Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: a randomized, placebo-controlled trial

Abstract

Background: Dexmedetomidine has sympatholytic effects. We investigated whether dexmedetomidine could attenuate stress responses in patients undergoing endoscopic transnasal transseptal transsphenoidal surgery. Methods: Forty-six patients were randomized to receive a continuous infusion of 0.9% saline (n = 23) or dexmedetomidine (n = 23). Immediately after general anesthesia induction, the dexmedetomidine group received a loading dose of 1 mcg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.2-0.7 mcg/kg/h and the control group received 0.9% saline at the same volume until 30 min before the end of surgery. Serum levels of epinephrine, norepinephrine, and glucose were assessed before surgery (T1) and the end of drug infusion (T2). The primary outcome was the change in norepinephrine levels between the two time points. Results: Changes (T2-T1 values) in perioperative serum norepinephrine levels were significantly greater in the dexmedetomidine group than in the control group (median difference, 56.9 pg/dL; 95% confidence interval, 20.7 to 83.8 pg/dL; P = 0.002). However, epinephrine level changes did not show significant intergroup differences (P = 0.208). Significantly fewer patients in the dexmedetomidine group than in the control group required rescue analgesics at the recovery area (4.3% vs. 30.4%, P = 0.047). Conclusions: Intraoperative dexmedetomidine administration reduced norepinephrine release and rescue analgesic requirement. Dexmedetomidine might be used as an anesthetic adjuvant in patients undergoing transnasal transseptal transsphenoidal surgery.

Effects of dexmedetomidine on the function of distal organs and oxidative stress after lower limb ischaemia–reperfusion in elderly patients undergoing unilateral knee arthroplasty

“…25 Our results reflected that XOD is a better indicator than inflammatory Attenuation of sympathetic activation to reduce stress response during surgery has been shown to be beneficial for postoperative outcomes. 26 In this study, the level of NE was significantly attenuated after tourniquet release in the Dex group than that of the Control group, indicating that the sympathetic activation induced by IRI was effectively dampened by Dex treatment. Since plasma NE does not penetrate the blood-brain barrier well, release from the adrenal medulla in response to sympathetic stimulation is effectively distinct from that of the central nervous system.…”

“…Surgical stimulus activates the sympathetic nervous system to initiate a cascade of stress responses and pituitary hormone secretion. Attenuation of sympathetic activation to reduce stress response during surgery has been shown to be beneficial for postoperative outcomes 26 . In this study, the level of NE was significantly attenuated after tourniquet release in the Dex group than that of the Control group, indicating that the sympathetic activation induced by IRI was effectively dampened by Dex treatment.…”

“…from that of the central nervous system. 26 We, therefore, speculate that Dex mainly inhibit the release of NE from peripheral presynaptic sympathetic nerve terminals. In addition, although the Ach level was unaffected, the ratio of Ach/NE increased by the administration of Dex in our study.…”

Intranasal dexmedetomidine combined with local anesthesia for conscious sedation during breast lumpectomy: A prospective randomized trial

“…Dexmedetomidine is a highly selective α 2 -adrenoreceptor agonist that induces sedation providing improved hemodynamic stability without eliciting respiratory depression (10)(11)(12)(13). Previous studies have reported that dexmedetomidine is rapidly and efficiently absorbed after intranasal administration, and is better tolerated compared with intravenous administration (14)(15)(16)(17).…”

Immunomodulatory Effects of Perioperative Dexmedetomidine in Ovarian Cancer: An In Vitro and Xenograft Mouse Model Study

“…As a highly selective a2 agonist, dexmedetomidine exhibits a specificity of 1620:1 (a2:a1) which is almost 8 times greater than clonidine (20). Patients that received intraoperative dexmedetomidine showed lower levels of epinephrine, norepinephrine and cortisol during the perioperative period (10,21,22). In fact, intraoperative dexmedetomidine infusion was reported to be as effective as epidural anesthesia in reducing the SSR (23).…”