Perioperative application of dexmedetomidine for postoperative systemic inflammatory response syndrome in patients undergoing percutaneous nephrolithotomy lithotripsy: results of a randomised controlled trial

Abstract

ObjectiveOur previous retrospective study demonstrated that perioperative dexmedetomidine (Dex) administration was associated with low systemic inflammatory response syndrome (SIRS) incidence. The present study was designed to investigate whether perioperative administration of Dex decreases the incidence of postpercutaneous nephrolithotomy lithotripsy (PCNL) SIRS in patients who undergo PCNL.DesignA randomised controlled trial was designed.ParticipantsA total of 190 patients were randomly assigned to receive Dex (DEX group, n=95) or saline control (CON group, n=95) and completed the study. In the DEX group, Dex was loaded (1 µg/kg) before anaesthesia induction and was infused (0.5 µg/kg/h) during surgery.OutcomesThe incidences of postoperative SIRS were recorded. Serum interleukin-6 (IL-6) and tumour necrosis factor α(TNF-α) were measured.ResultsThe incidence rates of SIRS were significantly lower in the DEX group than in the CON group (35.8% vs 50.5%, p=0.04). No patients developed sepsis in either group. These results might be attributed to inhibition of inflammatory responses and the resulting lower serum levels of IL-6 and TNF-α, caused by Dex administration. However, compared with the CON group, the lower incidence rate of SIRS in the DEX group did not result in better outcomes, such as shorter postoperative hospitalisation stays and lower costs.ConclusionThe present study showed that Dex administration during PCNL might be beneficial for decreasing the incidence of SIRS through inhibiting the release of inflammatory mediators, but not clinical consequences such as postoperative hospitalisation duration and costs. Further effects of Dex administration on SIRS in patients who are scheduled for PCNL should be explored in future studies.Trial registration numberChiCTR-ICR-15006167.

Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off‑pump coronary‑artery bypass grafting

“…This leads to secondary multiple organ injury and dysfunction, affecting postoperative outcomes (including prolonged hospitalization and increased medical costs) and quality of life (27). The postoperative use of dexmedetomidine in patients in ICU effectively inhibits the release of inflammatory mediators, reducing the incidence rate of systemic inflammatory response syndrome (28)(29)(30)(31). Dexmedetomidine also significantly suppresses the production of lipopolysaccharide-induced proinflammatory mediators, including TNF-α, IL-6, and CRP, both in vivo and in vitro (31)(32)(33)(34).…”

Comparative Evaluation of Dexmeditomidine & Fentanyl in Terms of Cardiovascular Stress Response During Anesthetic Airway Management in Major Surgical Procedures

“…Hyperinflammatory responses damage organs like lung, heart and kidney paving for unfavourable pathological changes, including tissue and cell degeneration, necrosis, changes in hemodynamic like inflammatory hyperaemia, increased vascular permeability (inflammatory exudation), fluid exudation and cellular exudation (inflammatory infiltration) resulting in systemic inflammatory response syndrome: which facilitates secondary multiple organ injury and dysfunction, affecting postoperative outcomes like prolonged hospitalization and increased medical costs. (27,28,29,30,31,32,33,34) Previous researchers proves efficacy of dexmedetomidine as anti-inflammatory agent & potent sedative also because it suppresses the production of lipopolysaccharide-induced proinflammatory mediators, including Tumour necrosis facto-α, Interleukin-6, and CRP, both in vivo and in vitro (31,32,33,34) . Interleukin-10 is a cytokine that inhibits the production of IL-6 and TNF-α decreasing intra & postoperative inflammation (35) .…”

ROLE OF TRANSCRIPTIONAL FACTOR NF-κB IN DEVELOPMENT OF OXIDATIVE STRESS IN HEART OF RATS DURING SYSTEMIC INFLAMMATORY RESPONSE INDUCED BY BACTERIAL LIPOPOLYSACCHARIDE

“…Синдром системної запальної відповіді (ССЗВ) -це клінічний прояв дизрегульованих імунних реакцій на інфекційні та неінфекційні подразники, що розвивається внаслідок дисбалансу у виробництві прозапальних та протиза-пальних цитокінів [1]. До неінфекційних чинників, які здатні викликати розвиток ССЗВ належать травматичні ушкодження різного походження, в тому числі і хірургічні травми [2]. Зокрема складні імплантації штучних клапанів серця можуть ускладнюватись ССЗВ [3].…”