Summary: In a randomised trial in diabetic patients having off-pump coronary bypass surgery, an intraoperative dexmedetomidine infusion reduced glucose variability, insulin requirements, and CRP compared with saline, with no difference in IL-6.
PICO Summary
| Element | Detail |
|---|---|
| Population | 68 diabetic patients (34 per group) undergoing elective off-pump coronary artery bypass grafting; RCT, India. |
| Intervention | Intraoperative dexmedetomidine infusion at 0.5 µg/kg/h. |
| Comparison | Equal-volume saline infusion. |
| Outcome | Dexmedetomidine reduced glucose variability (14.38 vs 16.44; p=0.042), mean insulin requirement (0.88 vs 1.38 U/h; p=0.001), and CRP at 12 and 24 hours. IL-6 did not differ between groups. No major adverse effects. |
Dexmedetomidine and glucose variability in CABG
RCT · diabetic off-pump CABG · 24 h
Intraoperative dexmedetomidine produced steadier perioperative glucose and lower insulin needs than saline in diabetic off-pump CABG. Endpoints are surrogate, so smoother glucose is shown but hard clinical benefit is not yet proven.
Expert Commentary
This is a coherent, mechanistically grounded trial in a genuinely high-risk setting, since perioperative glucose variability independently predicts poor outcomes after cardiac surgery. The logic is clean: surgical stress drives a sympathetic and counter-regulatory hormone surge that fuels insulin resistance and glucose swings, and a central alpha-2 agonist that dampens that outflow should reduce both, which is what the data show, with steadier glucose and a meaningful drop in insulin requirement. That the effect appeared even in off-pump surgery, which is already less inflammatory than on-pump bypass, is a reasonable point in its favour. I would read it with appropriate restraint: the sample is modest at 68, it is single-centre, and the endpoints are glucose variability and biomarkers rather than hard outcomes such as wound infection, arrhythmia, or length of stay, so clinical benefit is inferred rather than demonstrated. The partial inflammatory signal, lower CRP but unchanged IL-6, fits the differing kinetics of those markers and should not be overinterpreted. Can I use this with my patients? This is primarily an anaesthetic decision, but as a physician co-managing diabetic surgical patients I find it supportive of using dexmedetomidine as one adjunct for smoother perioperative glucose, while keeping standard insulin protocols and a 140 to 180 mg/dL target central and awaiting outcome-powered trials.
References
Goel K, Kohli JK, Shri I, Kalaiselvan J, Sharma LK, Avinash R. Glucose variability in diabetic patients receiving dexmedetomidine during off-pump coronary artery bypass grafting: GV-IN-DEX, a randomised controlled trial. Ann Card Anaesth. 2025;28(4):432–438. doi:10.4103/aca.aca_33_25