Effects of Dextromethorphan on Patients with Cardiovascular Disorders

Taylor Chuich^*
*Correspondence: Taylor Chuich, Value Institute, Christiana Care Health System, Newark, DE, USA, Email:

Introduction

Dexmedetomidine may be associated with higher drug expenditures and its ability to lower overall morbidity and mortality has not been conclusively proved, but its other known effects offer postoperative cardiac surgery patients advantages that other forms of sedation cannot. Older patients having cardiac surgery are most at risk, with a 25% likelihood of developing a major postoperative neurocognitive impairment (postoperative NCD or P-NCD) three months after surgery. P-NCD is associated with morbidity, death, loss of autonomy, early retirement, and higher healthcare costs. The effectiveness of postoperative dexmedetomidine sedation in preventing significant P-NCD following heart surgery is compared in this multicenter randomised trial to standard protocols. The largest interventional trial with a substantial P-NCD endpoint will be CODEX.

To increase the sample size and boost the test's statistical effectiveness, we merged analyses of numerous data from related studies. In order to provide a theoretical framework and assist in the practical treatment of cardiac disorders, we utilised a meta-analysis in this study to examine the sedative impact of dexmedetomidine on patients following heart surgery. Myocardial protection is crucial in cardiac procedures, and multimodal strategies are needed in the perioperative period to decrease and prevent increases in myocardial oxygen demand and consumption, which can result in postoperative cardiac complications like myocardial ischemia, dysfunction, and heart failure. Dexmedetomidine has been shown to lessen cardiac issues in patients following cardiac surgery. Clinical studies on the effects of dexmedetomidine on outcomes following paediatric cardiac surgery have yielded conflicting findings.

Delirium is a form of acute brain dysfunction that frequently affects patients who have undergone heart surgery and raises mortality and morbidity rates. Risk factors associated with it include old age, drug use, cardiopulmonary bypass, and hypothermia. Dexmedetomidine infusions might have a neuroprotective effect. However, there is ongoing discussion regarding the effect of preoperative dexmedetomidine therapy on the development of Postoperative Delirium (POD) in patients undergoing cardiac or non-cardiac surgery. This study's objective was to determine whether administering dexmedetomidine intraoperatively to adult cardiac surgery patients decreased their risk of developing delirium. Many cardiovascular procedures are hurriedly extubated and necessitate a brief period of anaesthesia. Both dexmedetomidine and propofol are desirable sedatives in this patient population due to their significantly varied pharmacokinetic and modes of action.

Although dexmedetomidine use in the Critical Care Unit (ICU) has increased, there aren't many research that directly contrast the two medications in this setting. We performed a retrospective cohort analysis with patients admitted to the ICU following cardiovascular surgery from January to June 2011. Dexmedetomidine or propofol were continuously infused into adult patients who underwent coronary artery bypass surgery and/or cardiac valve surgery following the procedure for short-term sedation. The duration of mechanical breathing following surgery was the primary outcome indicator (in hours). The duration of the hospital stay, the amount of time spent in the intensive care unit (ICU), the frequency of delirium, and the requirement for a second sedative were all secondary outcomes.

Abuse of dextromethorphan (DM) causes mania-like symptoms in some. The suppression of cardiac hormones that resemble ouabain can reduce the activation of ERK/Akt signalling associated with manic potential. The ouabain inhibitor rostafuroxin (ROSTA) dramatically reduced the elevated phosphorylations of ERK/Akt and hyperlocomotion caused by DM in this investigation, indicating that DM causes the manic potential. ROSTA significantly reduced DM-induced GluN2B (the MDA receptor subunit) expression, phospho- PKC/GluN2B association, and protein kinase C (PKC) phosphorylation. The nuclear factor erythroid-2-related factor 2 (Nrf2)-dependent system was immediately activated by DM. But after 1 hour of administration, DM increased oxidative parameters and decreased Nrf2 nuclear translocation, Nrf2 DNA binding activity, -glutamylcysteine mRNA expression, and subsequent GSH/ GSSG level. ROSTA dramatically reduced the modifications in Nrf2-related redox parameters and locomotor activity brought on by DM in wild-type mice, as well as the effects of the PKC inhibitor rottlerin and the GluN2B inhibitor traxoprodil. Importantly, DM failed to change the aforementioned parameters in PKC knockout mice. Further evidence that PKC is a crucial target for the anti-manic potential of ROSTA or GluN2B antagonism comes from the fact that traxoprodil and ROSTA both failed to improve the PKC depletion effect. According to our findings, ROSTA reduces DM-induced manic potential by reducing ERK/Akt activation, GluN2B/PKC signalling, and Nrf2-dependent system activity [1-5].

Conflict of Interest

None.

References

1. Marra, Pasquale, Arianna Di Stadio, Vito Colacurcio and Alfonso Scarpa, et al. "Sedation with intranasal dexmedetomidine in the pediatric population for auditory brainstem response testing: Review of the existing literature." Healthcare 10 (2022): 287.

Google Scholar, Crossref 

2. Rudikoff, Andrew G, David D. Tieu, Franklin M. Banzali and Carolyn V. Nguyen, et al. "Perioperative acetaminophen and dexmedetomidine eliminate post-operative opioid requirement following pediatric tonsillectomy." J Clin Med 11 (2022): 561.

Google Scholar, Crossref, Indexed at

3. Allam Ayat A, Nermin E. Eleraky, Nadeen H. Diab and Mahmoud Elsabahy, et al. "Development of sedative dexmedetomidine sublingual in situ gels: In vitro and in vivo evaluations." Pharmaceutics 14 (2022): 220.

Google Scholar

4. Syrous, Nesjla Sofia, Terje Sundstrøm, Eirik Søfteland, and Ib Jammer. "Effects of intraoperative dexmedetomidine infusion on postoperative pain after craniotomy: A narrative review." Brain Sci 11 (2021): 1636.

Crossref, Indexed at

5. Yoo, Young Chul, Won Sik Jang, Ki Jun Kim and Jung Hwa Hong, et al. "Effect of Dexmedetomidine on Biochemical Recurrence in Patients after Robot-Assisted Laparoscopic Radical Prostatectomy: A Retrospective Study." J Pers Med 11 (2021): 912.

Google Scholar, Crossref, Indexed at