Dexmedetomidine Combined with General Anesthesia Provides Similar Intraoperative Stress Response Reduction When Compared with a Combined General and Epidural Anesthetic Technique

Li, Yun; Wang, Bin; Zhang, Lili; He, Shuqing; Hu, Xianwen; Wong, Gordon; Zhang, Ye

doi:10.1213/ane.0000000000001165

Cited by 81 publications

(78 citation statements)

References 54 publications

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“…21 The other study compared a dexmedetomidine infusion group with two other groups (epidural and control, n = 30 each group) during a gastrectomy and showed that dexmedetomidine decreased emergence agitation compared with the control (7% vs 27%). 22 Our result is in line with these previous studies. According to our distribution graph of Riker scales, most patients were scale 4 (calm, 41/60, 68.3%) in the DEX-Sevo group.…”

Section: Discussionsupporting

confidence: 94%

Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial

Kim

Ahn

Yang

et al. 2019

Can J Anesth/J Can Anesth

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Section: Discussionsupporting

confidence: 94%

Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial

Kim

Ahn

Yang

et al. 2019

Can J Anesth/J Can Anesth

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“…Dexmedetomidine can be used as an adjuvant in the perioperative setting. When administered during surgery, dexmedetomidine reduces the consumption of opioids and anaesthetics, and blunts the stress response via reduced levels of serum catecholamines, cortisol and cytokines. Intraoperative dexmedetomidine has been shown to reduce the incidence of delirium in children.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery

Li¹,

Wang²,

Mu³

et al. 2020

British Journal of Surgery

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Background Delirium is common in elderly patients after surgery and is associated with poor outcomes. This study aimed to investigate the impact of intraoperative dexmedetomidine on the incidence of delirium in elderly patients undergoing major surgery. Methods This was a randomized double‐blind placebo‐controlled trial. Elderly patients (aged 60 years or more) scheduled to undergo major non‐cardiac surgery were randomized into two groups. Patients in the intervention group received a loading dose of dexmedetomidine 0·6 μg/kg 10 min before induction of anaesthesia followed by a continuous infusion (0·5 μg per kg per h) until 1 h before the end of surgery. Patients in the control group received volume‐matched normal saline in the same schedule. The primary outcome was the incidence of delirium during the first 5 days after surgery. Delirium was assessed with the Confusion Assessment Method (CAM) for non‐ventilated patients and CAM for the Intensive Care Unit for ventilated patients. Results In total, 309 patients who received dexmedetomidine and 310 control patients were included in the intention‐to‐treat analysis. The incidence of delirium within 5 days of surgery was lower with dexmedetomidine treatment: 5·5 per cent (17 of 309) versus 10·3 per cent (32 of 310) in the control group (relative risk (RR) 0·53, 95 per cent c.i. 0·30 to 0·94; P = 0·026). The overall incidence of complications at 30 days was also lower after dexmedetomidine (19·4 per cent (60 of 309) versus 26·1 per cent (81 of 310) for controls; RR 0·74, 0·55 to 0·99, P = 0·047). Conclusion Intraoperative dexmedetomidine halved the risk of delirium in the elderly after major non‐cardiac surgery. Registration number: ChiCTR‐IPR‐15007654 ( http://www.chictr.org.cn).

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“…NE, E, Cor, tumor necrosis factor-α and IL-6 compared with combined general and epidural anesthesia. What's more, the former obtained hemodynamic stability and less adverse effects during the surgery [27]. As a preanesthetic medication (1 μg/kg) and intraoperative infusion (0.5 μg/kg/h), DEX was found to be effective in suppressing metabolic stress response to major abdominal surgeries as indicated by stable blood glucose levels [28].…”

Section: Discussionmentioning

confidence: 96%

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

Qin

Xiang

et al. 2019

Preprint

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Background: Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it. Methods: One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 µg/kg), medium (0.50 µg/kg) or high dose (1.0 µg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block ( n = 25). The primary outcomes were stress marker levels during the operation. Results: One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner ( P < 0.05 ), accompanied with decreased anesthetic and opioid consumption during the operation ( P < 0.05 ), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine ( P < 0.05 ). Conclusion: The addition of dexmedetomidine at the dose of 0.5 µg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery. Trial registration : This study was registered at www.chictr.org.cn on November 6th, 2016 (ChiCTR-IOR-16009753). Keywords: Dexmedetomidine, Nerve block, Abdominal muscles, Stress response, Laparoscopy

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Dexmedetomidine Combined with General Anesthesia Provides Similar Intraoperative Stress Response Reduction When Compared with a Combined General and Epidural Anesthetic Technique

Abstract: When used in conjunction with TIVA, intraoperative dexmedetomidine blunts surgical stress responses to an extent comparable to combined epidural and general anesthesia without compromising hemodynamic stability and with minimal adverse effects during the intraoperative period.

Cited by 81 publications

References 54 publications

Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial

Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial

Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

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