Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials

Huang, Suqin; Zhang, Jian; Zhang, Xiong-Xin; Liu, Lu; Yu, Yang; Kang, Xianhui; Wu, Xiaomin; Zhu, Shengmei

doi:10.4103/0366-6999.209891

Cited by 35 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One-lung ventilation (OLV) refers to mechanical separation of the two lungs for independent ventilation of one lung from the other (1,2) in order to provide a suitable operating space for the surgeon, and to protect the healthy lung against bleeding or edema caused by the damaged lung (3,4). Nevertheless, OLV can lead to a mismatch in ventilation/perfusion (V/Q) ratio consequently leading to increased intrapulmonary shunt as well as hypoxemia (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. the effects of dexmedetomidine on HPV as well as the extent of oxygen saturation during OLV (3,5).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

et al. 2020

View full text Add to dashboard Cite

Background:One-lung ventilation (OLV) is commonly used during thoracic surgery. At this time, hypoxemia is considered one of the remarkable consequences of the anesthesia management. Hypoxic pulmonary vasoconstriction (HPV) is the defense mechanism against hypoxia. Objectives: The aim of the present study was to investigate the effect of infusion of dexmedetomidine on improving the oxygenation during OLV among the adult patients undergoing thoracic surgery. Methods: A total of 42 patients undergoing OLV by general anesthesia with isoflurane inhalation were randomly assigned into two groups: IV infusion of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained throughout the surgery. Hemodynamic parameters, PaO2, PaCO2, and complications at recovery phase were recorded. The collected information was analyzed using SPSS software version 22. Results: In the dexmedetomidine group, the mean hemodynamic parameters had a significant reduction at 30 and 60 minutes following OLV. Administration of dexmedetomidine resulted in a significant increase in the PaCO2 and a reduction in the PaO2 when changing from two-lung ventilation to OLV, where PaO2 reached its maximum value within 10 minutes after OLV in the DISO group, and it began to gradually increase to the end of operation. The duration of the recovery phase, also complications at the recovery phase decreased significantly in DISO group. Conclusions:The results of the study showed that, dexmedetomidine may improve arterial oxygenation during OLV in adult patients undergoing thoracic surgery, and can be a suitable anesthetic agent for thoracic surgery.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A number of previous animal and clinical studies had tried to reveal the various mechanisms which might contribute to the lung protective effect of DEX. First, DEX, as a new highly selective α 2 adrenergic receptor agonist, could alleviate lung injury by improving ventilation/perfusion ratio and oxygenation by directly stimulating α 2B receptors in lung vascular smooth muscles 14 . Second, DEX had direct protective effects on airway.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

Liu

Zhu²,

Zhou

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Postoperative pulmonary complications (PPCs) are common and significant problems for oral and maxillofacial surgery patients. Dexmedetomidine (DEX), an α2-adrenoreceptor agonist, has been proven having lung protection effects. However, since now, there has not been final conclusion about whether DEX can reduce the incidence of PPCs. We hypothesize that, in oral and maxillofacial surgery with fibular free flap reconstruction patients, DEX may decrease the incidence of PPCs.Methods: This was a prospective, double-blind, randomized, placebo-controlled, single-centered trial with two parallel arms. A total of 160 patients at intermediate-to-high risk of PPCs undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy were enrolled and randomized to receive continuous infusion of either DEX or placebo (normal saline). 0.4 ug/kg of DEX was given over 10mins as an initial dose followed by a maintaining dose of 0.4 ug/kg/h till the second day morning after surgery. At the same time, the normal saline was administered a similar quantity. The primary outcome was the incidence of PPCs according to Clavien-Dindo score within 7 days after surgery. Results: The two groups had similar characteristics at baseline. 18(22.5%) of 80 patients administered DEX, and 32(40.0%) of 80 patient administered placebo experienced PPCs within the first 7 days after surgery (relative risk [RR] 0.563,95% confidence interval [CI] 0.346-0.916; P=0.017). In the first 7 days after surgery, the DEX group had a lower incidence of PPCs and a better postoperative survival probability (Log-rank test, P=0.019), and was less prone to occur PPCs (Cox regression, P=0.025, HR=0.516). When the total dose of DEX was more than 328μg, the patients were unlikely to have PPCs (ROC curve, AUC=0.614, P=0.009).Conclusions: For patients undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy who were at intermediate or high risk of developing PPCs, continuous infusion of DEX could decrease the occurrence of PPCs during the first 7 days after surgery and shorten the length of hospital stay after surgery, but did not increase the prevalence of bradycardia or hypotension. Trial registration: Chinese Clinical Trial Registry, www.chictr.org.cn, number: ChiCTR1800016153; Registered on May 15, 2018.

show abstract

“…Therefore, our study was the first prospective clinical trial about the relationship between DEX and PPCs in patients undergoing oral and maxillofacial surgery with microvascular reconstruction and tracheotomy. adrenergic receptor agonist, could alleviate lung injury by improving ventilation/perfusion ratio and oxygenation by directly stimulating α 2B receptors in lung vascular smooth muscles 14 . Second, DEX had direct protective effects on airway.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction: a prospective, double-blind, randomized, placebo-controlled trial

Liu

Zhu²,

Zhou

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Postoperative pulmonary complications (PPCs) are common and significant problems for oral and maxillofacial surgery patients. Dexmedetomidine (DEX), an α2-adrenoreceptor agonist, has been proven having lung protection effects. However, since now, there has not been final conclusion about whether DEX can reduce the incidence of PPCs. We hypothesize that, in oral and maxillofacial surgery with fibular free flap reconstruction patients, DEX may decrease the incidence of PPCs.Methods: This was a prospective, double-blind, randomized, placebo-controlled, single-centered trial with two parallel arms. A total of 160 patients at intermediate-to-high risk of PPCs undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy were enrolled and randomized to receive continuous infusion of either DEX or placebo (normal saline). 0.4ug/kg dose of DEX was given over 10mins as an initial dose followed by a maintaining dose of 0.4ug/kg/h till the second day morning after surgery. At the same time, the normal saline was administered a similar quantity. The primary outcome was the incidence of PPCs according to Clavien-Dindo score within 7 days after surgery.Results: The two groups had similar characteristics at baseline. 18(22.5%) of 80 patients administered DEX, and 32(40.0%) of 80 patient administered placebo experienced PPCs within the first 7 days after surgery (relative ratio [RR] 0.563,95% confidence interval [CI] 0.346-0.916; P=0.017). In the first 7 days after surgery, the DEX group had a lower incidence of PPCs and a better postoperative survival probability (Log-rank test, P=0.019), and was less prone to occur PPCs (Cox regression, P=0.025, HR=0.516). When the total dose of DEX was more than 328μg, the patients were unlikely to have PPCs (ROC curve, AUC=0.614, P=0.009).Conclusions: Continuous infusion of DEX marks a huge decrease in the appearance of PPCs within the first 7days after surgery, for patients undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy.Trial registration: Chinese Clinical Trial Registry, www.chictr.org.cn, number: ChiCTR1800016153; Registered on May 15, 2018.

show abstract

Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials

Cited by 35 publications

References 22 publications

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction: a prospective, double-blind, randomized, placebo-controlled trial

Contact Info

Product

Resources

About