Main Article Content

Shumaila Ali Rai
Aamir Furqan
Muhammad Imran Khan
Kaneez Um e farwa
Ahmed Adnan
Dr Waseema Afzal


Objective: To compare the effects of dexmedetomidine alone (DA) with dexmedetomidine plus ketamine (KD) combination in addition to routine fentanyl administration in post-cardiac surgery patients

Methodology: The trial was conducted at the Department of Anaesthesia and Critical Care, Chaudhary Pervaiz Elahi Institute of Cardiology Multan, from July 2020 to December 2020. A total of 40 patients planned for elective coronary artery bypass grafting (CABG) were randomized by lottery method for dexmedetomidine alone (Group DA, n=20) or dexmedetomidine plus Ketamine (Group KD, n=20) to maintain Ramsay sedation score > 4 during assistedventilation. All patients received fentanyl for postoperative analgesia. The mean arterial blood pressure, heart rate, sedation score, pain score, and mean extubation time were compared between two groups and analyzed by using SPSS version 23.

Results: Total fentanyl dose was 45.65 ± 8.23 microgram in group KD and 146.01 ± 14.18 microgram in group DA (p = 0.001). The time of weaning was 344.65 ± 43.89 minutes and 446.60 ± 73.75 minutes in groups KD and DA, respectively (p = 0.001). The time of Extubation was 389.90 ± 35.89 minutes and 535.30 ± 36.25 minutes in groups KD and DA, respectively (p <0.001). The ICU stay, heart rate, mean arterial pressure, Ramsay score, and non-verbal Pain score was comparable in both study groups (p>0.05).

Conclusion: Utilizing Ketamine plus dexmedetomidine for sedation post-Coronary Artery Bypass Graft (CABG) procedure gave a brief term of mechanical ventilation and early extubation with less fentanyl requirement than dexmedetomidine alone. Hemodynamic stability was present in both groups.

Article Details

How to Cite
Ali Rai S, Furqan A, Khan MI, Kaneez Um e farwa, Adnan A, Afzal DW. DEXMEDETOMIDINE ALONE OR WITH KETAMINE IN ADDITION TO ROUTINE FENTANYL ADMINISTRATION IN POST CARDIAC SURGERY PATIENTS: A RANDOMIZED CONTROLLED TRIAL. J Postgrad Med Inst [Internet]. 2022 Mar. 31 [cited 2024 Jul. 23];36(1):39-43. Available from:
Original Article


- Sharma V, Chen K, Alansari SAR, Verma B, Soltesz EG, Johnston DR, Tong MZ, et al. Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery. Ann Thorac Surg. 2021 May;111(5):1494-1501.

- Lee S. Dexmedetomidine: present and future directions. Korean J Anesthesiol. 2019;72(4):323.

- Kim WH, Cho D, Lee B, Song JJ, Shin TJ. Changes in brain activation during sedation induced by dexmedetomidine. J Int Med Res. 2017;45(3):1158-67.

- Pasero D, Sangalli F, Baiocchi M, Blangetti I, Cattaneo S, Paternoster G, et al. Experienced use of dexmedetomidine in the intensive care unit: A report of a structured consensus. Turk J Anaesthesiol Reanimation. 2018;46(3):176.

- Mion G. History of anaesthesia: The ketamine story–past, present, and future. Europ J Anaesthesiol. 2017;34(9):571-5.

- Goyal R. Dexmedetomidine: The game changer or a team player?. J Anaesthesiol Clin Pharmacol. 2016;32(2):144.

- Amornyotin S. Use of a combination of Ketamine and dexmedetomidine (Ketodex) in different clinical cases. J Addict Med Ther Sci. 2020;6(1):41-4.

- Mogahd MM, Mahran MS, Elbaradi GF. Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery. Ann Card Anaesth. 2017;20(2):182-187.

- Gumus F, Polat A, Yektas A, Totoz T, Bagci M, Erentug V, et al. Prolonged mechanical ventilation after CABG: Risk factor analysis. J Cardiothorac Vasc Anesth. 2015;29:52 8.

- Curtis JA, Hollinger MK, Jain HB. Propofol based versus dexmedetomidine based sedation in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2013;27:1289 94.

- Trouillet JL, Combes A, Vaissier E, Luyt CE, Ouattara A, Pavie A, et al. Prolonged mechanical ventilation after cardiac surgery: Outcome and predictors. J Thorac Cardiovasc Surg. 2009;138:948 53.

- Fougères E, Teboul JL, Richard C, Osman D, Chemla D, Monnet X. Hemodynamic impact of a positive end expiratory pressure setting in acute respiratory distress syndrome: Importance of the volume status. Crit Care Med. 2010;38:802 7.

- Barletta JF, Miedema SL, Wiseman D, Heiser JC, McAllen KJ. Impact of dexmedetomidine on analgesic requirements in patients after cardiac surgery in a fast track recovery room setting. Pharmacotherapy. 2009;29:1427 32.

- Herr DL, Sum Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: Dexmedetomidine based versus propofol based sedation regimens. J Cardiothorac Vasc Anesth. 2003;17:576 84.

- Martin E, Ramsay G, Mantz J, Sum Ping ST. The role of the alpha2 adrenoceptor agonist dexmedetomidine in postsurgical sedation in the Intensive Care Unit. J Intensive Care Med. 2003;18:29 41.

- Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: A wonder drug? Indian J Anaesth. 2011;55:323 4.

- Anger KE, Szumita PM, Baroletti SA, Labreche MJ, Fanikos J. Evaluation of dexmedetomidine versus propofol based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Crit Path Cardiol. 2010;9:221 6.

- Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. dexmedetomidine vs. midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. J Am Med Assoc. 2012;307:1151 60.

- Corbett SM, Rebuck JA, Greene CM, Callas PW, Neale BW, Healey MA, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med. 2005;33:940 5.

- Carson SS, Kress JP, Rodgers JE, Vinayak A, Campbell Bright S, Levitt J, et al. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med. 2006;34:1326 32.

- Reichert MG, Jones WA, Royster RL, Slaughter TF, Kon ND, Kincaid EH. Effect of a dexmedetomidine substitution during a nationwide propofol shortage in patients undergoing coronary artery bypass graft surgery. Pharmacotherapy. 2011;31:673 7.

- McVey JD, Tobias JD. Dexmedetomidine and Ketamine for sedation during spinal anesthesia in children. J Clin Anesth. 2010;22:538 45.

- Triltsch AE, Welte M, von Homeyer P, Grosse J, Genähr A, Moshirzadeh M, et al. Bispectral index guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo controlled phase II study. Crit Care Med. 2002;30:1007 14.

- Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: A meta analysis. Intensive Care Med. 2010;36:926 39.

- Mukhtar AM, Obayah EM, Hassona AM. Preliminary experience with dexmedetomidine in pediatric anesthesia. Anesth Analg. 2006;103:250.

- Tosun Z, Akin A, Guler G, Esmaoglu A, Boyaci A. Dexmedetomidine ketamine and propofol ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth. 2006;20:515 9.

- Mester R, Easley RB, Brady KM, Chilson K, Tobias JD. Monitored anesthesia care with a combination of Ketamine and dexmedetomidine during cardiac catheterization. Am J Ther. 2008;15:24 30.

Most read articles by the same author(s)