Use of Dexmedetomidine in Liver Disease: A Systematic Review and Meta-Analysis

Soleimanpour, Hassan; Nia, Kavous Shahsavari; Sanaie, Sarvin; Ghojazadeh, Morteza; Alavian, Seyed Moayed

doi:10.5812/hepatmon.98530

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…In general, the hepatoprotective effects of DEX have primarily been attributed to its anti-inflammatory properties. A recent review article further outlines the potential mechanisms by which DEX exerts its hepatoprotective effects, including the downregulation of ICAM-1 expression, the inhibition of iNOS activity, and reductions in the levels of catecholamines, endothelin-1, TNF-α, and IL-10 ( 32 ). In animal models, several signaling pathways, including the TLR-4/NF- κ B ( 33 ), NLRP3 ( 34 ), NLRC5 ( 35 ), PPARgamma/STAT3 ( 36 ), and GSK-3β/MKP-1/Nrf2 signalings ( 37 ), have been shown to be responsible for the hepatoprotective actions of DEX.…”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative dexmedetomidine on hepatic ischemia-reperfusion injury in pediatric living-related liver transplantation: A propensity score matching analysis

et al. 2022

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BackgroundHepatic ischemia-reperfusion injury (HIRI) is largely unavoidable during liver transplantation (LT). Dexmedetomidine (DEX), an α2-adrenergic agonist, exerts a variety of organ-protective effects in pediatric populations. However, evidence remains relatively limited about its hepatoprotective effects in pediatric living-related LT.MethodsA total of 121 pediatric patients undergoing living-related LT from June 2015 to December 2018 in our hospital were enrolled. They were classified into DEX or non-DEX groups according to whether an infusion of DEX was initiated from incision to the end of surgery. Primary outcomes were postoperative liver graft function and the severity of HIRI. Multivariate logistic regression and propensity score matching (PSM) analyses were performed to identify any association.ResultsA 1:1 matching yielded 35 well-balanced pairs. Before matching, no significant difference was found in baseline characteristics between groups except for warm ischemia time, which was longer in the non-DEX group (44 [38–50] vs. 40 [37–44] min, p = 0.017). After matching, the postoperative peak lactic dehydrogenase levels decreased significantly in the DEX group than in the non-DEX group (622 [516–909] vs. 970 [648–1,490] IU/L, p = 0.002). Although there was no statistical significance, a tendency toward a decrease in moderate-to-extreme HIRI rate was noted in the DEX group compared to the non-DEX group (68.6% vs. 82.9%, p = 0.163). Patients in the DEX group also received a significantly larger dosage of epinephrine as postreperfusion syndrome (PRS) treatment (0.28 [0.17–0.32] vs. 0.17 [0.06–0.30] µg/kg, p = 0.010). However, there were no significant differences between groups in PRS and acute kidney injury incidences, mechanical ventilation duration, intensive care unit, and hospital lengths of stay. Multivariate analysis revealed a larger graft-to-recipient weight ratio (odds ratio [OR] 2.657, 95% confidence interval [CI], 1.132–6.239, p = 0.025) and intraoperative DEX administration (OR 0.333, 95% CI, 0.130–0.851, p = 0.022) to be independent predictors of moderate-to-extreme HIRI.ConclusionThis study demonstrated that intraoperative DEX could potentially decrease the risk of HIRI but was associated with a significant increase in epinephrine requirement for PRS in pediatric living-related LT. Further studies, including randomized controlled studies, are warranted to provide more robust evidence.

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Section: Discussionmentioning

confidence: 99%

Effect of intraoperative dexmedetomidine on hepatic ischemia-reperfusion injury in pediatric living-related liver transplantation: A propensity score matching analysis

et al. 2022

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“…This systematic review investigated the role of dexmedetomidine in PS in ED. Dexmedetomidine, due to its hemodynamic profile, is widely used for PS (12); nevertheless, its use in emergency settings has been less studied. The present study aimed to compare the efficacy of dexmedetomidine and other sedative agents in emergency patients by systematically reviewing the current studies.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for Procedural Sedation in the Emergency Department: A Systematic Review

et al. 2021

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Context: Procedural sedation (PS) plays an important role in facilitating emergency procedures. Dexmedetomidine is an alpha-adrenergic agonist which can play a role in this issue. This study aimed to systematically review the literature about the role of dexmedetomidine in PS in the emergency department (ED). Methods: In this study, several databases, namely PubMed, Embase, Ovid, ProQuest, Scopus, Web of Science, and Cochrane Library, were searched since 1999 up to November 30, 2020. The inclusion criteria in this study were randomized clinical trials performed on ED patients using dexmedetomidine for PS and articles only in the English language. The exclusion criteria were the studies that were not clinical trials or were not performed in the ED, low-quality studies or animal studies. Results: A total of 473 articles were identified in this study. Five studies fulfilled the inclusion and exclusion criteria. Three articles studied the adult population. One study used dexmedetomidine in an intranasal way, and one study used an intramuscular route for drug administration. Conclusions: Although the reviewed studies reported dexmedetomidine as a safe and effective agent for PS, there are not sufficient data on this issue. Therefore, it is required to perform further studies to a draw firmer conclusion.

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“…Evidence regarding the safety of the off-label use of DEX in children [ 6 ] and LT recipients [ 34 , 35 ] remains limited. Potential adverse effects include bradycardia, hypertension, hypotension, elevated blood glucose, decreased serum potassium concentration, interaction with tacrolimus, and drug accumulation [ 6 , 35 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

Zhang

Cui

et al. 2021

Ann Transplant

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Background Dexmedetomidine (DEX) attenuates hepatic ischemia-reperfusion injury (HIRI) in adult liver transplantation (LT), but its effects on postoperative liver graft function in pediatric LT remain unclear. We sought to investigate whether intraoperative DEX administration was associated with improved liver graft function in pediatric LT recipients. It was hypothesized that DEX administration was associated with reduced HIRI and improved liver graft function. Material/Methods From November 2015 to May 2020, 54 deceased pediatric LT recipients were categorized into a control group and a DEX group. Intraoperatively, the DEX group received an additional infusion of DEX at 0.4 μg/kg/h from incision to the end of the operation in comparison with the control group. Preoperative, intraoperative, and postoperative data were reviewed. Postoperative liver enzyme levels and HIRI severity were assessed and compared. Independent risk factors for HIRI were determined by multivariate logistic regression analysis using a stepwise forward conditional method. Results We enrolled 28 and 26 patients in the DEX and control groups, respectively. Patients in the DEX group exhibited a reduced incidence of moderate-to-severe HIRI (88.5% vs 60.7%, P =0.020) and decreased level of serum alanine aminotransferase (median [interquartile range]: 407 [230–826] vs 714 [527–1492] IU/L, P =0.048) compared with the controls. Binary logistic analysis revealed that longer cold ischemia time (odds ratio [OR]=1.006; 95% confidence interval [CI]=1.000–1.013; P =0.044) and intraoperative DEX use (OR=0.198; 95% CI=0.045–0.878; P =0.033) were independent predictors for moderate-to-severe HIRI. Conclusions Intraoperative low-dose DEX administration was associated with a lower incidence of moderate-to-severe HIRI in pediatric deceased LT. However, further studies are needed to confirm our results and elucidate the underlying mechanisms.

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Use of Dexmedetomidine in Liver Disease: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 23 publications

Effect of intraoperative dexmedetomidine on hepatic ischemia-reperfusion injury in pediatric living-related liver transplantation: A propensity score matching analysis

Effect of intraoperative dexmedetomidine on hepatic ischemia-reperfusion injury in pediatric living-related liver transplantation: A propensity score matching analysis

Dexmedetomidine for Procedural Sedation in the Emergency Department: A Systematic Review

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

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