Preventive Effects of Dexmedetomidine on Renal Dysfunction and Hemodynamic Stability in Malignant Obstructive Jaundice Patients During Peri-Operative Period

Wu, Fan; Duan, Haixia; Xie, Yaying

doi:10.12659/msm.916329

Cited by 12 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In clinical practice, the intraoperative use of dexmedetomidine was mainly used to assist in sedation, maintaining hemodynamic stability and preventing the patient's postoperative delirium. 22,[36][37][38] However, there was currently a lack of clinical evidence for the intraoperative use of dexmedetomidine in the nine types of non-cardiac major surgery to affect postoperative sleep disturbance. Clinicians seemed to have not noticed and considered this problem in their actual work.…”

Section: Discussionmentioning

confidence: 99%

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Duan¹,

Wang²,

Peng³

et al. 2020

NSS

View full text Add to dashboard Cite

The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine. Methods: A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were >6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use. Results: In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43-0.56]) and matched cohort (0.49 [95% CI: 0.42-0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13-0.33; P<0.0001) and 0.30 (95% CI,0.19-0.47; P<0.0001), respectively. In addition, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31-0.44; P<0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P<0.0001) than that in the medium-(0.4-0.6 μg•kg −1 •h −1) and high-dose (0.6-0.8 μg•kg −1 •h −1) groups. Conclusion: Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) is most effective for prevention of postoperative sleep disturbance.

show abstract

Section: Discussionmentioning

confidence: 99%

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Duan¹,

Wang²,

Peng³

et al. 2020

NSS

View full text Add to dashboard Cite

show abstract

“…[3][4][5] Several studies have compared the efficacy of dexmedetomidine at enhancing urine output and at decreasing the concentration of blood urea nitrogen and creatinine after surgery. [6][7][8] However, there is no general consensus about the target dose, timing of initiation and discontinuation of dexmedetomidine in this context. The primary objective of these meta-analyses was to characterize the use of dexmedetomidine and to evaluate its impact on renal markers and outcomes in patients after surgery.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…A total of 19 studies with 3,395 patients were included in the final pooled analyses. [3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23] Of these patients, 1,683 received dexmedetomidine while 1,652 did not. Study review and inclusion is outlined in Figure 1.…”

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

The effect of dexmedetomidine on renal function after surgery: A systematic review and meta‐analysis

Loomba

Villarreal

Dhargalkar

et al. 2021

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

What is known and objective: Acute kidney injury (AKI) is a complication following surgery and has been associated with worsened patient outcomes. Providers have used agents that may confer a degree of renal protection in the perioperative stage.Such is the case of dexmedetomidine, a selective alpha-2 adrenergic agonist used in the intensive care unit (ICU) as a sedative agent. The primary objective of this metaanalysis was to characterize the use of dexmedetomidine and to evaluate its impact on renal markers and outcomes in patients after surgery.Methods: A systematic review of manuscripts was performed to identify patients who received dexmedetomidine after surgery by searching the PubMed, Embase, and Cochrane databases. The following parameters were captured: blood urea nitrogen (BUN), serum creatinine, creatinine clearance, neutrophil gelatinase-associated lipoprotein (NGAL), cystatin C, urine output, duration of mechanical ventilation, ICU length of stay, AKI, need for dialysis, and mortality. Results and Discussion:Nineteen studies with 3,395 patients were included in the analyses. The mean bolus and infusion dose of dexmedetomidine were 0.82 µg/kg and 0.54 mcg/kg/hr, respectively. There was a significant difference in creatinine clearance and NGAL in favour of the dexmedetomidine group. In addition, the dexmedetomidine group had a shorter ICU length of stay, and a lower risk of acute kidney injury and mortality compared to the control. There was no difference in the rest of the parameters. What is new and conclusion: Dexmedetomidine appears to have postoperative renalprotective effects. This is evidenced by lower NGAL levels and increased creatinine clearance in those who received dexmedetomidine. These effects are associated with decreases in ICU length of stay and risk of AKI and mortality. K E Y W O R D S acute kidney injury, blood urea nitrogen, creatinine, dexmedetomidine, length of stay, postoperative complications A systematic review of the literature was performed to identify published retrospective or prospective case series and randomized clinical studies describing the use of dexmedetomidine and its impact on renal function. This was a newly conducted review without a previously established protocol. The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement.

show abstract

“…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

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

Preventive Effects of Dexmedetomidine on Renal Dysfunction and Hemodynamic Stability in Malignant Obstructive Jaundice Patients During Peri-Operative Period

Cited by 12 publications

References 16 publications

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

The effect of dexmedetomidine on renal function after surgery: A systematic review and meta‐analysis

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

Contact Info

Product

Resources

About