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

Abstract

Background: Postoperative pulmonary complications (PPCs) are common and significant problems for oral and maxillofacial surgery patients. Dexmedetomidine (DEX), an α 2 -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 μg/kg of DEX was given over 10mins as an initial dose followed by a maintaining dose of 0.4 μg/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.

Pulmonary effects of dexmedetomidine infusion in thoracic aortic surgery under hypothermic circulatory arrest: a randomized placebo-controlled trial

“…However, perioperative infusion of dexmedetomidine in our study neither improved oxygenation and lung mechanics and nor reduced systemic inflammatory insults, which were inconsistent with previous findings 22 – 24 , 31 . Of the primary endpoints of our study, the a/A O 2 , which was used for the power calculation, accurately reflects lung oxygenation and is not easily influenced by FiO 2 .…”

“…In a sepsis model, dexmedetomidine attenuated the level of secondary lung and kidney damage 19 . In clinical studies, the use of dexmedetomidine improved the oxygenation and dynamic compliance in patients with moderate chronic obstructive pulmonary disease (COPD) during lung cancer surgery 23 and prevented the occurrence of postoperative pulmonary complications following orofacial surgery 31 . Moreover, the intraoperative infusion of dexmedetomidine suppressed the increases in the level of high mobility group box-1 and IL-6 after CPB 11 .…”

<p>Activation of PI3K/Akt/HIF-1α Signaling is Involved in Lung Protection of Dexmedetomidine in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Pilot Study</p>

“…Previous literatures also pointed out that continuous infusion of DEX could decrease the occurrence of PPCs during the first seven postoperative days and shorten the length of hospital stay. 42 , 43 Although the average length of hospital stay was 7–8 days in the present study, these patients usually needed 3–4 days approximately to schedule indispensable preoperative examinations; thus, most patients could discharge within 1 day or so after the removal of the drain.…”

Effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery: A Double-Blind, Randomized Trial

“…The protective effects of penehyclidine hydrochloride and dexmedetomidine on pulmonary injury have been con rmed in many animal and human studies, but there are few studies on the effects of penehyclidine hydrochloride and dexmedetomidine on pulmonary complications. Dexmedetomidine has been shown to prevent pulmonary complications after oral and maxillofacial reconstruction [23] and video-assisted thoracoscopic surgery [24] . Although the exact protective mechanism remains to be studied, penehyclidine hydrochloride and dexmedetomidine may play a protective role in pulmonary ischemia/reperfusion injury and anti-in ammatory reaction as described previously.…”