Introduction. Dexmedetomidine (a highly selective α2-adrenergic agonist) is used for analgosedation in various interventions. Some studies have noted that a loading dose of dexmedetomidine 1.0 μg/kg/15 minutes can lead to a decrease in the diameter of the coronary arteries in both healthy volunteers and patients with coronary heart disease (CHD). The aim of the study was to evaluate the effect of monoanesthesia with dexmedetomidine on the diameter of the stented artery (proximal and distal to the site of stenosis) during elective endovascular stenting of the coronary arteries. Materials and methods. A quasi-experimental study "before and after" was carried out. The study included 22 patients from September 2021 to January 2022. A comparison of 27 indicators was carried out, since 5 patients underwent simultaneous stenting of 2 coronary arteries. Results. The diameter of the proximal section of the stented artery before the loading dose of dexmedetomidine was 2.9 mm [2.5–3.4]; after loading dose – 3.0 mm [2.5–3.4] (p = 0.6). The initial diameter of the distal segment of the coronary artery was 2.2 mm [1.7–2.4], while after a loading dose of dexmedetomidine it was 2.2 mm [2.0–2.5] (p = 0.001). Discussion. In this study, there was no change in the proximal segment of the coronary artery when using a loading dose of dexmedetomidine 0.5 mcg/kg/10 minutes. Whereas an increase in the diameter of the distal coronary arteries has been reported with the above loading dose of dexmedetomidine. Conclusion. Despite a number of limitations of this study (factors affecting the diameter of the coronary arteries that were not taken into account), with a certain degree of optimism, one can speak of a smaller effect of a loading dose of dexmedetomidine 0.5 μg/kg/10 minutes on the diameter of the lumen of the coronary arteries.

INTRODUCTION: Intraprocedural analgosedation in planned percutaneous coronary interventions is a priority method of anesthesia, since it provides comfort for patient in comparison with when it is absent; it leads to a fast recovery of patients and reduction of the incidence of complications in comparison with the general anesthesia. The question of the optimal sedation method is still open. AIM: To carry out a comparative analysis of sedation with Phenazepam® and Dexmedetomidine in planned percutaneous coronary interventions in patients with stable coronary heart disease. MATERIALS AND METHODS: A prospective randomized study was conducted from September 2021 to January 2022. The study included patients with stable ischemic heart disease (serum troponin T level less than 0.32 ng/ml; absence of anginous pain at the beginning of X-ray endovascular intervention), who had planned percutaneous coronary intervention. The Phenazepam® sedation group included 40 patients, including 30.0% (n = 12) women and 70.0% (n = 28) men. 40 patients were included in the Dexmedetomidine sedation group: 30.0% (n = 12) women, 70.0% (n = 28) men. RESULTS: There was a statistically significant (p < 0.001) reduction of blood pressure and heart rate in patients in the group of sedation with Dexmedetomidine at the stage of stenting of the coronary artery, compared with analogous parameters in the group of sedation with Phenazepam®. Patients in the group of sedation with Dexmedetomidine developed chest pain at the stage of coronary artery stenting reliably 3.13 times less often (p = 0.024) than patients of the group of sedation with Phenazepam® (OR: 0.32; 95% CI: 0.13–0.80). With use of Dexmedetomidine, relief of anginal pain with narcotic analgesics was required 20 times less often (p < 0.001) than with Phenazepam® (OR: 0.05; 95% CI: 0.01–0.38). One can confidently speak about the superiority and safety of analgosedation with Dexmedetomidine in planned percutaneous coronary interventions over sedation with Phenazepam®. CONCLUSIONS: Dexmedetomidine provides deeper sedation and sufficient pain relief in patients in planned percutaneous coronary interventions than Phenazepam®. At the same time, Dexmedetomidine has a more pronounced hypotensive and a negative chronotropic effect.

The optimal method of anesthetic management in percutaneous coronary interventions (PCI) is procedural analgosedation that in most cases is provided by the combination of benzodiazepine and an opioid analgesic. However, there are no protocols and recommendations for its implementation at this time.The objective: to choose an adequate and safe method of analgosedation for elective endovascular stenting of coronary arteries.Subjects and Methods. A randomized study was conducted from September 2021 to January 2022. The group where analgosedation with fentanyl and sibazon was used included 33 patients. 30 patients were enrolled in the group of analgosedation with dexmedetomidine. A comparison was made in terms of the level of sedation (RASS scale), hemodynamic parameters, blood oxygen saturation (SpO2), the incidence of anginal pain at the stage of stenting and the need for additional analgesia, and the level of serum troponin T.Results. Dexmedetomidine significantly induces a deeper level of sedation (RASS -2) compared to the combination of benzodiazepine and fentanyl (RASS -1) at the stage of intracoronary stent placement (p < 0.001). In the group of analgosedation with dexmedetomidine, there was a statistically significant decrease in blood pressure and heart rate versus the group of analgosedation with fentanyl and sibazon (p < 0.05). Analgesia with narcotic analgesics was required 9.1 times lower (p =0.028) at the stage of installation of intracoronary stents in the group of dexmedetomidine analgosedation versus the group of fentanyl and sibazon analgosedation (OR 0.11; 95% CI 0.13–0.92).Conclusion. Anesthesia for elective percutaneous coronary interventions with dexmedetomidine may be more adequate and safer than the combination of a benzodiazepine and an opioid analgesic. At the stage of coronary artery stenting, dexmedetomidine provides deeper sedation, significant prevention of the development of anginal pain, a pronounced hypotensive and negative chronotropic effect compared to analgosedation with fentanyl and sibazon.

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

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