Effect of dexmedetomidine on postoperative systemic inflammation and recovery in patients undergoing digest tract cancer surgery: A meta-analysis of randomized controlled trials

Abstract

Perioperative immune function, postoperative cognitive function and prognosis are momentous issues for patients undergoing digestive tract cancer surgery. Studies have investigated the efficacy of dexmedetomidine (DEX) administration on these issues, but the results are inconsistent. Therefore, this meta-analysis aimed to summarize all the existing evidence and draw a conclusion more accurately on these associations. Trials were located through electronic searches of the PubMed, Embase, the Cochrane Library and Web of Science databases sources (from the establishment date of databases to April 2022). Bibliographies of the retrieved articles were checked. A total of 17 RCTs involving 1619 patients were included. The results showed that DEX decreased the level of C-reactive protein (SMD = -4.26, 95%CI: -6.16, -2.36), TNF-α (SMD = -4.22, 95%CI: -5.91, -2.54) and IL-6 (SMD = -2.71, 95%CI: -4.46, -0.97), and increased the level of IL-10 (SMD = 1.74, 95%CI: 0.25, 3.24). DEX also increased CD4+ T cells (SMD = 0.55, 95%CI: 0.29, 0.82) and CD4+/CD8+ ratio (SMD = 0.62, 95%CI: 0.24, 1.01). Thus, DEX was associated with alleviation of postoperative systemic inflammatory response and immune dysfunction. Furthermore, DEX increased mini-mental state examination scores at 12h (SMD = 1.10, 95%CI: 0.74,1.45), 24h (SMD = 0.85, 95%CI: 0.59, 1.11), 48h (SMD = 0.89, 95%CI: 0.50, 1.28) and 72h (SMD = 0.75, 95%CI: 0.38, 1.11) after surgery. DEX decreased the occurrence of postoperative cognitive dysfunction (POCD) at 24h (OR = 0.22, 95%CI: 0.11, 0.46) and 72h (OR = 0.39, 95%CI: 0.22, 0.68) after surgery. DEX decreased first flatus time (SMD = -1.55, 95%CI: -2.82, -0.27) and hospital stay (SMD = -1.23, 95%CI: -1.88, -0.59). Therefore, based on perioperative immune dysfunction alleviation, DEX attenuated POCD and potential neuroinflammation, improved postoperative recovery and clinical prognosis of patients undergoing digest tract cancer surgery. Further studies are necessary to elucidate the clinical application of DEX from an immunological perspective.

Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial

“…Finally, we found that intraoperative dexmedetomidine treatment reduced the length of hospital stay and the incidence of postoperative pulmonary complications. Although the sensitivity analysis and TSA revealed these results to be inconclusive, they were highly consistent with those of other meta-analyses [ 36 , 40 ]. Based on the results, the mechanisms by which dexmedetomidine improves oxygenation and pulmonary function during OLV can be speculated.…”

Trial watch: dexmedetomidine in cancer therapy

“…Two meta-analyses indicated that DEX administered during cancer surgery reduced the secretion of protumorigenic inflammatory cytokines such as IL-6 and TNF-α but increased the levels of circulating T cells. It should be noted that not all included RCTs have investigated DEX-mediated immunomodulation and its consequences on immunosurveillance 59 , 60 ( Figure 4 ). Very few RCTs aimed to evaluate the impact of DEX on recurrence-free survival or overall survival, yielding mostly inconclusive results.…”

“…Both meta-analyses concluded on a DEX-induced decrease in protumor and inflammatory cytokines such as CRP, IL-6, IL-8 and TNF-α. 59 , 60 Many other studies dealing with the surgical removal of various solid primary tumors demonstrated that patients receiving intravenous DEX during the perioperative period had an attenuated increase in glucocorticoid stress compared to the control group. 61–70 Interestingly, two trials observed that DEX affected the activity of the corticotropic axis by attenuating the concentrations of circulating catecholamines and adrenocorticotropic hormone (ACTH).…”

Anesthesia-mediated neuroinflammatory sequelae in post operative cognitive dysfunction: mechanisms and therapeutic implications

“…Zeng et al performed a similar meta-analysis of dexmedetomidine in 2023, which also included data on MMSE testing of post-operative patients to evaluate cognitive functioning (220). The researchers found that there was a significant reduction in POCD occurrence at 12 h, 24 h and 72 h post-surgery (244). Another meta-analysis focused solely on cognitive function, which was evaluated through MMSE testing of post-operative elderly patients, found that dexmedetomidine had a preventative effect on the incidence of POCD (245).…”