriate. The United States Federal Drug Administration has advised that dexmedetomidine is only used for short-term sedation (<24 h) because of adverse effects such as tachyphylaxis, complications of respiratory failure, and acute respiratory distress syndrome.5 It also should be noted that longtime administration of dexmedetomidine increased the propensity toward hypotension which may against organ perfusion. Meanwhile, administration of dexmedetomidine will prolong both extubation time and length of ICU stay and increase the total cost of hospitalization.1 Thus we need to weigh
the
pros
and
cons
before
a
definite
conclusion
of
dexmedetomidine cardioprotection has been reached. We agree with the authors that the large-scale clinical trials and long-term follow-up are required to substantiate whether the high-dose dexmedetomidine benefit postoperative cardiovascular morbidity and mortality. We are participating in a perspective multicenter randomized double blind and parallel control study in China with respect to dexmedetomidine and outcomes of cardiac surgery.
References 1. Chi X, Liao M, Chen X, et al: Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 30: 44-50, 2016 2. Peivandi A A, Dahm M, Opfermann U T, et al: Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction. Herz 29:658-664, 2004 3. Croal B L, Hillis G S, Gibson P H, et al: Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation 114: 1468-1475, 2006 4. Paparella D, Cappabianca G, Malvindi P, et al: Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg 32: 481-487, 2007 5.US Food and Drug Administration. Safety information: Precedex (dexmedetomidine
hypochloride).
Available
from
http://www.fdagov/Safety/ MedWatch/SafetyInformation/ucm233675.htm (accessed 29 January 2013)