Hepatic protective effect of dexmedetomidine after partial hepatectomy surgery: A prospective controlled study

Abstract

Background: Inflow occlusion of the portal triad is a common blood loss-reducing method during hepatectomy which may induce ischemic-reperfusion injury of the remaining parts of the liver. Dexmedetomidine is used for reducing ischemic-reperfusion injury in hepatectomy. Aim: The aim of this study was to assess the protective effect of dexmedetomidine on liver after partial hepatectomy using inflow occlusion. Setting and Design: This prospective controlled, double-blinded, randomized study included any patients of either sex with age between 20 and 70 years, those in physical status American Society of Anesthesiologists Classes I and II, and those who were planned for partial hepatectomy. Patients and Methods: Patients with elective hepatectomy were randomized into dexmedetomidine group, which received dexmedetomidine at 0.3 mg/kg/h, and control group, which received a placebo. Statistical Analysis: Statistical analysis was performed using IBM SPSS software version 18. Data were tested using Kolmogorov–Smirnov test, independent t -test or Mann–Whitney U-test, and Chi-square or Fisher's exact test. The statistical significance was considered at P < 0.05. Results: Serum albumin, aspartate aminotransferase, alanine aminotransferase, prothrombin time were higher in control group in comparison to dexmedetomidine group. Hypotension duration was lower in control group in comparison to dexmedetomidine group. Vasoconstrictor usage, amount of blood loss, and colloid, crystalloid, and blood given to patients were higher in control group in comparison to the study group. Conclusions: Dexmedetomidine can protect the liver during hepatic resection surgery with inflow occlusion with decreasing blood loss and need for blood transfusion.

The Protective Effect of Dexmedetomidine Against Ischemia-Reperfusion Injury after Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

“…TBIL content was reported in two studies (Ding et al, 2018;Taman and Elhefnawy, 2019). Pooled results with a fixed effect model revealed that dexmedetomidine inhibited the increase in TBIL level at 24 h after surgery compared with control (WMD −4.51, 95% CI: −7.32-−1.71, p 0.002, I 2 0%) (Figure 2G).…”

“…A detailed overview of PRISMA flow chart for database searching and study identification is presented in Figure 1. Eight studies enrolling 468 participants were included in this meta-analysis (Wang et al, 2014;Tan et al, 2016;Zhang et al, 2017;Ding et al, 2018;Jiang et al, 2018;Taman and Elhefnawy, 2019;Xing et al, 2020;Zhang et al, 2020). Characteristics of included RCTs and study participants were summarized in Tables 1, 2.…”

“…Three RCTs were published in English (Wang et al, 2014;Taman and Elhefnawy, 2019;Zhang et al, 2020), while the other five were published in Chinese with English abstracts (Tan et al, 2016;Zhang et al, 2017;Ding et al, 2018;Jiang et al, 2018;Xing et al, 2020). These studies all involved one control and one dexmedetomidine intervention group, except one trial which set one control and two intervention groups (same dose of dexmedetomidine given through portal vein and internal jugular vein, respectively) (Xing et al, 2020).…”

“…In subsequent analysis, this three-arm trial was considered as two independent double-arm trials to facilitate data merging. Dexmedetomidine administration was given intravenously by using a loading dose plus continuous infusion in five studies (Wang et al, 2014;Tan et al, 2016;Zhang et al, 2017;Ding et al, 2018;Zhang et al, 2020), a constant administration rate ranging from 0.3 to 0.5 μg/kg/h in two studies (Jiang et al, 2018;Taman and Elhefnawy, 2019), and a single dose injection in one study (Xing et al, 2020). Dexmedetomidine and control were given before or during the operation except for one study in which they were given during postoperative stay in anesthesia intensive care unit (AICU) (Jiang et al, 2018).…”

“…Animal experiments showed that dexmedetomidine decreased hepatic IR induced oxidative stress and inflammatory responses in liver, serum, and other remote organs (Sahin et al, 2013;Tüfek et al, 2013;Kucuk et al, 2014). Several clinical studies in recent years also proved the hepatoprotective properties of dexmedetomidine against IR injury in patients receiving hepatectomy (Wang et al, 2014;Taman and Elhefnawy, 2019;Zhang et al, 2020). Although most of these researches yield a positive outcome, a comprehensive meta-analysis is still needed to fully evaluate the protective effect of dexmedetomidine on hepatic IR injury.…”