Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery

Lee, Sang Ho; Lee, Chang Yeong; Lee, Jin Gu; Kim, Namo; Lee, Hye Mi; Oh, Young Jun

doi:10.1097/md.0000000000002854

Cited by 50 publications

(74 citation statements)

References 36 publications

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“…No difference was seen in meta-analysis (risk ratio 3.08, 0.13 to 74.41). Finally, four studies reported on non-epidural analgesic techniques consisting of nerve blocks, intrathecal opiates, and intravenous dexmedetomidine 120121122123. None of the non-epidural analgesic studies reported any difference in PPCs between control and intervention groups.…”

Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

144

120

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OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGNSystematic review and meta-analysis of randomised controlled trials. DATA SOURCESMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIARandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESISReviewers independently identified studies, extracted data, and assessed the quality of evidence. Metaanalyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONSPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGIS...

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Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

144

120

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“…In addition to these effects, dexmedetomidine is important in various tissues via different mechanisms. For example, intraoperative dexmedetomidine improves the quality of recovery and postoperative pulmonary function (6), dexmedetomidine post-conditioning reduces brain injury following brain hypoxia-ischemia in neonatal rats (7,8), and it protects from intestinal ischemia-reperfusion injury (9).…”

Section: Introductionmentioning

confidence: 99%

Reduced mitochondrial response sensitivity is involved in the anti‑apoptotic effect of dexmedetomidine pretreatment in cardiomyocytes

et al. 2018

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Dexmedetomidine is a commonly used α2-adreno-ceptor agonist, which affects various organs, including providing beneficial effects on the heart. However, the mechanism underlying the cardiac benefit remains to be fully elucidated. In the present study, it was demonstrated that dexmedetomidine pretreatment on primary cultured rat cardiomyocytes protected against reactive oxygen species (ROS)‑induced apoptosis. In terms of the potential mechanism, it was demonstrated that dexmedetomidine inhibited mitochondrial biogenesis and mitochondrial respiratory complexes, but with increased coupling efficiency. However, dexmedetomidine upregulated mitochondrial membrane potential (Δψm) and resisted against the loss of Δψm induced by carbonilcyanide p‑triflouromethoxyphenylhydrazone. Due to the importance of mitochondria affecting ROS, the present study investigated the dexmedetomidine‑suppressed mitochondrial response to H2O2 stimulation, which was explained by suppressed ROS levels and the suppression of the increased oxygen consumption rate. Results demonstrated for the first time, to the best of our knowledge, a novel protective mechanism for dexmedetomidine on cardiomyocytes through the attenuated response of mitochondria towards H2O2, which had a protective effect against ROS‑induced apoptosis.

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“…After searching the database and comparing the present criteria, a total of 17 trials were included in the meta-analysis (16,19,20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). These trials are all randomized control trials.…”

Section: Selection Of Trialsmentioning

confidence: 99%

“…Two trials didn't give enough information about their randomization (19,20). Six trials had the right method of their allocation concealment (16,20,27,29,31,33). Blinding was used in thirteen trials (16, 19, 20, 22, 24-27, 29-31, 33, 34).…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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Effect of dexmedetomidine on lung function and prognosis a systematic review and meta-analysis

Chen

Yang

Sun

et al. 2020

Preprint

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Background: This systematic review and meta-analysis aimed to evaluate the effect of dexmedetomidine on lung function and prognosis.Methods: We searched PubMed, Embase and the Cochrane Library from inception to January 30, 2020 following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Randomized controlled trials of dexmedetomidine associated with lung function were assessed. The primary outcomes are pH, PaO2, PaCO2, respiratory index (RI) and time to extubation. The secondary outcomes are PaO2/FiO2, length of hospital stay and events of pulmonary complications.Results: 17 trials of 924 patients were included. Compared with placebo group, dexmedetomidine group had higher PaO2 (MD: 10.96; 95% CI: from 0.77 to 21.15; p=0.04) and PaO2/FiO2 (MD: 30.77; 95% CI: from 19.11 to 42.43; p<0.00001). The dexmedetomidine group had lower PaCO2 (MD: -0.88; 95% CI: from -1.66 to -0.11; p=0.002) and shorter length of hospital stay (MD: -1.19; 95% CI: from -2.21 to -0.16; p=0.02). The dexmedetomidine group had lower occurrence of pulmonary complications (RR: 0.28; 95% CI: from 0.09 to 0.82; p=0.02). However, there is no significant difference in pH, respiratory index and extubation time.Conclusion: Dexmedetomidine has better influence on lung function and prognosis.

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Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery

Cited by 50 publications

References 36 publications

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Reduced mitochondrial response sensitivity is involved in the anti‑apoptotic effect of dexmedetomidine pretreatment in cardiomyocytes

Effect of dexmedetomidine on lung function and prognosis a systematic review and meta-analysis

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