Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery

Peng, Ke; Shen, Yue; Ying, Yao; Kiaii, Bob; Rodríguez, Víctor Manuel Velasco; Boyd, Douglas; Lubarsky, David A.; Zhang, Zugui; Xia, Zhengyuan; Feng, Xiao; Yang, Jian; Liu, Hong; Ji, Fu

doi:10.1016/j.bja.2021.03.040

Cited by 28 publications

(22 citation statements)

References 26 publications

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“…A recent study found an association between dexmedetomidine and improved 5-year survival after cardiac surgery. 34 The infusion rate and duration of dexmedetomidine in this trial were in concordance with those in current practice. Dexmedetomidine infusion (0.4 μg/kg/h intraoperatively and 0.1 μg/kg/h postoperatively) has been used in the perioperative setting.…”

Section: Discussionsupporting

confidence: 79%

Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant

Shan

Wang

et al. 2022

JAMA Netw Open

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Section: Discussionsupporting

confidence: 79%

Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant

Shan

Wang

et al. 2022

JAMA Netw Open

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“…In this context, the results of the secondary outcomes were reported as estimated effect size with unadjusted P value, and no firm clinical inferences could be made based on the secondary outcomes. 25…”

Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Long

Feng

Shan

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Results from previous studies evaluating the effects of remote ischemic preconditioning (RIPC) on morbidity and mortality after cardiac surgery are inconsistent. This meta-analysis of randomized controlled trials (RCTs) aims to determine whether RIPC improves cardiac and renal outcomes in adults undergoing cardiac surgery. METHODS: PubMed, EMBASE, and Cochrane Library were comprehensively searched to identify RCTs comparing RIPC with control in cardiac surgery. The coprimary outcomes were the incidence of postoperative myocardial infarction (MI) and the incidence of postoperative acute kidney injury (AKI). Meta-analyses were performed using a random-effect model. Subgroup analyses were conducted according to volatile only anesthesia versus propofol anesthesia with or without volatiles, high-risk patients versus non–high-risk patients, and Acute Kidney Injury Network (AKIN) or Kidney Disease Improving Global Outcomes (KDIGO) criteria versus other criteria for AKI diagnosis. RESULTS: A total of 79 RCTs with 10,814 patients were included. While the incidence of postoperative MI did not differ between the RIPC and control groups (8.2% vs 9.7%; risk ratio [RR] = 0.87, 95% confidence interval [CI], 0.76–1.01, P = .07, I2 = 0%), RIPC significantly reduced the incidence of postoperative AKI (22% vs 24.4%; RR = 0.86, 95% CI, 0.77–0.97, P = .01, I2 = 34%). The subgroup analyses showed that RIPC was associated with a reduced incidence of MI in non–high-risk patients, and that RIPC was associated with a reduced incidence of AKI in volatile only anesthesia, in non–high-risk patients, and in the studies using AKIN or KDIGO criteria for AKI diagnosis. CONCLUSIONS: This meta-analysis demonstrates that RIPC reduces the incidence of AKI after cardiac surgery. This renoprotective effect of RIPC is mainly evident during volatile only anesthesia, in non–high-risk patients, and when AKIN or KDIGO criteria used for AKI diagnosis.

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“…Perioperative dexmedetomidine used decreases the postoperative mortality of patients who underwent heart surgeries and decreased the delirium rate. 98,99 Moreover, some essential variables (eg, consumption of opioids or intraoperative volatile anesthetics) were not included in the final analysis, which was considered as potential factors influencing cancer recurrence. 100,101 In addition, no difference in recurrence-free survival time with or without dexmedetomidine was noted.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Perioperative dexmedetomidine used decreases the postoperative mortality of patients who underwent heart surgeries and decreased the delirium rate. 98 , 99 …”

Section: Future Perspectivesmentioning

confidence: 99%

The Role of Dexmedetomidine in Tumor-Progressive Factors in the Perioperative Period and Cancer Recurrence: A Narrative Review

Cai¹,

Liu²,

Huang³

et al. 2022

DDDT

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Dexmedetomidine, a specific α2 adrenergic receptor agonist, is highly frequently used in the perioperatively for its favorable pharmacology, such as mitigating postoperative cognitive dysfunction. Increasing attention has been recently focused on the effect of whether dexmedetomidine influences cancer recurrence, which urges the discussion of the role of dexmedetomidine in tumor-progressive factors. The pharmacologic characteristics of dexmedetomidine, the tumor-progressive factors in the perioperative period, and the relationships between dexmedetomidine and tumor-progressive factors were described in this review. Available evidence suggests that dexmedetomidine could reduce the degree of immune function suppression, such as keeping the number of CD3+ cells, NK cells, CD4+/CD8+ ratio, and Th1/Th2 ratio stable and decreasing the level of proinflammatory cytokine (interleukin 6 and tumor necrosis factor-alpha) during cancer operations. However, dexmedetomidine exhibits different roles in cell biological behavior depending on cancer cell types. The conclusions on whether dexmedetomidine would influence cancer recurrence could not be currently drawn for the lack of strong clinical evidence. Therefore, this is still a new area that needs further exploration.

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Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery

Cited by 28 publications

References 26 publications

Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant

Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant

Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The Role of Dexmedetomidine in Tumor-Progressive Factors in the Perioperative Period and Cancer Recurrence: A Narrative Review

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