Effects of dexmedetomidine on heart rate control and pre-operative outcome in patients with acute aortic dissection: a propensity-matched analysis

Chen, Shenglong; Chai, Yunfei; Wang, Zhonghua; Liu, Xinqiang; Ding, Hongguang; Zeng, Hongke

doi:10.21037/apm-20-363

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…At each time point during the arousal period, the HR of the observation group was lower than that of the control group. e difference may be caused by the inhibition of sympathetic nerve excitement by dexmedetomidine [18]. However, from the point of view of adverse reactions, this inhibitory effect was not serious, and the incidence of adverse reactions of dexmedetomidine during intraoperative wake-up was significantly lower than that of the control group.…”

Section: Discussionmentioning

confidence: 89%

Comparison of Dexmedetomidine and Etomidate on Intraoperative Wake-Up Equality, Hemodynamics, and Cerebral Protection in Operation of the Brain Functional Area

Peng

Guan

2021

Evidence-Based Complementary and Alternative Medicine

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In recent years, with the increasing incidence of brain functional area tumors, the clinical application of functional area tumor resection has become extremely urgent. Intraoperative wake-up is an important auxiliary method of this operation, which can effectively reduce the damage of the brain function area caused by the operation and anesthesia itself while playing the role of auxiliary function area and tumor positioning. However, the intraoperative wake-up requires a higher anesthesia effect, so higher requirements are put forward for the choice of anesthetic drugs. Based on hemodynamic and serum molecular observations, this study found that dexmedetomidine- and etomidate-assisted anesthesia were used for intraoperative wake-up in brain functional area surgery, both of which could maintain hemodynamic stability. In addition, the arousal effect and brain protection of dexmedetomidine were better than those of etomidate, and the incidence of adverse reactions was lower during the arousal period. This can provide relevant reference for clinical improvement of the anesthesia effect and surgical safety of intraoperative wake-up.

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Section: Discussionmentioning

confidence: 89%

Comparison of Dexmedetomidine and Etomidate on Intraoperative Wake-Up Equality, Hemodynamics, and Cerebral Protection in Operation of the Brain Functional Area

Peng

Guan

2021

Evidence-Based Complementary and Alternative Medicine

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“…showed that it can inhibit in ammatory response, improve myocardial ischemia-reperfusion injury, and reduce the cardiovascular response during surgery, thereby stabilizing hemodynamics [20]. Studies have shown that preoperative pretreatment and intraoperative perfusion of dexmedetomidine can reduce heart rate and blood pressure to a certain extent, reduce myocardial oxygen consumption, and contribute to the recovery of damaged myocardium and stable heart rate [21]. Neostigmine, as a cholinesterase inhibitor and as a muscle relaxant antagonist, is often used postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of dexmedetomidine and neostigmine on heart rate in robot-assisted thoracoscopic atrial septal defects repair: a randomized controlled trial

Han,

Zhao,

Lei

et al. 2023

Preprint

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Background Robot-assisted thoracoscopic repair of atrial septal defect is performed under cardiopulmonary bypass (CPB) and the heart beats without stopping, which requires very high control of perioperative heart rate. Heart rate variability (HRV) refers to small changes in the time between successive cardiac cycles, which can reflect autonomic nervous system activity and provide a quantitative assessment of cardiac sympathetic vagal tone and balance. Methods A total of 40 patients undergoing robot-assisted thoracoscopic surgery for atrial septal defect were randomly assigned to two groups receiving neostigmine or dexmedetomidine. we monitored the changes in heart rate and HRV of neostigmine and dexmedetomidine group at five time periods. Results Perioperative data showed that platelet values in the neostigmine group were higher than those in the dexmedetomidine group before surgery and significantly higher than those in the neostigmine group after surgery. In addition, CPB time of the two groups was also significantly different, with the CPB time of neostigmine group being significantly higher than that of dexmedetomidine group (P < 0.05). The comparison of heart rate showed that both drugs could reduce heart rate during surgery to some extent. Neostigmine was more effective than dexmedetomidine in reducing heart rate after CPB initiation. In the analysis of HRV, the values of LF, HF and LF/HF in the neostigmine group have significant differences than those in the dexmedetomidine group(P < 0.05).In addition, the ASDNN and RMSDD value of dexmedetomidine group was significantly higher than that of Neostigmine group in multiple time periods. Conclusions Prophylactic use of small doses of neostigmine to control heart rate is safe and effective under the condition of a certain depth of anesthesia. It has a better effect on lowering heart rate than dexmedetomidine. In addition, although the autonomic nerve regulation ability of patients in the neostigmine group was decreased, it was still higher than that in the dexmedetomidine group to a certain extent. This confirms the usefulness of Neostigmine in cardiopulmonary bypass non-stop surgery. Trial registration: The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2000036140) on August 21, 2020.

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“…The current study showed that DEX administration in patients with Stanford type A AD significantly reduced the use of anti-hypertensive drugs and the required morphine dose. In addition to its sedative effect, DEX is a highly selective α2 adrenergic agonist which could effectively inhibit the production of stress-related catecholamine [Chen 2020], and also exert a synergistic effect with opioids, thus reducing the dose of sedatives and attenuating the impact of morphine on respiration [Xu 2016]. Although this phenomenon was not observed in Stanford type B AD patients, we speculate that it may be because the incidence of pain and the dosage of antihypertensive drugs in Stanford type B AD patients were lower than in type A AD patients.…”

Section: E492mentioning

confidence: 99%

The Preventive Effect of Dexmedetomidine Against Delirium in Patients with Aortic Dissection: A Retrospective Cohort Study

Zhang

Yin

Wang

et al. 2022

HSF

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Background: Dexmedetomidine (DEX) is often used to reduce the incidence of delirium in intensive care unit (ICU) patients. However, it was found in our clinical practice that the incidence of delirium in some patients with aortic dissection (AD) remained high even after using DEX. The aim of the present study was to clarify whether the protective effects of DEX against delirium were different between Stanford type A and B AD patients during ICU stay. Methods: Data of patients with Stanford type A or B AD who were treated in the ICU of our hospital between 2015 and 2018 retrospectively were reviewed. They were divided into four groups: A1 group (Stanford type A AD patients using DEX), A2 group (Stanford type A AD patients without using DEX), B1 group (Stanford type B AD patients using DEX), and B2 group (Stanford type B AD patients without using DEX). Patients in A1 and B1 groups received intravenous administration of DEX within 1 h admission to the ICU and after surgery or stent implantation at a loading dose of 1 µg/kg, followed by continuous infusion of 0.2–0.7 µg/(kg·h) for >24 h. The mortality rate, delirium incidence, length of ICU stay, and drug administration were compared between the four groups. Results: After intravenous administration of DEX, the delirium incidence in B1 group was reduced significantly compared with that in B2 group (2.8% vs. 17.8%, P = 0.04), while there was no significant difference between A1 and A2 group (20.8% vs. 24.3%, P = 0.7). However, DEX administration significantly reduced the use of anti-hypertensive drugs (P = 0.04) and morphine (P = 0.02) in Stanford type A AD patients. Conclusion: The use of DEX reduced the incidence of delirium in Stanford type B AD patients during ICU stay, therefore reducing the risk of medical accidents and risk of rupture of the aortic dissecting aneurysm. The preventive effect of DEX against delirium in Stanford type A AD patients was not obvious, and whether increasing the dosage of DEX could enhance the therapeutic efficacy in this group of patients needs to be further observed in future studies.

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Effects of dexmedetomidine on heart rate control and pre-operative outcome in patients with acute aortic dissection: a propensity-matched analysis

Cited by 3 publications

References 17 publications

Comparison of Dexmedetomidine and Etomidate on Intraoperative Wake-Up Equality, Hemodynamics, and Cerebral Protection in Operation of the Brain Functional Area

Comparison of Dexmedetomidine and Etomidate on Intraoperative Wake-Up Equality, Hemodynamics, and Cerebral Protection in Operation of the Brain Functional Area

Comparison of the effects of dexmedetomidine and neostigmine on heart rate in robot-assisted thoracoscopic atrial septal defects repair: a randomized controlled trial

The Preventive Effect of Dexmedetomidine Against Delirium in Patients with Aortic Dissection: A Retrospective Cohort Study

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