Dexmedetomidine Versus Propofol Sedation Improves Sublingual Microcirculation After Cardiac Surgery: A Randomized Controlled Trial

Abstract

This trial demonstrated that dexmedetomidine sedation may be better able to improve microcirculation in cardiac surgery patients during the early postoperative period compared with propofol.

Dexmedetomidine provides better hemodynamic stability than fentanyl without impairing microcirculation during isoflurane anesthesia in bitches with pyometra submitted to ovariohysterectomy

“…As it is a potent selective alpha 2 agonist, dexmedetomidine has a dual alpha 2 adrenoceptor activation characteristic, since its effect in vascular smooth muscle cells results in vasoconstriction while the activation of receptors in endothelial cells and the inhibition of the sympathetic nervous system causes vasodilation (3,13). The results presented here are consistent with the expected pharmacodynamics of dexmedetomidine, as a decrease in heart rate associated with an increase in blood pressure was observed, which was also shown in other experiments (15)(16)(17).…”

“…Patients with reduced tissue oxygenation due to a compromised cardiovascular system support the importance of monitoring the microcirculation during anesthesia and intensive care treatment in sepsis (2). Microcirculation plays an essential role in oxygen and other nutrients delivery, tissue perfusion and fluid homeostasis (3) One of the most important parameters to be monitored during anesthesia of septic patients is the arterial blood pressure. However, even if the macro-hemodynamic goals are achieved, it's the coherence and the balance between them and the microcirculation that should be pursued.…”

Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials

“…Nine studies 7,13,14,17e19,22,25,27 assessed POD incidence in 2438 elderly (!65 yr) patients, and the remaining nine studies included 871 younger patients (<65 yr). 15,16,20,21,23,24,26,28,29 Dexmedetomidine significantly reduced POD incidence in each subgroup, (OR 0.19; 95% CI 0.10e0.36, P<0.01, I 2 ¼15%; GRADE: moderate) in the younger age-group, and (0.44; 95% CI 0.30e0.65, P<0.01, I 2 ¼55%; GRADE: moderate) for the elderly (Fig. 3a and Supplementary Table S4).…”

“…13,18,22e24 Three studies with the same primary endpoint (POD decrease) used more than twice of this maintenance dose and showed no advantage with dexmedetomidine. 14,17,25 Dexmedetomidine duration of administration was reported in some studies, the minimum duration was 2 h 17 and maximum duration was nearly 24 h. 15 In other studies dexmedetomidine was administered during surgery, 22 during MV, 16,19,28 before extubation, 13,21 or until next morning. 7 Here, exact duration of administration was unobtainable.…”

“…We performed a subgroup analysis of nine cardiac surgery studies comprising 1301 patients 13e16, 21,23,24,26,27 and nine non-cardiac surgery studies with 2008 patients. 7,17e20,22,25,28,29 Forest plot revealed significant differences in POD incidence with (OR 0.41; 95% CI 0.26e0.63, P<0.01, I 2 ¼11%) for cardiac surgery and (OR 0.33; 95% CI 0.18e0.59, P<0.01, I 2 ¼72%) for non-cardiac surgery, favouring dexmedetomidine (Fig.…”