Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass

Abstract

Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

Dexmedetomidine reduces the neuronal apoptosis related to cardiopulmonary bypass by inhibiting activation of the JAK2&ndash;STAT3 pathway

“…These results were also in accordance with a previous study that reported that dexmedetomidine reduced the inflammatory response to coronary artery-bypass graft surgery under mini-CPB. 39 …”

Dexmedetomidine Alleviates Postpartum Depressive Symptoms following Cesarean Section in Chinese Women: A Randomized Placebo‐Controlled Study

“…DEX can significantly alleviate persistent postoperative pain, with DEX combined with sufentanil significantly improving postoperative self‐controlled analgesia following cesarean section . Interestingly, both clinical and preclinical studies show DEX to inhibit infection, stress, and inflammatory responses induced by surgical trauma, with stress and immune‐inflammation intimately associated with the pathophysiology of postpartum depressive disorders …”

“…25 Interestingly, both clinical and preclinical studies show DEX to inhibit infection, stress, and inflammatory responses induced by surgical trauma, with stress and immune-inflammation intimately associated with the pathophysiology of postpartum depressive disorders. 26,27 Overall, alterations in NE regulation seem closely linked to the etiology, course, and management of PDS, with a 2 -AR playing an important role, given its regulation of NE release. Consequently, it is proposed that DEX, as a prophylactic intervention, may reduce maternal postpartum depressive disorders.…”

Effects of dexmedetomidine on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis

“…DEX can inhibit the sympathetic nerve, and reduce the release of catechins, which can exert direct and indirect effects on immune cells, and maintain autoimmune stability. In addition, DEX can regulate NF-κB pathway by activating cholinergic anti-inflammatory pathway, which can inhibit the release of IL-10 and TNF-α to achieve anti-inflammatory effects ( 21 ).…”