Comparison of the effects of dexmedetomidine and neostigmine on heart rate in robot-assisted thoracoscopic atrial septal defects repair: a randomized controlled trial

Abstract

Background Robot-assisted thoracoscopic repair of atrial septal defect is performed under cardiopulmonary bypass (CPB) and the heart beats without stopping, which requires very high control of perioperative heart rate. Heart rate variability (HRV) refers to small changes in the time between successive cardiac cycles, which can reflect autonomic nervous system activity and provide a quantitative assessment of cardiac sympathetic vagal tone and balance. Methods A total of 40 patients undergoing robot-assisted thoracoscopic surgery for atrial septal defect were randomly assigned to two groups receiving neostigmine or dexmedetomidine. we monitored the changes in heart rate and HRV of neostigmine and dexmedetomidine group at five time periods. Results Perioperative data showed that platelet values in the neostigmine group were higher than those in the dexmedetomidine group before surgery and significantly higher than those in the neostigmine group after surgery. In addition, CPB time of the two groups was also significantly different, with the CPB time of neostigmine group being significantly higher than that of dexmedetomidine group (P < 0.05). The comparison of heart rate showed that both drugs could reduce heart rate during surgery to some extent. Neostigmine was more effective than dexmedetomidine in reducing heart rate after CPB initiation. In the analysis of HRV, the values of LF, HF and LF/HF in the neostigmine group have significant differences than those in the dexmedetomidine group(P < 0.05).In addition, the ASDNN and RMSDD value of dexmedetomidine group was significantly higher than that of Neostigmine group in multiple time periods. Conclusions Prophylactic use of small doses of neostigmine to control heart rate is safe and effective under the condition of a certain depth of anesthesia. It has a better effect on lowering heart rate than dexmedetomidine. In addition, although the autonomic nerve regulation ability of patients in the neostigmine group was decreased, it was still higher than that in the dexmedetomidine group to a certain extent. This confirms the usefulness of Neostigmine in cardiopulmonary bypass non-stop surgery. Trial registration: The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2000036140) on August 21, 2020.