Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New Onset AF After CABG Surgery

Atrial fibrillation (AF) occurs in 20% to 40% of patients after Coronary artery bypass grafting (CABG) and is associated with numerous detrimental sequelae. In postoperative period, the patient may be exposed to several proarrhythmogenic factors as increased endogenous catecholamines, inflammatory and oxidative mediators secondary to surgical stress and the systemic response to cardiopulmonary bypass, use of inotropic support. Steroids suppress the release of the above-mentioned inflammatory mediators. Dexmedetomidine is sympatholytic, along with anti-inflammatory properties. so combined use of both drugs may have synergistic effect to prevent post operative AF (POAF)

Inclusion Criteria:- Scheduled for CABG Surgery with cardiopulmonary bypass (CPB) pumpExclusion Criteria:History of heart block.Patients with preoperative bradycardia (HR < 60 / min)Patients with preoperative hypotension (systolic blood pressure < 90 mmhg)Previous episodes of AF or flutter.Uncontrolled diabetes mellitus requiring insulin treatment with recent hyperglycemia which required hospital treatment.History of peptic ulcer disease.Active systemic bacterial or mycotic infection.Permanent pacemaker.Any documented or suspected supraventricular or ventricular arrhythmias.Urgent or emergency surgery.Planned off-pump surgery.Patient Refusal.