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Moon J, Chun DH, Kong HJ, Lee HS, Jeon S, Park J, Kim NY, Kim HI. The Intraoperative Administration of Dexmedetomidine Alleviates Postoperative Inflammatory Response in Patients Undergoing Laparoscopy-Assisted Gastrectomy: A Double-Blind Randomized Controlled Trial. Biomedicines 2023; 11:3253. [PMID: 38137474 PMCID: PMC10741238 DOI: 10.3390/biomedicines11123253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Surgical stress can compromise the immune system of patients with cancer, affecting susceptibility to perioperative infections, tumor progression, treatment responses, and postoperative recovery. Perioperatively reducing inflammatory responses could improve outcomes. We determined the impact of intraoperative dexmedetomidine administration on the inflammatory response and postoperative recovery in patients undergoing elective laparoscopy-assisted gastrectomy. These patients were randomly assigned to the dexmedetomidine or control group (n = 42 each). The primary endpoint was the C-reactive protein (CRP) level on postoperative day 1. The secondary endpoints included the perioperative interleukin (IL)-6 levels, postoperative numerical rating scale (NRS) scores, and rescue analgesic doses. There were no significant between-group differences in terms of CRP levels. The IL-6 levels at the end of the surgery, NRS scores in the post-anesthesia care unit, and rescue pethidine requirements within the first hour postoperatively were significantly lower in the dexmedetomidine group than in the control group. The bolus deliveries-to-attempts ratio (via patient-controlled analgesia) at 2 h differed significantly between the two groups. However, IL-6 reduction was confined to a single timepoint, and the postoperative analgesic effects lasted for the first 2 h postoperatively. Low-dose dexmedetomidine infusion (0.4 µg kg-1 h-1) during laparoscopy-assisted gastrectomy exerts minimal anti-inflammatory effects.
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Affiliation(s)
- Jiae Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Duk-Hee Chun
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea
| | - Hee Jung Kong
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Soyoung Jeon
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Jooeun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Takahashi K, Yoshikawa Y, Kanda M, Hirata N, Yamakage M. Dexmedetomidine as a cardioprotective drug: a narrative review. J Anesth 2023; 37:961-970. [PMID: 37750978 DOI: 10.1007/s00540-023-03261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
Dexmedetomidine (DEX), a highly selective alpha2-adrenoceptors agonist, is not only a sedative drug used during mechanical ventilation in the intensive care unit but also a cardio-protective drug against ischemia-reperfusion injury (IRI). Numerous preclinical in vivo and ex vivo studies, mostly evaluating the effect of DEX pretreatment in healthy rodents, have shown the efficacy of DEX in protecting the hearts from IRI. However, whether DEX can maintain its cardio-protective effect in hearts with comorbidities such as diabetes has not been fully elucidated. Multiple clinical trials have reported promising results, showing that pretreatment with DEX can attenuate cardiac damage in patients undergoing cardiac surgery. However, evidence of the post-treatment effects of DEX in clinical practice remains limited. In this narrative review, we summarize the previously reported evidence of DEX-induced cardio-protection against IRI and clarify the condition of the hearts and the timing of DEX administration that has not been tested. With further investigations evaluating these knowledge gaps, the use of DEX as a cardio-protective drug could be further facilitated in the management of patients undergoing cardiac surgery and might be considered in a broader area of clinical settings beyond cardiac surgery, including patients with acute myocardial infarction.
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Affiliation(s)
- Kanako Takahashi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan.
| | - Masatoshi Kanda
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Hirata
- Department of Anesthesiology, Kumamoto University, Kumamoto, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
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Peršec J, Šribar A, Ilić M, Mamić I, Kifer D, Domijan AM, Maleš Ž, Turčić P. Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery. Acta Pharm 2023; 73:691-708. [PMID: 38147472 DOI: 10.2478/acph-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
The aim of this study was to compare the effects of dexmedetomidine and dexamethasone as adjuvants to preoperative epidural administration of local anesthetic (ropivacaine) in thoracic surgery on the postoperative level of pain, use of analgesics, inflammation, and oxidative stress. The study enrolled 42 patients who underwent elective thoracic surgery in a one-year period at the University Hospital Dubrava (Zagreb, Croatia). Based on a computer-generated randomization list the patients were assigned to the dexmedetomidine (n = 18) or dexamethasone (n = 24) group. Postoperatively, patients of dexmedetomidine group reported lower pain (VAS value 1 h post surgery, 3.4 ± 2.7 vs. 5.4 ± 1.8, dexmedetomidine vs. dexamethasone, p < 0.01) and had lower anal-gesic requirements in comparison with dexamethasone group. Thus, dexmedetomidine in comparison with dexamethasone was more efficient in lowering pain and analgesia requirements 24 h after the surgery. On the contrary, dexamethasone had better anti-inflammatory properties (CRP level 24 h post surgery, 131.9 ± 90.7 vs. 26.0 ± 55.2 mg L-1, dexmedetomidine vs. dexamethasone, p < 0.01). Both dexmedetomidine and dexamethasone exhibited antioxidant effects, however, their antioxidant properties should be further explored. The results of this study improve current knowledge of pain control in thoracic surgery.
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Affiliation(s)
- Jasminka Peršec
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrej Šribar
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Monika Ilić
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
| | - Ivan Mamić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
| | - Domagoj Kifer
- 4University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Biophysics, Zagreb, Croatia
| | - Ana-Marija Domijan
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Željan Maleš
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Petra Turčić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
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Abbasciano RG, Tomassini S, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Butt A, Lai F, Kumar T, Wozniak MJ, Murphy GJ. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Cochrane Database Syst Rev 2023; 10:CD013584. [PMID: 37873947 PMCID: PMC10594589 DOI: 10.1002/14651858.cd013584.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. OBJECTIVES The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. SEARCH METHODS CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. SELECTION CRITERIA RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. DATA COLLECTION AND ANALYSIS Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I2. MAIN RESULTS A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I2 = 92%) and IL-8 (SMD -0.92, 95% CI -1.20 to -0.65, I2 = 91%) were unclear due to heterogeneity. Heterogeneity for inflammation outcomes persisted across multiple sensitivity and moderator analyses. The pooled treatment effect for in-hospital or 30-day mortality was RR 0.78, 95% CI 0.68 to 0.91, I2 = 0%, suggesting a significant clinical benefit. There was little or no treatment effect on mortality when analyses were restricted to studies at low risk of bias. Post hoc analyses failed to demonstrate consistent treatment effects on inflammation and clinical outcomes. Levels of certainty for pooled treatment effects on the primary outcomes were very low. AUTHORS' CONCLUSIONS A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery.
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Affiliation(s)
| | | | - Marius A Roman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Suraj Pathak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joussi Ramzi
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carla Lucarelli
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ayesha Butt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Yoo SH, Jue MJ, Kim YH, Cho S, Kim WJ, Kim KM, Han JI, Lee H. The Effect of Dexmedetomidine on the Mini-Cog Score and High-Mobility Group Box 1 Levels in Elderly Patients with Postoperative Neurocognitive Disorders Undergoing Orthopedic Surgery. J Clin Med 2023; 12:6610. [PMID: 37892748 PMCID: PMC10607676 DOI: 10.3390/jcm12206610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Dexmedetomidine prevents postoperative cognitive dysfunction by inhibiting high-mobility group box 1 (HMGB1), which acts as an inflammatory marker. This study investigated the HMGB1 levels and the cognitive function using a Mini-Cog© score in elderly patients undergoing orthopedic surgery with dexmedetomidine infusion. In total, 128 patients aged ≥ 65 years were analyzed. The patients received saline in the control group and dexmedetomidine in the dexmedetomidine group until the end of surgery. Blood sampling and the Mini-Cog© test were performed before the surgery and on postoperative days 1 and 3. The primary outcomes were the effect of dexmedetomidine on the HMGB1 levels and the Mini-Cog© score in terms of postoperative cognitive function. The Mini-Cog© score over time differed significantly between the groups (p = 0.008), with an increase in the dexmedetomidine group. The postoperative HMGB1 levels increased over time in both groups; however, there was no significant difference between the groups (p = 0.969). The probability of perioperative neurocognitive disorders decreased by 0.48 times as the Mini-Cog© score on postoperative day 3 increased by 1 point. Intraoperative dexmedetomidine has shown an increase in the postoperative Mini-Cog© score. Thus, the Mini-Cog© score is a potential tool for evaluating cognitive function in elderly patients.
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Affiliation(s)
- Seung Hee Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
| | - Mi Jin Jue
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
| | - Yu-Hee Kim
- Advanced Biomedical Research Institute, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea;
| | - Sooyoung Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
| | - Won-joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul 01757, Republic of Korea;
| | - Jong In Han
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
| | - Heeseung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea; (S.H.Y.); (M.J.J.); (S.C.); (W.-j.K.); (J.I.H.)
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Ferreira LO, Vasconcelos VW, Lima JDS, Vieira Neto JR, da Costa GE, Esteves JDC, de Sousa SC, Moura JA, Santos FRS, Leitão Filho JM, Protásio MR, Araújo PS, Lemos CJDS, Resende KD, Lopes DCF. Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights. J Pers Med 2023; 13:1506. [PMID: 37888117 PMCID: PMC10608001 DOI: 10.3390/jpm13101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 10/28/2023] Open
Abstract
Patients undergoing coronary revascularization with extracorporeal circulation or cardiopulmonary bypass (CPB) may develop several biochemical changes in the microcirculation that lead to a systemic inflammatory response. Surgical incision, post-CPB reperfusion injury and blood contact with non-endothelial membranes can activate inflammatory signaling pathways that lead to the production and activation of inflammatory cells, with cytokine production and oxidative stress. This inflammatory storm can cause damage to vital organs, especially the heart, and thus lead to complications in the postoperative period. In addition to the organic pathophysiology during and after the period of exposure to extracorporeal circulation, this review addresses new perspectives for intraoperative treatment and management that may lead to a reduction in this inflammatory storm and thereby improve the prognosis and possibly reduce the mortality of these patients.
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Affiliation(s)
- Luan Oliveira Ferreira
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil
| | - Victoria Winkler Vasconcelos
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Janielle de Sousa Lima
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jaime Rodrigues Vieira Neto
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Giovana Escribano da Costa
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jordana de Castro Esteves
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Sallatiel Cabral de Sousa
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jonathan Almeida Moura
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Felipe Ruda Silva Santos
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - João Monteiro Leitão Filho
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | | | - Pollyana Sousa Araújo
- Department of Cardiovascular Anesthesiology, Hospital Clínicas Gaspar Vianna, Belém 66083-106, Brazil; (P.S.A.); (C.J.d.S.L.)
| | - Cláudio José da Silva Lemos
- Department of Cardiovascular Anesthesiology, Hospital Clínicas Gaspar Vianna, Belém 66083-106, Brazil; (P.S.A.); (C.J.d.S.L.)
| | - Karina Dias Resende
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Dielly Catrina Favacho Lopes
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil
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Anastasiadis K, Antonitsis P, Murkin J, Serrick C, Gunaydin S, El-Essawi A, Bennett M, Erdoes G, Liebold A, Punjabi P, Theodoropoulos KC, Kiaii B, Wahba A, de Somer F, Bauer A, Kadner A, van Boven W, Argiriadou H, Deliopoulos A, Baker RΑ, Breitenbach I, Ince C, Starinieri P, Jenni H, Popov V, Moorjani N, Moscarelli M, Di Eusanio M, Cale A, Shapira O, Baufreton C, Condello I, Merkle F, Stehouwer M, Schmid C, Ranucci M, Angelini G, Carrel T. 2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery. Perfusion 2023; 38:1360-1383. [PMID: 35961654 DOI: 10.1177/02676591221119002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care.
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Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - John Murkin
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Cyril Serrick
- Department of Perfusion, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Aschraf El-Essawi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mark Bennett
- Department of Anesthesia, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andreas Liebold
- Department of Cardio-thoracic Surgery, University Hospital Ulm, Ulm, Germany
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Health, Sacramento, CA, USA
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway and Department of Circulation and Medical Imaging, University of Science and Technology, Trondheim, Norway
| | - Filip de Somer
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Adrian Bauer
- Department of Cardiovascular Perfusion, MediClin Heart Center, Coswig, Saxony-Anhalt, Germany
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | | | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Robert Α Baker
- Cardiothoracic Surgery Quality and Outcomes, and Perfusion, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Ingo Breitenbach
- Department of Thoracic and Cardiovascular Surgery, Braunschweig Clinic, Braunschweig, Germany
| | - Can Ince
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Hansjoerg Jenni
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | - Vadim Popov
- Department of Cardio-Vascular Surgery, Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | - Marco Moscarelli
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Marco Di Eusanio
- Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alex Cale
- Department of Cardiac Surgery, Hull and East Yorkshire Hospitals NHS Trust, UK
| | - Oz Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ignazio Condello
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Frank Merkle
- Academy for Perfusion, German Heart Institute Berlin, Berlin, Germany
| | - Marco Stehouwer
- Department of Clinical Perfusion, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianni Angelini
- Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Thierry Carrel
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
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Wang L, Xiao L, Hu L, Chen X, Wang X. Development and validation of a nomogram for predicting intraoperative hypotension in cardiac valve replacement. Biomark Med 2023; 17:849-858. [PMID: 38214145 DOI: 10.2217/bmm-2023-0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background: Cardiac valve replacement risks include intraoperative hypotension, endangering organ perfusion. Our nomogram predicted hypotension risk in valve surgery, guiding early intervention. Methods: Analyzing 561 patients from July to November 2022, we developed a nomogram to predict hypotension in valve replacement patients, validated using data from December 2022 to January 2023 on 241 patients, with robust statistical confirmation. Results: Our study identified age, hypertension, left ventricular ejection fraction and serum creatinine as hypotension predictors. The resulting nomogram, validated with high concordance index and area under the curve scores, provided a clinically useful tool for managing intraoperative risk. Conclusion: For valve replacement patients, factors like age, hypertension, low left ventricular ejection fraction and high serum creatinine predicted hypotension risk. Our nomogram enabled clinicians to quantify this risk and proactively manage it.
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Affiliation(s)
- Lei Wang
- Department of Thoracic & Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liqiong Xiao
- Department of Thoracic & Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lanyue Hu
- Department of Thoracic & Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Thoracic & Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoliang Wang
- Department of Thoracic & Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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9
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Huang X, He C. The efficacy of dexmedetomidine for septic shock: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34414. [PMID: 37657031 PMCID: PMC10476718 DOI: 10.1097/md.0000000000034414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/29/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The efficacy of dexmedetomidine was elusive for septic shock. This meta-analysis aimed to explore the efficacy of dexmedetomidine for septic shock. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases have been searched through October 2022 and we included randomized controlled trials reporting the effect of dexmedetomidine in patients with septic shock. RESULTS Five randomized controlled trials were included in the meta-analysis. Compared with control group for septic shock, dexmedetomidine treatment was able to substantially decrease Sequential Organ Failure Assessment score (mean difference [MD] = -0.99; 95% confidence interval [CI] = -1.14 to -0.84; P < .00001) and duration of mechanical ventilation (MD = -0.90; 95% CI = -1.27 to -0.54; P < .00001), but showed no obvious influence on morality at 28 days (odds ratio = 0.79; 95% CI = 0.38 to 1.66; P = 054), hospital mortality (odds ratio = 0.66; 95% CI = 0.35 to 1.24; P = .20) or intensive care unit length of stay (MD = -1.47; 95% CI = -4.60 to 1.66; P = .36). CONCLUSIONS Dexmedetomidine administration may help treat patients with septic shock.
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Affiliation(s)
- Xue Huang
- Department of Critical Care, North Kuanren Hospital, Chongqing, China
| | - Chunyan He
- Department of Critical Care, North Kuanren Hospital, Chongqing, China
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10
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Di Franco C, Evangelista F, Briganti A. Multiple uses of dexmedetomidine in small animals: a mini review. Front Vet Sci 2023; 10:1135124. [PMID: 37342619 PMCID: PMC10278766 DOI: 10.3389/fvets.2023.1135124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Dexmedetomidine is an alpha-2 adrenergic agonist, which use had an exponential increase in human and veterinary medicine in the last 10 years. The aim of this mini review is to summarize the various uses of dexmedetomidine underlining its new applications and capabilities in the small animals' clinical activity. While this drug was born as sedative in veterinary medicine, some studies demonstrated to be effective as an analgesic both in single administration and in continuous infusion. Recent studies have also shown the role of dexmedetomidine as an adjuvant during locoregional anesthesia, increasing the duration of the sensitive block and consequently decreasing the demand for systemic analgesics. The various analgesic properties make dexmedetomidine an interesting drug for opioid-free analgesia. Some studies highlighted a potential neuroprotective, cardioprotective and vasculoprotective role of dexmedetomidine, thus conferring it a place in critical care medicine, such as trauma and septic patients. Dexmedetomidine has demonstrated to be a multitasking molecule and it is ready to face new challenges.
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Affiliation(s)
- Chiara Di Franco
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Flavia Evangelista
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
- Vet Hospital H24, Firenze, Italy
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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11
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Poon WH, Ling RR, Yang IX, Luo H, Kofidis T, MacLaren G, Tham C, Teoh KLK, Ramanathan K. Dexmedetomidine for adult cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 2023; 78:371-380. [PMID: 36535747 DOI: 10.1111/anae.15947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
The effects of dexmedetomidine in adults undergoing cardiac surgery are inconsistent. We conducted a systematic review and meta-analysis to analyse the effects of peri-operative dexmedetomidine in adults undergoing cardiac surgery. We searched MEDLINE via Pubmed, EMBASE, Scopus and Cochrane for relevant randomised controlled trials between 1 January 1990 and 1 March 2022. We used the Joanna Briggs Institute methodology checklist to assess study quality and the GRADE approach to certainty of evidence. We assessed the sensitivity of results to false data. We used random-effects meta-analyses to analyse the primary outcomes: durations of intensive care and tracheal intubation. We included 48 trials of 6273 participants. Dexmedetomidine reduced the mean (95%CI) duration of intensive care by 5.0 (2.2-7.7) h, p = 0.001, and tracheal intubation by 1.6 (0.6-2.7) h, p = 0.003. The relative risk (95%CI) for postoperative delirium was 0.58 (0.43-0.78), p = 0.001; 0.76 (0.61-0.95) for atrial fibrillation, p = 0.015; and 0.49 (0.25-0.97) for short-term mortality, p = 0.041. Bradycardia and hypotension were not significantly affected. Trial sequential analysis was consistent with the primary meta-analysis. Adjustments for possible false data reduced the mean (95%CI) reduction in duration of intensive care and tracheal intubation by dexmedetomidine to 3.6 (1.8-5.4) h and 0.8 (0.2-1.4) h, respectively. Binary adjustment for methodological quality at a Joanna Briggs Institute score threshold of 10 did not alter the results significantly. In summary, peri-operative dexmedetomidine reduced the durations of intensive care and tracheal intubation and the incidence of short-term mortality after adult cardiac surgery. The reductions in intensive care stay and tracheal intubation may or may not be considered clinically useful, particularly after adjustment for possible false data.
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Affiliation(s)
- W H Poon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R R Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - I X Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - H Luo
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore
| | - T Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore
| | - G MacLaren
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore
| | - C Tham
- Department of Anesthesiology, National University Hospital, Singapore
| | - K L K Teoh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore
| | - K Ramanathan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore
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Kumar A, Ghotra GS, Dwivedi D, Bhargava DV, Joshi A, Tiwari N, Ramamurthy HR. Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A Randomized Controlled Study. World J Pediatr Congenit Heart Surg 2023; 14:334-344. [PMID: 36823972 DOI: 10.1177/21501351221151053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background: High thoracic epidural analgesia (HTEA) plays a pivotal role in reducing stress and neuroendocrine response in cardiac surgeries. Aim: The primary objective is to assess the effect of HTEA, in pediatric cardiac surgery, on inflammatory markers (interleukin [IL]-6, IL-8, and tumor necrosis factor-α). The secondary objectives are to assess its effect on various organ systems, that is, pulmonary (PaO2, P/F ratio), renal (Creatinine clearance, somatic near infrared spectroscopy [NIRS], serum neutrophil gelatinase-associated lipocalin values), cardiac (cardiac index, serum Trop-I, and lactate levels), mechanical ventilation duration, and length of stay in hospital (LOS). Methods: The study included 188 pediatric patients, who underwent, on-pump cardiac surgery randomized into the Epidural Group (n = 92) and Non-Epidural Group (n = 96). After general anesthesia, a 23 G epidural catheter was placed at the T4-5 level with a Bupivacaine infusion while the Non-epidural Group received fentanyl infusion. Blood samples were collected at four-time points, T0(preop), T1(4 h), and on the first and second postoperative days (T2 and T3). Results: The inflammatory markers were reduced, while the outcomes variables of mechanical ventilation (MV) duration had lower values in the epidural group (19.5 h vs 47.3 h, P = .002). LOS was shorter (10.1 days vs 13.3 days, P = .016). pO2, PF ratio, and renal NIRS values were better in the Epidural Gp, while other parameters were comparable. Non-epidural Gp had more complications esp. Acute kidney injury requires RRT. Conclusion: HTEA use in pediatric, on-pump cardiac surgery offers a favorable profile in terms of reduction in the inflammatory markers and positive effect on the organ systems with lesser MV duration and the LOS.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia & Critical Care, 521937Army Hospital (Research & Referral), New Delhi, India
| | - Gurpinder Singh Ghotra
- Department of Anaesthesia & Critical Care, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Deepak Dwivedi
- Department of Anaesthesia & Critical Care, Department of Anaesthesia & Critical Care, 30154Command Hospital (Eastern command), Kolkata, India
| | - D V Bhargava
- Department of Anaesthesia & Critical Care, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Ankur Joshi
- Department of Anaesthesia & Critical Care, 521937Army Hospital (Research & Referral), New Delhi, India
| | - Nikhil Tiwari
- Department of Cardiothoracic Surgery, 521937Army Hospital (Research & Referral), New Delhi, India
| | - H R Ramamurthy
- Department of Paediatrics, 521937Army Hospital (Research & Referral), New Delhi, India
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13
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Xiao M, Jiang CF, Gao Q, Pan J, Zhang H, Wu SN, Dou MS. Effect of Dexmedetomidine on Cardiac Surgery Patients. J Cardiovasc Pharmacol 2023; 81:104-13. [PMID: 36607614 DOI: 10.1097/FJC.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023]
Abstract
ABSTRACT Dexmedetomidine, an alpha-2 adrenoreceptor agonist that is widely used as a sedative medication, is becoming more and more attractive in clinical application on cardiac surgery patients. In this review, we aim to summarize and discuss both retrospective studies and clinical trials regarding the effect of dexmedetomidine on patients who underwent cardiac surgery (including coronary artery bypass grafting, valve surgery, aortic surgery, percutaneous coronary intervention, and so on), which illustrates that the clinical effects of dexmedetomidine could effectively reduce mortality, major complications, and the intensive care unit and hospital length of stay without comprising safety. In addition, inconsistent results from both retrospective studies and clinical trials have also been demonstrated. Although the effectiveness and safety of dexmedetomidine on cardiac surgery patients is suggested, high-quality clinical trials are needed for further verification.
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14
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Dong A, Zhang Y, Lu S, Yu W. Influence of Dexmedetomidine on Myocardial Injury in Patients with Simultaneous Pancreas-Kidney Transplantation. Evid Based Complement Alternat Med 2022; 2022:7196449. [PMID: 36437830 PMCID: PMC9691300 DOI: 10.1155/2022/7196449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 09/09/2023]
Abstract
Background Diabetes is one of the most common chronic diseases in the world. End-stage renal disease (ESRD) caused by diabetes is the most serious long-term complication. The main cause of death in patients with simultaneous pancreas-kidney transplantation (SPKT) is cardiovascular disease. Although dexmedetomidine (Dex) has unique advantages in heart protection against ischaemic/reperfusion injury, few clinical studies have been conducted on its cardioprotective effect in SPKT. This study aimed to explore the influence of Dex on myocardial injury in patients undergoing SPKT and to analyze its possible mechanism. Methods A randomized controlled trial (RCT) was performed from July 1, 2018 to December 1, 2020. Eighty patients, regardless of gender, scheduled for SPKT were randomly allocated into a Dex group (D group) receiving Dex at a rate of 1 µg/kg for 10 minutes before anaesthesia induction and then continuous infusion at 0.5 µg/kg/hour until the end of surgery and control group (C group) receiving equivalent capacity of saline. Serum cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), tumour necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were recorded at 5 minutes after anaesthesia induction (baseline,T0), 5 minutes before renal arteriovenous opening (T1), 30 minutes after renal arteriovenous opening (T2), 30 minutes after pancreatic related arteriovenous opening (T3), immediately after surgery (T4), 4 hours after surgery (T5), and 24 hours after surgery (T6). Adverse cardiovascular events were recorded during the perioperative period. Changes in ECG S-T segments and T waves were monitored at T0-T6. Myocardial infarction and percutaneous coronary intervention were recorded with an average follow-up of one year. Results Compared with T0, TNF-α and IL-6 concentrations significantly increased at T1-T6 in the C and D groups (P < 0.05). IL-6 concentration increased significantly after renal artery opening and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, TNF-α, and IL-6 concentrations were significantly reduced in group D at T2-T6 (P < 0.05). Compared with T0, cTnI and CK-MB concentrations were significantly increased at T3-T6 in the C and D groups (P < 0.05). cTnI and CK-MB concentrations increased significantly after the opening of renal artery, and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, cTnI and CK-MB concentrations were significantly reduced in the D group at T3-T6 (P < 0.05). There was no significant difference in patient characteristics amongst groups, including the proportion of intraoperative vasoactive drug use and adverse cardiovascular events during the follow-up period. Heart rate, mean blood pressure, central venous pressure, and cardiac output were not remarkably different between the two groups at any time point. Conclusions Perioperative reperfusion could aggravate myocardial injury in SPKT. Dex may be considered a way to reduce myocardial injury caused by inflammatory action by decreasing the release of inflammatory factors. Trial Registration Number: Chinese Clinical Trial Registry ID: ChiCTR2200060084.
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Affiliation(s)
- Aili Dong
- Tianjin First Center Hospital, Tianjin 300192, China
| | - Yajing Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Shujun Lu
- Tianjin First Center Hospital, Tianjin 300192, China
| | - Wenli Yu
- Tianjin First Center Hospital, Tianjin 300192, China
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15
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Gao S, Ma G, Zhou L, Guan S, Zhang J. Effects of Dexmedetomidine Pretreatment, Posttreatment, and Whole-Course Pumping on Myocardial Damage during Cardiac Valve Replacement. Int Heart J 2022; 63:837-842. [DOI: 10.1536/ihj.22-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shenqiang Gao
- Department of Anesthesia, Tai'an City Central Hospital
| | - Guifen Ma
- Department of Anesthesia, Tai'an City Central Hospital
| | - Lina Zhou
- Department of Anesthesia, Tai'an City Central Hospital
| | - Shanhui Guan
- Department of Anesthesia, Tai'an City Central Hospital
| | - Jinjun Zhang
- Taishan Sanatorium and Hospital of Shandong Province
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Abstract
BACKGROUND The usefulness of ultra-fast track cardiac anaesthesia may give great benefits to patients; however, its usefulness has not been completely evaluated in infants and toddlers, who are generally considered the most difficult group for ultra-fast track cardiac anaesthesia. METHOD A total of 130 children were allocated randomly into to a ultra-fast track cardiac anaesthesia group (Group D) or a conventional anaesthesia group (Group C) (each n = 65). In Group D, dexmedetomidine was administrated at a dosage of 1 µg/kg/hour after induction. The patient- controlled intravenous analgesia was dexmedetomidine and sufentanil. In Group C, patients were infused with of the same volume of normal saline, and sufentanil alone for patient-controlled intravenous analgesia. The dosages of sufentanil, extubation time, haemodynamic parameters, postoperative hospitalisation conditions, pain and sedation scores, blood gas analysis, and inotropic scores were all recorded. RESULTS The dosage of sufentanil (1.49 ± 0.05 vs. 3.81 ± 0.04 µg, p < 0.001) and extubation time (2.63 ± 0.52 vs. 436.60 ± 22.19 minutes, p < 0.001) in Group D were all significantly lower than those in Group C. Moreover, cardiac intensive care unit stay time, total hospital stay, hospitalisation costs, postoperative lactate levels, and inotropic scores were also significantly lower in Group D. CONCLUSIONS Using of ultra-fast track cardiac anaesthesia in infants and toddlers is effective, it not only reduce the perioperative requirement for opioids and shorten the extubation time but also decreases the inotrope requirement and provide a better postoperative condition for young children.
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17
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Lee J, Hwang HW, Jeong JY, Kim YM, Park C, Kim JY. The Effect of Low-Dose Dexmedetomidine on Pain and Inflammation in Patients Undergoing Laparoscopic Hysterectomy. J Clin Med 2022; 11:2802. [PMID: 35628926 PMCID: PMC9147550 DOI: 10.3390/jcm11102802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
Dexmedetomidine has sedative, sympatholytic, analgesic, and anti-inflammatory effects. We investigated the effects of intraoperative dexmedetomidine infusion without a loading dose in the prevention of pain and inflammation after laparoscopic hysterectomy. In this study, 100 patients undergoing laparoscopic hysterectomy under desflurane anesthesia were randomized to receive either 0.9% saline or dexmedetomidine (0.4 μg/kg/h) after induction to trocar removal. The primary endpoints were postoperative pain and inflammatory response presented by the level of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10, and C-reactive protein (CRP). The secondary endpoints were hemodynamics during the anesthesia and surgery and postoperative nausea and vomiting. Postoperative pain was decreased in the dexmedetomidine group for every time point, and post-anesthesia care unit (PACU) rescue fentanyl doses were decreased in the dexmedetomidine group. The inflammatory response representing TNF-α, IL-6, IL-10, and CRP were similar across the two groups. Postoperative nausea and vomiting from PACU discharge to 24 h post-surgery were reduced in the dexmedetomidine group. During anesthesia and surgery, the patient's heart rate was maintained lower in the dexmedetomidine-receiving group. Dexmedetomidine of 0.4 μg/kg/h given as an intraoperative infusion significantly reduced postoperative pain but did not reduce the inflammatory responses in patients undergoing laparoscopic hysterectomy.
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Affiliation(s)
- Jiyoung Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea; (J.L.); (H.W.H.); (C.P.)
- Department of Medical Sciences, Graduate School of Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Korea
| | - He Won Hwang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea; (J.L.); (H.W.H.); (C.P.)
| | - Ju-Yeon Jeong
- CHA Future Medical Research Institute, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea;
| | - Yong Min Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea;
| | - Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea; (J.L.); (H.W.H.); (C.P.)
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Korea
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Singh A, Broad J, Brenna CTA, Kaustov L, Choi S. The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Surg Open 2022; 3:e130. [PMID: 37600088 PMCID: PMC10431438 DOI: 10.1097/as9.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this review is to examine the effect of dexmedetomidine on delayed neurocognitive recovery (dNCR; cognitive dysfunction ≥1 week postoperative) after major noncardiac surgery. Background Dexmedetomidine (DEX) effectively reduces delirium in the intensive care unit and reportedly attenuates cognitive decline following major noncardiac surgery. Ascertaining the true effect on postoperative cognition is difficult because studies are limited by suboptimal selection of cognitive assessment tools, timing of testing, and criteria for defining significant cognitive decline. Methods Prospective randomized trials comparing perioperative DEX to placebo for major noncardiac surgery assessing cognitive function ≥1 week postoperative were included. Pediatric, nonhuman, and non-English trials, and those where executive function was not assessed were excluded. Data were abstracted by 3 reviewers independently and in parallel according to PRISMA guidelines. The a priori binary primary outcome is dNCR defined as cognitive function declining by the minimal clinically important difference or accepted alternate measure (eg, Reliable Change Index ≥1.96). Bias was assessed with the Cochrane Collaboration tool. Data were pooled using a random effects model. Results Among 287 citations identified, 26 (9%) met criteria for full-text retrieval. Eleven randomized trials (1233 participants) were included for qualitative analysis, and 7 trials (616 participants) were included for meta-analysis of dNCR. Dexmedetomidine did not reduce the incidence of dNCR significantly (OR 0.57, 95% CI 0.30-1.10, P = 0.09) compared with placebo. There was no difference in the incidence of delirium (OR 0.94, 95% CI 0.55-1.63, P = 0.83) and a higher incidence of hemodynamic instability (OR 2.11, 95% CI 1.22-3.65, P = 0.008). Conclusions Dexmedetomidine does not reduce dNCR 1 week after major noncardiac surgery. This meta-analysis does not yet support the use of perioperative DEX to improve short term cognitive outcomes at this time; trials underway may yet change this conclusion while larger trials are needed to refine the point estimate of effect and examine long-term cognitive outcomes.
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Affiliation(s)
- Amara Singh
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jeremy Broad
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Connor T. A. Brenna
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Lilia Kaustov
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Stephen Choi
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Perioperative Brain Health Centre, Sunnybrook Research Institute, Toronto, ON, Canada
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Miao J, Cai M, Sun J, Gu Y, Du B. Protective effect of dexmedetomidine on lung injury during one-lung ventilation in elderly patients undergoing radical esophagectomy. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20827x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
| | | | | | - Yi Gu
- Nantong University, China
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Chen M, Li X, Mu G. Myocardial protective and anti-inflammatory effects of dexmedetomidine in patients undergoing cardiovascular surgery with cardiopulmonary bypass: a systematic review and meta-analysis. J Anesth 2021; 36:5-16. [PMID: 34342722 PMCID: PMC8330189 DOI: 10.1007/s00540-021-02982-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
Cardiopulmonary bypass (CPB) technology provides potential for cardiac surgery, but it is followed by myocardial injury and inflammation related to ischemia–reperfusion. This meta-analysis aimed to systematically evaluate the cardioprotective effect of dexmedetomidine on cardiac surgery under CPB and its effect on accompanied inflammation. PubMed, Cochrane Library, EMBASE and Web of Science databases were comprehensively searched for all randomized controlled trials (RCTs) published before April 1st, 2021 that explored the application of dexmedetomidine in cardiac surgery. Compared with the control group (group C), the concentrations of CK-MB in the perioperative period and cTn-I at 12 h and 24 h after operation in dexmedetomidine group (group D) were significantly decreased (P < 0.05). In addition, in group D, the levels of interleukin-6 at 24 h after operation, tumor necrosis factor-a at the 12 h and 24 h after operation were significantly decreased (P < 0.05). At the same time, the length of Intensive Care Unit stay in group D was significantly shorter than group C (P < 0.05). However, there was no significant difference in interleukin-10 level, C reactive protein level, the time on ventilator and length of hospital stay between the two groups (P > 0.05). The application of dexmedetomidine in cardiac surgery with CPB can reduce CK-MB and cTn-I concentration and interleukin-6, tumor necrosis factor-α levels to a certain extent and shorten the length of Intensive Care Unit stay, but it has no significant effect on IL-10 level, C reactive protein level, the time on ventilator and length of hospital stay.
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Affiliation(s)
- Milian Chen
- Department of Anesthesiology, Shehong People's Hospital, NO. 19, Guanghan road, Shehong, 629200, Sichuan, People's Republic of China.
| | - Xia Li
- Department of Anesthesiology, Shehong People's Hospital, NO. 19, Guanghan road, Shehong, 629200, Sichuan, People's Republic of China
| | - Guo Mu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China
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Moon J, Yoo YC, Kim MH, Jeon S, Joo HJ, Chun DH, Kim NY. Administration of Low-Dose Dexmedetomidine Did Not Affect Acute Inflammatory Response after Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy: A Double-Blind Randomized Controlled Trial. J Clin Med 2021; 10:3145. [PMID: 34300310 DOI: 10.3390/jcm10143145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
During cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), attenuation of inflammatory responses that increase susceptibility to postoperative complications, morbidity, and mortality is important. We aimed to evaluate whether intraoperative dexmedetomidine infusion impacted inflammatory response in patients undergoing CRS with HIPEC. Fifty-six patients scheduled for CRS with HIPEC were randomly assigned to the control (n = 28) and dexmedetomidine (n = 28) groups. The primary endpoint was the effect of dexmedetomidine on the interleukin-6 (IL-6) level measured at pre-operation (Pre-OP), before HIPEC initiation (Pre-HIPEC), immediately after HIPEC; after the end of the operation; and on postoperative day (POD) 1. In both groups, the IL-6 levels from Pre-HIPEC until POD 1 and the C-reactive protein (CRP) levels on PODs 1, 2, and 3 were significantly higher than the Pre-OP values (all Bonferroni corrected, p < 0.001). However, total differences in IL-6 and CRP levels, based on the mean area under the curve, were not detected between the two groups. The continuous intraoperative infusion of dexmedetomidine (0.4 μg/kg/h) in patients undergoing CRS with HIPEC did not significantly lower the inflammatory indices. Further dose investigative studies are needed to find the dexmedetomidine dose that provides anti-inflammatory and sympatholytic effects during HIPEC.
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Shah K. Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1724147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThe standard goals of anesthetic management for an off pump coronary artery bypass (OPCAB) surgery are that it should be safe, provide cardiac and other organ protection and stability, preserve neurocognitive integrity, maintain hemodynamics, allow early emergence and ambulation, and offer pain relief in the postoperative period. The cardiac surgical team should collaborate and plan the best preoperative strategy, so as to provide optimal care and a rapid and expeditious recovery of these patients. Scientific evidence and practical experience make total intravenous anesthesia (TIVA) the recommended choice for cardiac surgery. Use of endotracheal tube (ETT) is associated with certain drawbacks which can be overcome with judicious use of ProSeal laryngeal mask airway (PLMA) for cardiac surgeries too. The core principles of ultrafast track anesthetic (UFTA) technique are choice and titration of short-acting anesthetic drugs, postoperative normothermia, multimodal analgesia, early extubation, ambulation, and discharge. Fast tracking with use of TIVA and PLMA in patients undergoing OPCAB at our center offers certain advantages over other techniques in terms of reduced airway and lung trauma, improved cardiac output and renal perfusion with spontaneous respiration, decreased stress and discomfort of ETT suctioning and weaning from ventilation, substantially reduced requirement of dosages of analgesics, anesthetics and opioids, resulting in better patient hemodynamics, alert and pain-free patient that are more amenable and cooperative for early feeds, postoperative chest physiotherapy and lung recruitment strategies, and early ambulation and discharge.
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Affiliation(s)
- Kalpana Shah
- Cardiac Anaesthesiologist, Breach Candy Hospital, Mumbai, India
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Choudhury M. Total Intravenous Anesthesia for Myocardial Protection and Preconditioning. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1723932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractPerioperative myocardial injury is common after any major surgical procedure even with best possible anesthesia and surgical management. Organ preservation during surgical procedure prevents morbidity and mortality. The effect of ischemic preconditioning on myocardial as well as other organ protection is well known. A variety of other agents also shown to have preconditioning thus protective effect on myocardium during anesthesia and surgery. The beneficial effect of volatile anesthetic preconditioning is well studied. However, the effect of intravenous anesthetic agents on this context is still way to go. This review is an attempt to look into the latest available research regarding the preconditioning and myocardial protective effect of intravenous anesthetic agents.
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Affiliation(s)
- Minati Choudhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Zhou H, Zhou D, Lu J, Wu C, Zhu Z. Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on Cardiac Injuries and the Inflammatory Response in Valve Replacement Surgery With a Sevoflurane Postconditioning Protocol: A Pilot Study. J Cardiovasc Pharmacol 2019; 74:91-7. [PMID: 31356535 DOI: 10.1097/FJC.0000000000000698] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Preventing myocardial ischemia–reperfusion injury in on-pump cardiac surgeries remains an enormous challenge. Sevoflurane postconditioning has been effective at overcoming this challenge by modulating inflammatory mediators and ameliorating antioxidative stress. Dexmedetomidine (DEX) is a commonly used medication for cardiac patients with organ-protective properties that lead to positive outcomes. Whether DEX also has cardiac-protective properties and the associated mechanism in sevoflurane postconditioning–based valve replacement surgeries are unknown. Objective: This study was conducted to observe the effect of DEX administration before cardiopulmonary bypass (CPB) on myocardial injury, oxidative stress, and inflammatory response indicators in the peripheral blood. Methods: Twenty-eight eligible cardiac patients who underwent valve replacement surgery with standard sevoflurane postconditioning were included in the study. The patients were randomly divided into a DEX group and a non-DEX group according to whether DEX (0.5-µg/kg overload dose for 10 minutes and a 0.5-μg/kg/h maintenance dose) or saline was administered from induction to the beginning of CPB. The primary outcome was the cardiac troponin I concentration (cTnI) in the blood 24 hours after CPB. The levels of malondialdehyde (MDA), superoxide dismutase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) were also measured. Results: The mean cTnI at 24 hours after CPB was clearly decreased in the DEX group compared with that in the non-DEX group (4.16 ± 1.58 vs. 6.90 ± 3.73, P < 0.05). TNF-α levels were lower in the DEX group after CPB (T1–T5), with a significant difference found at 1–6 hours after CPB (1 hour, 19.03 vs. 28.09; 6 hours, 20.74 vs. 30.94, P < 0.05). The IL-6 and IL-8 concentrations in the DEX group were dramatically increased at 6 hours after CPB (P < 0.05). The MDA content and superoxide dismutase activity were comparable between the 2 groups. A lower proportion of anemia cases were noted after CPB in the DEX group than in the non-DEX group (non-DEX, 10% vs. DEX, 5%, P < 0.05). Conclusions: In valve replacement surgery with sevoflurane postconditioning, pre-CPB administration of DEX can reduce the cTnI level at 24 hours after CPB and brings synergic benefits of the inflammatory response.
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Wu H, Tang J, Pan J, Han M, Cai H, Zhang H. Effects of dexmedetomidine on stress hormones in patients undergoing cardiac valve replacement: a randomized controlled trial. BMC Anesthesiol 2020; 20:142. [PMID: 32505177 PMCID: PMC7275125 DOI: 10.1186/s12871-020-00993-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Stress response always occurs in cardiac valve replacement patients undergoing cardiopulmonary bypass (CPB). Methods 60 patients undergoing cardiac valve replacement were recruited and randomized into control and Dex groups. Dex group received 1.0 μg·kg-1 of Dex for 10 min intravenously before anesthesia, followed by 0.5 μg·kg-1·h-1 of Dex, steadily administered throughout the procedure. And controlled group received the identical velocity of saline as Dex group. Plasma level of cortisol (Cor), epinephrine (E), norepinephrine (NE), and serotonin (5-HT) were evaluated at four timepoints: Before administration (T0), sawn sternum (T1), end of extracorporeal circulation (T2), and 24 h post operation (T3). General data of operation and recovery such as heart rate (HR), mean arterial pressure (MAP), intraoperative bispectral index (BIS), and hospitalization time in the intensive care unit (ICU) were also compared. Results Increase of Cor, E, NE, and 5-HT for the Dex group was significant lesser than that in the control group (P < 0.05), and ICU hospitalization time and ventilator support time was significantly shorter in the Dex group. The proportion of patients discharged from the hospital with better prognosis was significantly higher than that in the control group, while there were no significant differences in hospitalization costs and vasoactive drugs use between the two groups. Conclusions Dex reduces plasma Cor, E and NE elevations in patients after CPB, alleviates the stress reaction of the body, shortens the hospitalization time and ventilator support time in ICU, and plays a positive role in the rehabilitation of patients undergoing cardiac valve replacement. Trial registration China Clinical Trial Registry (No. ChiCTR-IPR-17010954) March 22rd, 2017.
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Affiliation(s)
- Hanhua Wu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, 563003, Guizhou Province, China
| | - Jinqing Tang
- Department of Anesthesiology, Third Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou Province, China
| | - Jiamei Pan
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, 563003, Guizhou Province, China
| | - Ming Han
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, 563003, Guizhou Province, China
| | - Huijun Cai
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, 563003, Guizhou Province, China
| | - Hong Zhang
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, 563003, Guizhou Province, China.
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Pan S, Chen Y, Zhang X, Xie Y. The JAK2/STAT3 pathway is involved in dexmedetomidine-induced myocardial protection in rats undergoing cardiopulmonary bypass. Ann Transl Med 2020; 8:483. [PMID: 32395527 PMCID: PMC7210156 DOI: 10.21037/atm.2020.03.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Many studies have reported that dexmedetomidine protects organs from ischemia/reperfusion-induced injury. However, the mechanism of this protective effect remains inconclusive. Methods Rats were randomly divided into 6 groups (n=8). Rats in the sham group were not subjected to cardiopulmonary bypass (CPB) while rats in the other groups underwent CPB for 2 h. Groups L and H received a low and a high dose of dexmedetomidine, respectively. Rats in group AG490 received 10 mg/kg of the Janus kinase 2 (JAK2) inhibitor, AG490, 30 min before anesthesia. Plasma levels of the inflammatory cytokines, interleukin (IL)-6 and IL-10, were measured by enzyme-linked immunosorbent (ELISA), and the apoptosis rate of myocardial cells, the expression of JAK2 and signal transducer and activator of transcription (STAT)3 mRNA, and the protein expression of JAK2, STAT3, pJAK2, pSTAT3, and caspase-3 were analyzed in myocardial tissues by real-time quantitative polymerase chain reaction (qRT-PCR), western blotting, and immunohistochemistry. Results We observed that, in both group L and group H, the level of IL-6 decreased (P<0.05), and the apoptosis rate of myocardial cells were reduced (P<0.05) compared to those in the CPB group. Moreover, qRT-PCR results revealed that dexmedetomidine administration reduced the expression of JAK2 and STAT3 mRNA (P<0.05); pJAK2 and pSTAT3 (P<0.05) protein levels were also reduced as assessed by western blotting and immunohistochemistry (P<0.05). Conclusions Dexmedetomidine treatment reduced CPB-related myocardial injury by inhibiting inflammatory reactions and myocardial apoptosis, and can be a potential therapy in CPB-related surgery.
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Affiliation(s)
- Sining Pan
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yanhua Chen
- Department of Anesthesiology of Cardiovascular Institute, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xu Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Yubo Xie
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Alhayyan A, McSorley S, Roxburgh C, Kearns R, Horgan P, McMillan D. The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surg Open Sci 2020; 2:1-21. [PMID: 32754703 PMCID: PMC7391900 DOI: 10.1016/j.sopen.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. METHODS This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. RESULTS Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12-24 and 24-72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein (P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. CONCLUSION There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.
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Affiliation(s)
- Aliah Alhayyan
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Stephen McSorley
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Campbell Roxburgh
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Department of Anaesthetics, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Paul Horgan
- Institute of Cancer Sciences, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Donald McMillan
- Institute of Cancer Sciences, Department of Surgery, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
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Xiong J, Quan J, Qin C, Wang X, Dong Q, Zhang B. Dexmedetomidine Exerts Brain-Protective Effects Under Cardiopulmonary Bypass Through Inhibiting the Janus Kinase 2/Signal Transducers and Activators of Transcription 3 Pathway. J Interferon Cytokine Res 2019; 40:116-124. [PMID: 31834821 DOI: 10.1089/jir.2019.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Brain injury is a major complication resulted from cardiopulmonary bypass (CPB). Dexmedetomidine (DEX) has potential brain-protective effects; however, the mechanism is unclear. The aim of this study is to investigate the effect of DEX on brain injury in CPB rats and its mechanism. The levels of interleukin-6 (IL-6), interleukin-10 (IL-10), S100β, and neuron-specific enolase (NSE) were measured by enzyme-linked immunosorbent assay. The hippocampus CA1 region in rats was observed by hematoxylin-eosin staining. Western blot and quantitative real-time polymerase chain reaction were performed to detect related proteins and mRNA expressions in the hippocampus tissues. We found that after CPB, the neuron cells in hippocampus CA1 region of rats were randomly arranged, and that the levels of IL-6, IL-10, S100β, NSE, Cleaved Caspase-3, and Bax were upregulated, while Bal-2 level was downregulated. However, after DEX treatment, the neuron cells arranged in an orderly manner, and the levels of IL-6, IL-10, S100β, NSE, Cleaved Caspase-3, and Bax were downregulated, but Bal-2 level was upregulated. DEX suppressed Janus kinase 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) pathway activated by CPB, ameliorated CPB-induced brain injury in rats by reducing inflammatory response, and inhibited neuronal apoptosis. The brain-protective effect of DEX may be related to the inhibition of the activation of JAK2/STAT3 pathway.
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Affiliation(s)
- Jijun Xiong
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Quan
- Department of Neurology, Guilin People's Hospital, Guilin, Guangxi, China
| | - Chaosheng Qin
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaogang Wang
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qinghua Dong
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingdong Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, Ma D. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth 2019; 123:777-794. [DOI: 10.1016/j.bja.2019.07.027] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 01/06/2023] Open
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Abqari S, Kappanayil M, Sudhakar A, Balachandran R, Nair SG, Kumar RK. Common inflammatory markers after cardiac surgery in infants and their relation to blood stream sepsis. Heliyon 2019; 5:e02841. [PMID: 31768439 PMCID: PMC6872838 DOI: 10.1016/j.heliyon.2019.e02841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/15/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background Limited information exists on trends of common inflammatory markers after infant heart surgery and their role in identifying post-operative sepsis. Methods 275 consecutive infants undergoing cardiac surgery (231 with and 44 without Cardiopulmonary Bypass) were studied prospectively. Daily trends (0-4 day post-operative) of leucocyte counts, platelet counts and C-reactive protein were recorded. Association of these trends with early post-operative bloodstream sepsis, Cardiopulmonary Bypass and surgical outcomes were studied. Observations Trends of these inflammatory markers were noted. While off-Cardiopulmonary Bypass Surgery, and sepsis were associated with a statisticaly insignificant rise in total leucocyte count peaking on first post-operative day, Cardiopulmonary Bypass exposure was associated with significant decline (p = 0.002), more pronounced with Cardiopulmonary Bypass-exposure exceeding 150 min. Percentage of neutrophils showed a rise (maximum on first post-operative day) but no significant association with sepsis or Cardiopulmonary Bypass.Platelet counts significantly declined after surgery, with nadir on 2nd POD (p < 0.001), the drop being more marked in patients operated on Cardiopulmonary Bypass (p < 0.005). Counts were significantly lower in patients exposed to >150 min Cardiopulmonary Bypass compared to those with shorter Cardiopulmonary Bypass. Septic patients had significantly lower platelet counts than uninfected patients, decline >2 SD from mean pre-operative level strongly associated with sepsis (p < 0.001).C-Reactive Protein levels rose markedly after surgery, peaking on 2nd POD; levels were significantly higher if operated on Cardiopulmonary Bypass. Cardiopulmonary Bypass >150 min was associated with lower mean C-Reactive Protein on first post-operative day, but significantly higher values on third and fourth post-operative days, as compared to Cardiopulmonary Bypass <150 min. Comparison of infected versus non-infected patients showed significantly higher mean C-Reactive Protein in the former group. Conclusion While leucocyte count, platelet count and C-Reactive Protein emerged as useful markers of post-operative inflammatory response and reaction to Cardiopulmonary Bypass, they proved unsatisfactory predictors of early post-operative sepsis.
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Affiliation(s)
- Shaad Abqari
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Rakhi Balachandran
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Suresh G Nair
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
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Yu HY, Wang SY, Quan CX, Fang C, Luo SC, Li DY, Zhen SS, Ma JH, Duan KM. Dexmedetomidine Alleviates Postpartum Depressive Symptoms following Cesarean Section in Chinese Women: A Randomized Placebo-Controlled Study. Pharmacotherapy 2019; 39:994-1004. [PMID: 31411762 DOI: 10.1002/phar.2320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Few studies have investigated the prophylactic efficacy of dexmedetomidine (DEX) in postpartum depressive symptoms (PDS). A randomized double-blind placebo-controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient-controlled intravenous analgesia (PCIA), can attenuate PDS. METHODS A total of 600 parturients scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated into the control group (infusion with 0.9% normal saline after delivery and PCIA with sufentanil) and the DEX group (DEX infusion 0.5 μg/kg after delivery and PCIA with DEX plus sufentanil). The prevalence of postpartum depressive disorders was indicated by the Edinburgh Postnatal Depression Scale (EPDS). Postoperative analgesia, sedation, and sleep quality of parturients were also assessed. RESULTS Postpartum blues and PDS prevalence in the DEX, versus control, group were significantly lower (5.0% vs 14.1%, p<0.001; 5.7% vs 16.3%, p<0.001, respectively), especially in parturients with antenatal depression or moderate stress during pregnancy. Compared with the control group, the EPDS score at postpartum days 7 and 42 in the DEX group was significantly lower (4.23 ± 4.37 vs 1.93 ± 3.36, p<0.001; 4.68 ± 4.78 vs 1.99 ± 3.18, p<0.001, respectively), as was the incidence of postpartum self-harm ideation at postpartum days 7 and 42 in the DEX group versus the control group (1.1% vs 4.0%, p=0.03; 0.4% vs 2.9%, p=0.04, respectively). The pain score and the sleep quality in the DEX group were better than that in the control group (p<0.001). CONCLUSION The application of DEX in the early postpartum period can significantly attenuate the incidence of postpartum depressive disorders.
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Affiliation(s)
- He-Ya Yu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Sai-Ying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Cheng-Xuan Quan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Chao Fang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Chao Luo
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Dan-Yang Li
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Shan-Shan Zhen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
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Zhou HM, Ling XY, Ni YJ, Wu C, Zhu ZP. Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning. J Int Med Res 2019; 47:3623-3635. [PMID: 31234690 PMCID: PMC6726774 DOI: 10.1177/0300060519856750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study was performed to determine the effect of dexmedetomidine (DEX) administration on myocardial damage in cardiac surgery with sevoflurane postconditioning. Methods We retrospectively examined all cardiac valve replacement surgeries from 1 April 2016 to 30 April 2017. Eligible patients were divided into two groups based on whether DEX was infused. DEX infusion was permitted only between intubation and the beginning of cardiopulmonary bypass (CPB). Sevoflurane was inhaled via the standard postconditioning procedure starting at aortic declamping. The cardiac troponin I (cTnI) level was measured at different time points. The postoperative outcomes and complications were also analyzed. Results One hundred patients were included in the study (DEX group, n = 53; non-DEX group, n = 47). Increased cTnI levels were significantly correlated with the New York Heart Association classification, CPB time, and DEX use. DEX use and the CPB time were potential independent factors contributing to changes in the cTnI level. The cTnI level at 6, 12, and 24 hours postoperatively was remarkably lower in the DEX than non-DEX group by 1.14, 7.83, and 5.86 ng/mL, respectively. Conclusions DEX decreased the cTnI level after CPB when sevoflurane postconditioning was used, especially at 6, 12, and 24 hours postoperatively.
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Affiliation(s)
- Hong-Mei Zhou
- 1 Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Xiao-Yan Ling
- 2 Outpatient-Nursing Department, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Yun-Jian Ni
- 1 Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Cheng Wu
- 1 Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Zhi-Peng Zhu
- 1 Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
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Lin L, Yueming Z, Meisheng L, Jiexue W, Yang J. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room]. Hua Xi Kou Qiang Yi Xue Za Zhi 2019; 35:613-617. [PMID: 29333775 DOI: 10.7518/hxkq.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). METHODS Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. RESULTS Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups. CONCLUSIONS As an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.
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Affiliation(s)
- Luo Lin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhang Yueming
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li Meisheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wang Jiexue
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ji Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Feng X, Guan W, Zhao Y, Wang C, Song M, Yao Y, Yang T, Fan H. Dexmedetomidine ameliorates lipopolysaccharide-induced acute kidney injury in rats by inhibiting inflammation and oxidative stress via the GSK-3β/Nrf2 signaling pathway. J Cell Physiol 2019; 234:18994-19009. [PMID: 30919976 DOI: 10.1002/jcp.28539] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
Acute kidney injury (AKI) is a frequent and serious complication of sepsis; however, there are currently no effective therapies. Inflammation and oxidative stress are the major mechanisms implicated in lipopolysaccharide (LPS)-induced AKI. Dexmedetomidine (DEX) has been reported to have remarkable anti-inflammatory and antioxidant effects. Here, we examined the renoprotective effects of DEX and potential underlying mechanisms in rats with LPS-induced AKI. We analyzed renal function and structure; serum inflammatory cytokine; renal oxidant and antioxidant levels; and renal expression of glycogen synthase kinase-3β (GSK-3β)/nuclear factor erythroid 2-related factor 2 (Nrf2) pathway-related proteins in rats 4 hr after administration of LPS. Pretreatment with DEX improved renal function and significantly reduced the levels of inflammatory cytokines and oxidative stress markers. Treatment with DEX and the GSK-3β inhibitor SB216367 promoted phosphorylation of GSK-3β, induced Nrf2 nuclear translocation, and increased transcription of the Nrf2 target genes heme oxygenase-1 and NAD(P)H quinone oxidoreductase-1, primarily in renal tubules. Alpha-2-adrenergic receptor (α2-AR) antagonist atipamezole and imidazoline I 2 receptor (I 2 R) antagonist idazoxan reversed the effects of DEX. These results suggest that the renoprotective effects of DEX are mediated via α2-AR and I 2 R-dependent pathways that reduce inflammation and oxidative stress through GSK-3β/Nrf2 signaling.
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Affiliation(s)
- Xiujing Feng
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Wei Guan
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Yuan Zhao
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Chaoran Wang
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Manyu Song
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Yujie Yao
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Tianyuan Yang
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
| | - Honggang Fan
- Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
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Wang G, Niu J, Li Z, Lv H, Cai H. The efficacy and safety of dexmedetomidine in cardiac surgery patients: A systematic review and meta-analysis. PLoS One 2018; 13:e0202620. [PMID: 30231052 PMCID: PMC6145508 DOI: 10.1371/journal.pone.0202620] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022] Open
Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine versus any other treatment without dexmedetomidine in patients who have undergone cardiac surgery. Electronic databases including PubMed, Embase, and Cochrane Library were systematically searched without limitations of language and publication time. Randomized controlled trials (RCTs) aiming to evaluate the efficacy and safety of dexmedetomidine versus any other treatment without dexmedetomidine in patients that have undergone cardiac surgery were selected. Endpoints such as hemodynamic indexes and adverse events in eligible studies were extracted by two researchers, independently. The data was analyzed using RevMan 5.3 and Stata 11.0 software. A total of 18 RCTs met the inclusion criteria, involving 1730 patients. Compared to control (any treatment without dexmedetomidine), dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95% confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial pressure, a standardized mean difference (SMD) of -1.74 for mean arterial blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23, -1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22 (95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96; p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In addition, dexmedetomidine could reduce time of surgery and stay in intensive care units, improve delirium with good safety. Our study shows clinical application of dexmedetomidine in cardiac surgery patients can reduce risks of abnormal hemodynamics with good safety.
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Affiliation(s)
- Guobin Wang
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jianhua Niu
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zhitao Li
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Haifeng Lv
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Hongliu Cai
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, P.R. China
- * E-mail:
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Gong Z, Li J, Zhong Y, Guan X, Huang A, Ma L. Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting. Exp Ther Med 2018; 16:4685-4689. [PMID: 30542420 PMCID: PMC6257246 DOI: 10.3892/etm.2018.6778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting were investigated. Eighty patients undergoing systemic anesthesia with extracorporeal coronary artery bypass grafting in The People's Hospital of Guangxi Zhuang Autonomous Region from January 2015 to August 2017 were selected and randomly divided into the observation group (n=40) and control group (n=40). The two groups were treated with dexmedetomidine and equal volume of normal saline, respectively. Moreover, safety indexes including EEG bispectral index (BIS) at 30 min before induction of anesthesia (T0), immediately after intubation (T1), when incision was made (T2), when chest was closed (T3), when operation was completed (T4) and at 6 h after operation (T5), intraoperative circulatory system-related complications, cortisol, epinephrine and norepinephrine levels at the end of surgery as well as anesthesia recovery time and postoperative mechanical ventilation time were recorded and compared. All the patients were followed up for 1 week. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were administered at 1, 3 and 7 days after operation, and the incidence of intraoperative awareness and postoperative cognitive dysfunction was recorded. BIS value in the observation group was lower than that in the control group (P<0.05) at T1-T4 time points, and the BIS value in the observation group was higher than that in the control group (P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension and hypotension in the observation group was significantly lower than those in the control group (P<0.05). At the end of operation, levels of cortisol, epinephrine and norepinephrine in the observation group were significantly lower than those in the control group (P<0.05). Anesthesia recovery time and postoperative mechanical ventilation time in the observation group was significantly shorter than the time in the control group (P<0.05). MMSE and MoCA scores of the observation group were better than those of the control group (P<0.05). The incidence of cognitive impairment and postoperative cognitive impairment in the observation group was significantly lower than those in the control group (P<0.05). Therefore, it is concluded that dexmedetomidine can effectively reduce the incidence of postoperative cognitive impairment in patients undergoing coronary artery bypass grafting, and it is of high safety for circulatory function.
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Affiliation(s)
- Zheng Gong
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Jun Li
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Yuling Zhong
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Xuehai Guan
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Ailan Huang
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Li Ma
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
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Chanowski EJP, Ismawan JM, Oakes DA. A Review of Perioperative Analgesic Strategies in Cardiac Surgery. Int Anesthesiol Clin 2018; 56:e56-83. [PMID: 30204605 DOI: 10.1097/AIA.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang L, Zhang A, Liu W, Liu H, Su F, Qi L. Effects of dexmedetomidine on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis. Exp Ther Med 2018; 16:3869-3874. [PMID: 30344663 PMCID: PMC6176194 DOI: 10.3892/etm.2018.6665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/06/2018] [Indexed: 12/26/2022] Open
Abstract
Effects of dexmedetomidine (DEX) on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis were investigated. A total of 94 patients with liver cirrhosis who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from December 2016 to November 2017 were included, and randomly divided into control and observation group (n=47). Patients in control group were given remifentanil for anesthesia, while patients in observation group were treated with remifentanil and for DEX anesthesia. Venous blood was collected immediately before induction of anesthesia (T1), 10 min (T2) after the beginning of surgery, immediately after surgery (T3) and 2 h after surgery (T4). Hemodynamic parameters, stress response factors, adverse reactions and levels of inflammatory cytokines and T lymphocyte subsets were compared between the two groups. The mean arterial pressure in both groups was lower at T2-T4 than that at T1 (p<0.05), and mean arterial pressure was lower in observation group than in control group (p<0.05). Visual analogue pain score (VAS) of observation group was significantly lower than that of control group at 6, 12 and 24 h after operation (p<0.05). There was no significant difference between the two groups in incidence of nausea, vomiting, hypoxemia and delayed awakening (p>0.05). Incidence of postoperative agitation in observation group was significantly lower than that in control group (p<0.05). The levels of CD3+, CD4+, and CD4+/CD8+ in both groups were significantly lower at T2-T4 than those at T1 (p<0.05). Levels of IL-10 and TNF-α in both groups were significantly higher at T2-T4 than those at T1, but levels of IL-2 and TNF-α were significantly lower in observation group than in control group (p<0.05). In conclusion, the use of DEX for anesthesia in patients with liver cirrhosis can improve hemodynamic stability, reduce stress response and reduce inflammation level without affecting immune function, which has important clinical significance.
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Affiliation(s)
- Lianzhu Wang
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Anjun Zhang
- Department of Anesthesiology, Rizhao City Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, P.R. China
| | - Wei Liu
- Department of Anesthesiology, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Hui Liu
- Department of Nursing, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Fan Su
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Ling Qi
- Department of Anesthesiology, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
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Xia Z, Li H, Irwin MG. Myocardial ischaemia reperfusion injury: the challenge of translating ischaemic and anaesthetic protection from animal models to humans. Br J Anaesth 2018; 117 Suppl 2:ii44-ii62. [PMID: 27566808 DOI: 10.1093/bja/aew267] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Myocardial ischaemia reperfusion injury is the leading cause of death in patients with cardiovascular disease. Interventions such as ischaemic pre and postconditioning protect against myocardial ischaemia reperfusion injury. Certain anaesthesia drugs and opioids can produce the same effects, which led to an initial flurry of excitement given the extensive use of these drugs in surgery. The underlying mechanisms have since been extensively studied in experimental animal models but attempts to translate these findings to clinical settings have resulted in contradictory results. There are a number of reasons for this such as dose response, the intensity of the ischaemic stimulus applied, the duration of ischaemia and lost or diminished cardioprotection in common co-morbidities such as diabetes and senescence. This review focuses on current knowledge regarding myocardial ischaemia reperfusion injury and cardioprotective interventions both in experimental animal studies and in clinical trials.
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Affiliation(s)
- Z Xia
- Department of Anaesthesiology Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong SAR, China
| | - H Li
- Department of Anaesthesiology
| | - M G Irwin
- Department of Anaesthesiology Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong SAR, China
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Mohamed H, Hosny H, Tawadros Md P, Elayashy Md Desa Fcai M, El-Ashmawi Md H. Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A Prospective Randomized Trial. J Cardiothorac Vasc Anesth 2018; 33:334-340. [PMID: 30075898 DOI: 10.1053/j.jvca.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Cardiac surgery is characterized by attenuation of microcirculatory perfusion. Dexmedetomidine has been proved to attenuate the microcirculatory derangements evoked by experimental sepsis. The authors investigated the effects of dexmedetomidine infusion on sublingual microcirculation in patients undergoing on-pump coronary artery bypass graft (CABG) surgery. DESIGN Prospective, randomized blinded study. SETTINGS Tertiary university hospital. PARTICIPANTS A total of 70 adults undergoing elective on-pump CABG surgery. INTERVENTION After a standard general anesthesia, participants were allocated randomly to receive either propofol continuous intravenous infusion, 50 to 70 µg/kg/min, or propofol infusion, 50 to 70 µg/kg/min plus dexmedetomidine infusion, 0.5 µg/kg/h, during cardiopulmonary bypass. Microcirculation was studied with side-stream dark field imaging at 3 times: immediately before starting bypass (T0), 30 minutes after initiation of bypass (T1), and 30 minutes after weaning from bypass (T2). MEASUREMENTS AND MAIN RESULTS Microvascular flow index was significantly higher in the dexmedetomidine group at T2 compared to the control group (2.20 ± 0.29 and 1.47 ± 0.30, respectively; p = 0.001). The perfused vessel density was significantly higher in the dexmedetomidine group at T2 compared to the control group (6.1 [3-8.9] mm/mm² and 3.3 [2.2-4.3] mm/mm², respectively; p = 0.01). The total vascular density was significantly higher in the dexmedetomidine group compared to the control group at T1 and T2 (9.9 [7.8-12.6] mm/mm² v 7.4 [6.1-9] mm/mm², p = 0.005; and 9.27 ± 2.27 mm/mm² v 7.24 ± 1.66 mm/mm², p = 0.003, respectively). CONCLUSION This trial demonstrated that dexmedetomidine infusion improved sublingual microcirculation indices in patients undergoing on-pump CABG surgery.
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Affiliation(s)
- Hassan Mohamed
- Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham Hosny
- Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton and Harefield Foundation Trust, London, United Kingdom.
| | - Pierre Tawadros Md
- Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hossam El-Ashmawi Md
- Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Qiu R, Yao W, Ji H, Yuan D, Gao X, Sha W, Wang F, Huang P, Hei Z. Dexmedetomidine restores septic renal function via promoting inflammation resolution in a rat sepsis model. Life Sci 2018; 204:1-8. [PMID: 29733849 DOI: 10.1016/j.lfs.2018.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute kidney injury occurred after sepsis, resulting in high mortality. This research aims to elucidate the mechanistic effect of DEX on the renal inflammation resolution during sepsis in rats. METHODS The rats were randomly divided into a sham group and the other three cecal ligation and puncture (CLP) model groups, based on different treatments: placebo, DEX and 2-adrenergic receptor (AR) inhibitor atipamezole (AT) treatment (DEX + AT) groups. The survival of septic rats within 24 h was recorded. Tissue pathology, plasma IL-1β, IL-6, TNF-α, lipoxygenase-5 and lipoxin A4 were evaluated. Western blotting and immunostaining was used to determine expression of TLR4, IκB, IKK, NF-κB p65 and pp65 in kidney tissue. Then qPCR was used to analyze the mRNA expression of renal α2A-AR, α2B-AR and α2C-AR. RESULTS Rat mortality and kidney inflammation were significantly increased in septic rats. Specifically, IL-1β, IL-6 and TNF-α plasma levels, NF-κB activity, and TLR4 expression in rat kidney tissues were increased after CLP. In the DEX treatment group, mortality was reduced, histology changes were minor, and lipoxygenase-5, and lipoxin A4 expression were increased. The expression of IL-1β, IL-6 and TNF-α, NF-κB activity and TLR4 expression in rat kidney tissues were also decreased. These results indicated that DEX treatment alleviates acute kidney injury induced by CLP. However, the effects of DEX were apparently suppressed by atipamezole in the DEX + AT group. CONCLUSION The current study demonstrated the protective effect of DEX on CLP-induced kidney injury, which may be effective by attenuating NF-κB pathway activation with lipoxin A4.
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Affiliation(s)
- Rongzong Qiu
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China; Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | - Weifeng Yao
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
| | - Haocong Ji
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China
| | - Dongdong Yuan
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | - Xiaofeng Gao
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China
| | - Weiping Sha
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China
| | - Fei Wang
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China
| | - Pinjie Huang
- Department of Anesthesiology, Huizhou First Hospital, Huizhou, Guangdong 516000, China
| | - Ziqing Hei
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
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Yan X, Cheng X, Zhou L, He X, Zheng W, Chen H. Dexmedetomidine alleviates lipopolysaccharide-induced lung injury in Wistar rats. Oncotarget 2018; 8:44410-44417. [PMID: 28574842 PMCID: PMC5546489 DOI: 10.18632/oncotarget.17899] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/27/2017] [Indexed: 12/17/2022] Open
Abstract
This study aimed to investigate the protective effects of dexmedetomidine on lipopolysaccharide (LPS)-induced lung injury in Wistar rats. 24 female Wistar rats were randomly assigned into 3 groups (n = 8): a control group, a LPS-challenged group, and a LPS plus dexmedetomidine group. Inflammation, oxidative stress, Nrf2/Keap1, and Akt signal were determined. The results showed that LPS caused inflammation and oxidative stress via increasing pro-inflammatory cytokines and oxidative products. Dexmedetomidine treatment alleviated inflammation and oxidative stress in LPS-challenged rats. Nrf2/Keap1 was inhibited and Akt signal was activated in the lung after exposure to LPS, while dexmedetomidine activated Nrf2/Keap1, which further mediated expressions of antioxidant genes. In conclusion, dexmedetomidine alleviated inflammatory response and oxidative stress in LPS-induced lung injury in rats via influencing Nrf2/Keap1 signal.
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Affiliation(s)
- Xuetao Yan
- Department of Anesthesiology, Shenzhen Bao'an Maternity and Child Health Hospital, Shenzhen, 518100, China
| | - Xiaoli Cheng
- Department of Pharmacy, Shenzhen Bao'an Maternity and Child Health Hospital, Shenzhen, 518100, China
| | - Liwen Zhou
- Department of Anesthesiology, Xiangyang Central Hospital, Xiangyang, 441021, China
| | - Xianghu He
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wenzhong Zheng
- Department of Anesthesiology, Shenzhen Bao'an Maternity and Child Health Hospital, Shenzhen, 518100, China
| | - Hu Chen
- Department of Anesthesiology, Shenzhen Bao'an Maternity and Child Health Hospital, Shenzhen, 518100, China
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Abstract
BACKGROUND The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. OBJECTIVES To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. SEARCH METHODS We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. SELECTION CRITERIA We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied was clonidine in 21 trials, dexmedetomidine in 24 trials and mivazerol in two trials.In non-cardiac surgery, there was high quality evidence that α-2 adrenergic agonists led to a similar risk of all-cause mortality compared with control groups (1.3% with α-2 adrenergic agonists versus 1.7% with control; RR 0.80, 95% CI 0.61 to 1.04; participants = 14,081; studies = 16). Additionally, the risk of cardiac mortality was similar between treatment groups (0.8% with α-2 adrenergic agonists versus 1.0% with control; RR 0.86, 95% CI 0.60 to 1.23; participants = 12,525; studies = 5, high quality evidence). The risk of myocardial infarction was probably similar between treatment groups (RR 0.94, 95% CI 0.69 to 1.27; participants = 13,907; studies = 12, moderate quality evidence). There was no associated effect on the risk of stroke (RR 0.93, 95% CI 0.55 to 1.56; participants = 11,542; studies = 7; high quality evidence). Conversely, α-2 adrenergic agonists probably increase the risks of clinically significant bradycardia (RR 1.59, 95% CI 1.18 to 2.13; participants = 14,035; studies = 16) and hypotension (RR 1.24, 95% CI 1.03 to 1.48; participants = 13,738; studies = 15), based on moderate quality evidence.There was insufficient evidence to determine the effect of α-2 adrenergic agonists on all-cause mortality in cardiac surgery (RR 0.52, 95% CI 0.26 to 1.04; participants = 1947; studies = 16) and myocardial infarction (RR 1.01, 95% CI 0.43 to 2.40; participants = 782; studies = 8), based on moderate quality evidence. There was one cardiac death in the clonidine arm of a study of 22 participants. Based on very limited data, α-2 adrenergic agonists may have reduced the risk of stroke (RR 0.37, 95% CI 0.15 to 0.93; participants = 1175; studies = 7; outcome events = 18; low quality evidence). Conversely, α-2 adrenergic agonists increased the risk of bradycardia from 6.4% to 12.0% (RR 1.88, 95% CI 1.35 to 2.62; participants = 1477; studies = 10; moderate quality evidence), but their effect on hypotension was uncertain (RR 1.19, 95% CI 0.87 to 1.64; participants = 1413; studies = 9; low quality evidence).These results were qualitatively unchanged in subgroup analyses and sensitivity analyses. AUTHORS' CONCLUSIONS Our review concludes that prophylactic α-2 adrenergic agonists generally do not prevent perioperative death or major cardiac complications. For non-cardiac surgery, there is moderate-to-high quality evidence that these agents do not prevent death, myocardial infarction or stroke. Conversely, there is moderate quality evidence that these agents have important adverse effects, namely increased risks of hypotension and bradycardia. For cardiac surgery, there is moderate quality evidence that α-2 adrenergic agonists have no effect on the risk of mortality or myocardial infarction, and that they increase the risk of bradycardia. The quality of evidence was inadequate to draw conclusions regarding the effects of alpha-2 agonists on stroke or hypotension during cardiac surgery.
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Affiliation(s)
- Dallas Duncan
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - Ashwin Sankar
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - W Scott Beattie
- Toronto General Hospital, University Health NetworkDepartment of AnaesthesiaEN 3‐453 Toronto General Hospital, University Health Network200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Duminda N Wijeysundera
- St. Michael's HospitalLi Ka Shing Knowledge Institute30 Bond StreetTorontoOntarioCanadaM5B 1W8
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Güzel A, Doğan E, Türkçü G, Kuyumcu M, Kaplan İ, Çelik F, Yıldırım ZB. Dexmedetomidine and Magnesium Sulfate: A Good Combination Treatment for Acute Lung Injury? J INVEST SURG 2018; 32:331-342. [PMID: 29359990 DOI: 10.1080/08941939.2017.1422575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: In this study, we aimed to investigate the therapeutic effects of magnesium sulfate (MgSO4) and dexmedetomidine (dex) in a model of acute lung injury (ALI). We determined whether concomitant administration decreased the inflammatory effects of hydrochloric acid (HCl)-induced ALI in a synergistic manner. Materials and Methods: In this study, 42 Sprague-Dawley rats were randomized into six groups: Group S (saline), Group SV (saline + mechanical ventilation), Group HCl (HCl), Group Dex (Dex), Group Mag (MgSO4), and Group DM (Dex + MgSO4). All groups except Group S were mechanically ventilated prior to HCl-induced ALI. Saline or HCl was administered via tracheostomy. Prior to treatment, HCl was administered to Group HCl, Group Dex, Group Mag, and Group DM to induce ALI. Dex and MgSO4 were administered intraperitoneally. The rats were monitored for 4 h after treatment to measure oxidative stress parameters in blood, and prolidase enzyme activity. Lung tissue damage were determined via histopathology. Results: A significant increase in heart rate and rapid desaturation was observed in HCl-administered groups. Treatment administration decreased the pulse values. Increased saturation values and decreased oxidative stress indices were observed in groups that were subsequently administered Dex and MgSO4. Serum prolidase activity increased significantly in Group HCl. Severe pathological findings were detected following HCl-induced ALI. Group Mag showed greater improvement in the pathology of HCl-induced ALI than did Group Dex. Administration of both Dex and MgSO4 did not improve the pathological scores. Conclusions: The antioxidant and anti-inflammatory effects of Dex and MgSO4 ameliorated the detrimental effects of HCI-induced ALI. However, adverse effects on hemodynamics and lung damage were observed when the two drugs were administered together.
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Affiliation(s)
- Abdulmenap Güzel
- a Department of Anesthesiology , Dicle University , Diyarbakır , Turkey
| | - Erdal Doğan
- a Department of Anesthesiology , Dicle University , Diyarbakır , Turkey
| | - Gül Türkçü
- b Department of Pathology , Dicle University , Diyarbakır , Turkey
| | - Mahir Kuyumcu
- a Department of Anesthesiology , Dicle University , Diyarbakır , Turkey
| | - İbrahim Kaplan
- c Department of Biochemistry , Dicle University , Diyarbakır , Turkey
| | - Feyzi Çelik
- a Department of Anesthesiology , Dicle University , Diyarbakır , Turkey
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Gallego-Ligorit L, Vives M, Vallés-Torres J, Sanjuán-Villarreal TA, Pajares A, Iglesias M. Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia. J Cardiothorac Vasc Anesth 2017; 32:1426-1438. [PMID: 29325842 DOI: 10.1053/j.jvca.2017.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 12/16/2022]
Abstract
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus. At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
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Affiliation(s)
- Lucía Gallego-Ligorit
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Marc Vives
- Department of Anesthesiology and Critical Care Medicine, Hospital de Bellvitge, Barcelona, Spain
| | - Jorge Vallés-Torres
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T Alberto Sanjuán-Villarreal
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Azucena Pajares
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Mario Iglesias
- Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), Madrid, Spain
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Chen Y, Zhang X, Zhang B, He G, Zhou L, Xie Y. Dexmedetomidine reduces the neuronal apoptosis related to cardiopulmonary bypass by inhibiting activation of the JAK2-STAT3 pathway. Drug Des Devel Ther 2017; 11:2787-2799. [PMID: 29033541 PMCID: PMC5628699 DOI: 10.2147/dddt.s140644] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cardiopulmonary bypass (CPB) constitutes one of the primary methodologies pertaining to cardiac surgery. However, this form of surgery can cause damage to the body. Many studies have reported that dexmedetomidine confers cerebral protection. In this study, we aimed to investigate the effect and mechanism of dexmedetomidine on neuronal apoptosis caused by CPB. Here, rats were treated with different doses of dexmedetomidine by intravenous infusion 2 hours after CPB. We observed that dexmedetomidine treatment to rats reduces the S100β, NSE levels in plasma, and neuronal apoptosis following CPB in a dose-dependent manner. Furthermore, we observed that the beneficial effect of dexmedetomidine treatment following CPB was associated with a reduction in IL6, an inflammatory cytokine in plasma and cortex. Our results suggest that dexmedetomidine provides neuroprotective effects by inhibiting inflammation and reducing neuronal apoptosis. There was a correlation between the protective effect on the brain and the dose of dexmedetomidine. In addition, dexmedetomidine administration inhibits phosphorylation of JAK2 and STAT3 proteins in the hippocampus of rats 2 hours after CPB. Therefore, we speculate that the JAK2–STAT3 pathway plays an important role in the neuroprotective effects of dexmedetomidine following brain injury induced by CPB.
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Affiliation(s)
- Yanhua Chen
- Department of Anesthesiology, Cardiovascular Institute
| | - Xu Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Guodong He
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lifang Zhou
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yubo Xie
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Stanzel RDP, Henderson M. Is There a Relationship between Pressure Gradients through Contemporary Oxygenators and Immune Cell Proliferation during Cardiopulmonary Bypass? A Pilot Study. J Extra Corpor Technol 2017; 49:160-167. [PMID: 28979039 PMCID: PMC5621579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/11/2017] [Indexed: 06/07/2023]
Abstract
There have been many advances in the perfusion equipment used for cardiopulmonary bypass (CPB) surgery. A key component, the membrane oxygenator, has had a number of modifications in recent years and a recent clinical evaluation demonstrated disparity in various aspects of device performance. One difference among oxygenators, which to-date has received little attention, was the impact on the patient's immune cells, with some oxygenators producing a significantly greater increase in immune cell numbers after cross clamp. Such increases in immune cell proliferation may contribute to the development of a systemic inflammatory response (SIR), which has been demonstrated to have a negative impact on patient outcomes. Although factors contributing to immune cell proliferation during CPB are recognized to be multi-factorial, the goal of the current communication was to perform an ad hoc analysis of these raw data for evidence that pressure gradients through an oxygenator contributes to this outcome. Despite the observation that higher-pressure gradient oxygenators appeared to associate with increased immune cell proliferation, no correlation was detected in this analysis. This finding, however, provides further evidence for the complex nature of inflammation during CPB, which deserves ongoing discussion and investigation.
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Affiliation(s)
- Roger D P Stanzel
- Cardiovascular Perfusion, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Mark Henderson
- Cardiovascular Perfusion, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Soliz JM, Ifeanyi IC, Katz MH, Wilks J, Cata JP, McHugh T, Fleming JB, Feng L, Rahlfs T, Bruno M, Gottumukkala V. Comparing Postoperative Complications and Inflammatory Markers Using Total Intravenous Anesthesia Versus Volatile Gas Anesthesia for Pancreatic Cancer Surgery. Anesth Pain Med 2017; 7:e13879. [PMID: 29344445 PMCID: PMC5750426 DOI: 10.5812/aapm.13879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/23/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The objective of this study is to evaluate postoperative complications and inflammatory profiles when using a total intravenous anesthesia (TIVA) or volatile gas-opioid (VO) based anesthesia in patients undergoing pancreatic cancer surgery. Methods Design, retrospective propensity score matched cohort; Setting, major academic cancer hospital; Patients, all patients who had pancreatic surgery between November 2011 and August 2014 were retrospectively reviewed. Propensity score matched patient pairs were formed. A total of 134 patients were included for analysis with 67 matched pairs; Interventions, Patients were categorized according to type of anesthetic used (TIVA or VO). Patients in the TIVA group received preoperative celecoxib, tramadol, and pregabalin in addition to intraoperative TIVA with propofol, lidocaine, ketamine, and dexmedetomidine. The VO-group received a volatile-opioid based anesthetic; Measurements, demographic, perioperative clinical data, platelet lymphocyte ratios, and neutrophil lymphocyte ratios were collected. Complications were graded and collected prospectively and later reviewed retrospectively. Results Patients receiving TIVA were more likely to have no complication or a lower grade complication than the VO-group (P = 0.014). There were no differences in LOS or postoperative inflammatory profiles noted between the TIVA and VO groups. Conclusions In this retrospective matched analysis of patients undergoing pancreatic cancer surgery, TIVA was associated with lower grade postoperative complications. Length of hospital stay (LOS) and postoperative inflammatory profiles were not significantly different.
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Affiliation(s)
- Jose M Soliz
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
- Corresponding author: Jose M Soliz, MD, Department of Anesthesiology and Perioperative Medicine University of Texas M.D., Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX 77030, E-mail:
| | - Ifeyinwa C Ifeanyi
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Jonathan Wilks
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Thomas McHugh
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Lei Feng
- Department of Biostatistics, Houston, TX, USA
| | - Thomas Rahlfs
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Morgan Bruno
- Department of Surgical Oncology, Houston, TX, USA
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Bhamidipati D, Goldhammer JE, Sperling MR, Torjman MC, McCarey MM, Whellan DJ. Cognitive Outcomes After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2017; 31:707-718. [DOI: 10.1053/j.jvca.2016.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 12/17/2022]
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