Does dexmedetomidine have a cardiac protective effect during non‐cardiac surgery? A randomised controlled trial

Abstract

This study was designed to determine the effects of dexmedetomidine on perioperative myocardial injury by observing peripheral circulatory changes in response to tracheal intubation and extubation, myocardial enzyme levels, myocardial ischaemia improvements, cardiovascular adverse events and cytokines in patients with coronary heart disease (CHD) undergoing non-cardiac surgery. This study was a prospective, randomized, double-blind trial. Eighty patients having CHD were scheduled for elective hip-replacement surgery and randomly allocated to receive a loading dose of 1 μg/kg dexmedetomidine followed by a 0.2 μg/kg per h infusion (Dex group; n = 40) or normal saline (control group; n = 40). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, rate-pressure product and changes in ST-T segment on the electrocardiogram were recorded every 5 min during surgery. Serum creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), glycogen phosphorylase BB (GP-BB), interleukin (IL)-6 and tumour necrosis factor (TNF)-α protein levels were determined preoperatively, at the end of surgery and 12 and 24 h after surgery. The improvement rate of myocardial ischaemia was higher in the Dex than control group (87.5% vs 32.5%, respectively; P < 0.05). In addition, the Dex group had lower serum CK-MB, IL-6, cTnI and GP-BB concentrations than the control group (P < 0.05). There was no significance difference in TNF-α between the two groups (P > 0.05). Dexmedetomidine can reduce myocardial injury and cytokine levels in patients with CHD undergoing non-cardiac surgery.

Effects of Intraoperative Ketamine Versus Dexmedetomidine on Release of Inflammatory Mediators in Laparoscopic Hysterectomy. Prospective Randomized Trial

“…Similar hemodynamic effects of dexmedetomidine were observed in several studies [19,20,30,31]. This is considered a myocardial protective effect of dexmedetomidine as it prevents the acute increases during airway management, reduces myocardial oxygen demand, and decreases the risk of myocardial injury [32].…”

Does Intraoperative Dexmedetomidine Attenuate Postoperative Inflammatory Response in the Adult Surgical Patients with General Anaesthesia? A Meta-analysis of Randomized Control Trials Studies

“…First, to provide more credible evidence and minimize potential bias, only RCTs were included and the focus was on a specific patient population, namely: general-anaesthetized adults undergoing surgery who had not taken antipsychotic medications and anti-inflammatory drugs (ie steroids, non-steroid anti-inflammatory drugs, etc) for chronic use or treatment with alpha-2 agonists or antagonists recently. In addition, based on the previous meta-analysis, we included four other RCTs (6,7,9,15) and excluded some studies with mixed intervention control and other interferences (3,(12)(13)(14). Though our metaanalysis was in line with the previous meta-analysis, this strict exclusion criteria added robustness to our main finding.…”

Assessment of the effect of dexmedetomidine in high risk cardiac patients undergoing laparoscopic cholecystectomy

“…Xu et al [17] studied the effects of dexmedetomidine on perioperative myocardial injury by observing peripheral circulatory changes in myocardial enzyme levels and hemodynamic changes in patients with coronary heart disease undergoing elective hip replacement surgery. Dexmedetomidine reduced myocardial injury and the patients were hemodynamically stable.…”