Anti-inflammatory Effects of Perioperative Dexmedetomidine Administered as an Adjunct to General Anesthesia: A Meta-analysis

Abstract

The aim of this meta-analysis is to examine the effects of dexmedetomidine on serum inflammatory markers when administered perioperatively. We searched multiple electronic databases for relevant research papers, and carried out meta-analyses of weighted mean differences and interpreted in the light of statistical heterogeneity (I2). Fifteen RCTs recruiting 641 patients were included. Dexmedetomidine treatment significantly decreased interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) levels with mean differences [95% CI] in the changes from baseline between dexmedetomidine treated and controls of −25.14 [−35.29, −15.00]; P < 0.00001 (for IL-6), −5.69 [−10.77, −0.60]; P < 0.04 (for IL-8), and −20.30 [−30.93, −9.67]; P < 0.0002 (for TNF-α) immediately after surgery; and −41.55 [−57.41, −25.70]; P < 0.00001 (IL-6), −6.46 [−10.83, −2.08]; P < 0.005 (IL-8), and −14.67 [−22.61, −6.73]; P < 0.0003 (TNF-α) on postoperative day 1 (random effects). IL-10 levels were found to increase significantly a day after surgery (8.33 [3.31, 13.36]; P = 0.001). Subgroup analyses did not reveal significant differences. In conclusion, perioperative adjunctive use of dexmedetomidine substantially decreases serum IL-6, IL-8 and TNF-α levels.

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

“…78,79 Similarly, dexmedetomidine may have anti-inflammatory effects and improve macrophage function. 80, 81 Some of these immune effects may be beneficial in patients with sepsis, the most common cause of ARDS. There is increasing recognition that sepsis is a heterogeneous condition and includes patients who have increased inflammation and are immunosuppressed.…”

Anti-Inflammatory Properties of Anesthetic Agents

“…A number of mechanisms of action have been postulated for dexmedetomidine, including: modulation of cytokine production by macrophages/monocytes during the stress response, which may also be stimulated via α2-adrenoceptors; inhibition of apoptosis; central sympatholytic effects, including stimulation of cholinergic anti-inflammatory pathways; and antinociceptive action involving interactions between pain and immune factors (proinflammatory cytokines) [1,2,4]. So far, however, these mechanisms remain unclear [37].…”

Intraoperative dexmedetomidine and postoperative cerebral hyperperfusion syndrome in patients who underwent superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease

“…[17,18] Although the exact mechanism remains unknown, dexmedetomidine has many beneficial biochemical properties, such as antioxidant effects, [19] anti-inflammatory effects, [20,21] suppressed glutamate release, [22] and apoptosis regulation. [23] Moreover, it preserves the regional CBF and produces an optimal balance in the microregional oxygen supply and consumption during severe hemorrhagic hypotension.…”

“…[27] Dexmedetomidine also showed an anti-inflammatory effect. [21] Dexmedetomidine inhibited the production of inflammatory cytokines such as interleukin-6, interleukin-8, and tumor necrosis factor-alpha. [28] Such proinflammatory cytokines-induced vasodilation and hyperemia are considered another cause of CHS.…”