Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off‑pump coronary‑artery bypass grafting

Zhai, Wenqian; Yang, Lieming; Sun, Peng; Li, Yunfei; Han, Jian; Wang, Guolin

doi:10.3892/etm.2020.9380

“…We included 48 trials of 6273 participants (online Supporting Information, Figure S1 and Table S4) [11, 25–70]. Dexmedetomidine was compared with saline placebo in 26 trials, propofol in 10 trials and various other drugs in 12 trials.…”

Section: Resultsmentioning

confidence: 99%

“…Heterogeneity: I 2 = 92%, 2 = 51.7988, p < 0.01 Ammar [30] Azeem [31] Balkanay [32] Bulow [33] Chi [34] Cho [35] Corbett [36] Cui [37] Djaiani [38] Dong [71] Elgebaly [40] Elgebaly [39] Gao [74] Goksedef [41] Huang [44] Khalil [47] Khalil [46] Kim [48] Kim [73] Li [50] Likhvantsev [51] Liu [52] Maldonado [53] Massoumi [54] Mogahd [55] Momeni [56] Park [57] Shehabi [59] Shi [retracted] Shokri [60] Soh [63] Subramaniam [64] Tosun [65] Turan [11] Wu [66] Zhai [68] Zi [70] Total . Evaluations (GRADE) organisation [13], and assessed for interstudy heterogeneity using I 2 statistics, s-squared values and p values from the chi-squared test, as well as visually inspecting forest plots [14].…”

Section: Random Effects Modelmentioning

confidence: 99%

Dexmedetomidine for adult cardiac surgery: a systematic review, meta‐analysis and trial sequential analysis

Poon

¹

,

Ling

²

,

Yang

³

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

“…Hemodynamic stability was one of the secondary endpoints. Previous studies have suggested the beneficial effect of dexmedetomidine on hemodynamic stability [27,28] . Dexmedetomidine may induce biphasic hemodynamic alterations.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies have suggested the beneficial effect of dexmedetomidine on hemodynamic stability. [ 27 , 28 ] Dexmedetomidine may induce biphasic hemodynamic alterations. Alpha-2 mediated vasoconstriction may result in transient tachycardia and elevated blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of dexmedetomidine and remifentanil on perioperative hemodynamics and recovery profile of patients undergoing laryngeal microsurgery

Kim

¹

,

Chang

²

,

Kim

³

et al. 2021

View full text Add to dashboard Cite

Background: Laryngeal microsurgery (LMS) causes hemodynamic instability and postoperative agitation, cough, pain, nausea, and vomiting. Moreover, because of a short operation time, it is associated with challenging anesthetic management. The aim of this study was to compare the usefulness of continuous administration of dexmedetomidine and remifentanil in inducing general anesthesia in patients undergoing LMS. Methods: This is a prospective randomized control design. Continuous intravenous infusion of dexmedetomidine (group D) or remifentanil (group R) was administered from 10 minutes before the induction of anesthesia to the end of surgery. In both groups, 1.5 mg/kg propofol and 0.5 mg/kg rocuronium were administered for the induction of anesthesia, and desflurane were titrated during the measurement of the bispectral index. We recorded hemodynamic data, recovery time, grade of cough, pain score, and analgesic requirements during the perioperative period. Results: 61 patients were finally analyzed (30 for group D, 31 for group R). The incidence of moderate to severe postoperative sore throat was higher in group R than in group D (42% vs 10%, P = .008), and the quantity of rescue fentanyl used in post-anesthesia care unit was significantly higher in group R than in group D (23.2 ± 24.7 mg vs 3.3 ± 8.6 mg; P < .001); however, the time required for eye opening was significantly longer in group D than in group R (599.4 ± 177.9 seconds vs 493.5 ± 103.6 seconds; P = .006). The proportion of patients with no cough or single cough during extubation was comparable between the 2 groups (group D vs group R: 73% vs 70%) as was the incidence of hemodynamic instability. Conclusion: Although there was a transient delay in emergence time, dexmedetomidine reduced postoperative opioid use and the incidence of sore throat. Dexmedetomidine may be used as an alternative agent to opioids in patients undergoing LMS.

show abstract

“…Two patients in the experimental group had vomiting reactions, while 6 patients in the control group had vomiting reactions. A study has also confirmed that DEX can reduce the stress response effectively, enhance immunity, and relieve postoperative pain and the incidence of adverse reactions in patients undergoing radical gastrectomy for gastric cancer [ 24 ]. This is consistent with the results of this work.…”

Section: Discussionmentioning

confidence: 99%

Effect of Perioperative Dexmedetomidine Anesthesia on Prognosis of Elderly Patients with Gastrointestinal Tumor Surgery

Guo

¹

,

Liu

²

,

Wang³

2022

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

It was to investigate the influence of perioperative dexmedetomidine (DEX) anesthesia on the prognosis of elderly patients with gastrointestinal tumor (GIT) surgery. 90 patients who underwent laparoscopic radical gastrectomy for GIT were included. They were randomly divided into the experimental group (45 cases) with DEX+general anesthesia, and the control group (45 cases) with epidural anesthesia+general anesthesia. The indicators after surgery were compared between the two groups. The mean arterial pressure (MAP) was 74.8 ± 3.5 mmHg and the heart rate (HR) was 52.7 ± 8.2 beats/min-1 in the experimental group, significantly lower than those of the control group ( P < 0.05 ). The Visual Analog Scale (VAS) scores of both groups decreased greatly associated to those before surgery ( P < 0.05 ). The levels of cortisol (COR) and immune adhesion inhibitor (FEIR) in the experimental group were significantly dissimilar from those in the control group ( P < 0.05 ). The tumor necrosis factor-alpha (TNF-α) was 96.4 ± 21.8 ng/L in the experimental group, observably lower than that in the control group ( P < 0.05 ). The postoperative diamine oxidase (DAO) and D-lactate (D-lac) were 62.4 ± 9.3 μmol/mL and 33.8 ± 7.2 ng/L, respectively, in the experimental group, much lower than those in the control group ( P < 0.05 ). There were also significant differences in the initial recovery of bowel sounds, defecation, and total length of hospital stay (LOHS) between the groups ( P < 0.05 ). DEX anesthesia had ideal sedative and analgesic effects, improving the prognosis of patients during surgery, and shortening the LOHS. Thus, it deserved a clinical application value.

show abstract

Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off‑pump coronary‑artery bypass grafting

Cited by 5 publications

References 26 publications

Dexmedetomidine for adult cardiac surgery: a systematic review, meta‐analysis and trial sequential analysis

Dexmedetomidine for adult cardiac surgery: a systematic review, meta‐analysis and trial sequential analysis

Comparison of the effects of dexmedetomidine and remifentanil on perioperative hemodynamics and recovery profile of patients undergoing laryngeal microsurgery

Effect of Perioperative Dexmedetomidine Anesthesia on Prognosis of Elderly Patients with Gastrointestinal Tumor Surgery

Contact Info

Product

Resources

About