Clinical study on the role of dexmedetomidine combined with esmolol in sympathetic electrical storm

Objective To evaluate the inhibition effect of dexmedetomidine combined with esmolol on sympathetic nerve activity in sympathetic electrical storm. Methods A total of 60 patients with sympathetic electrical storm in the Cardiac Internal Care Unit (CCU) of Henan Province People's Hospital from May 2015 to May 2017 were divided into esmolol group (n=30) and dexmedetomidine+ esmolol group (n=30) by random number table. Patients in esmolol group were given a loading dose of 0.5 mg/kg of esmolol for two minutes, followed with continuous intravenous injection of 0.05-0.2 mg·kg-1·min-1. Patients in dexmedetomidine+ esmolol group were given 0.5 mg/kg of esmolol for two minutes, followed with dexmetomidine by intravenous injection of 1 μg·kg-1·10 min-1 and maintenance dose of 0.5 μg·kg-1·h-1. All of the patients were given continuous ECG monitoring to assess the occurrence of sympathetic electrical storm. Hemodynamic changes of cardiac index (CI), extravascular lung water (EVLW) were accessed by pulse indicator continuous cardiac output monitoring (PICCO) method and plasma brain natriuretic peptide (BNP) were recorded for evaluation of the cardiac function. Results After 3-d treatment, the frequency of sympathetic electrical storm was significantly reduced in the dexmedetomidine+ esmolol group compared with the esmolol group [(1.33±0.61) times daily vs. (2.40±0.86) times daily, P=0.040], CI, EVLW and plasma BNP were significantly improved [(4.39±0.70)L·min-1·m-2vs.(3.12±0.17)L·min-1·m-2, P=0.004; (6.38±0.69)ml/kg vs.(7.67±1.03)ml/kg, P=0.037; (2 447.57±461.79)pg/ml vs. (3 637.40±779.59)pg/ml, P=0.045]. Conclusions Dexmedetomidine may effectively inhibit the sympathetic activity. Combined with esmolol may have better effect.