Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

Abstract

The aim of the present study was to compare the effects of two methods of dexmedetomidine (Dex) administration on myocardial injury, inflammation and stress in ischemic myocardium during rheumatic heart valve replacement. In total, 90 patients were included in the present study and were divided into the following three groups: i) Dex group (1.0 µg/kg Dex pre-administered 10 min prior to anesthesia, then 0.5 µg/kg/h Dex for maintenance); ii) Dex pre-conditioning group (Pre-Dex; 1.0 µg/kg Dex administered 10 min prior to anesthesia, then saline for maintenance); and iii) control group (saline 10 min prior to anesthesia and saline during maintenance), with 30 patients in each group. Heart rate (HR) and mean artery pressure (MAP) were recorded at eight time-points: i) T1, pre-medication; ii) T2, 10 min post-medication; iii) T3, immediately post-intubation; iv) T4, upon skin incision; v) T5, upon sawing the sternum; vi) T6, immediately post-cardiopulmonary bypass; vii) T7, immediately post-operation; and viii) T8, 24 h post-operation. The serum cardiac troponin I (cTnI), interleukin (IL)-8, IL-10 and malondialdehyde (MDA) levels were also detected at T1, T6, T7 and T8. Blood glucose levels were detected at T1, T5, T6 and T7. In comparison with the control group, patients in the Dex group exhibited a significant increase in cardiac function, as indicated by an increase in HR, MAP and IL-10 levels, and a significant decrease in cTnI, IL-8, MDA and glucose levels. Both Dex perfusion and Dex preconditioning were able to reduce myocardial injury, inflammation, oxidative stress and stress response in rheumatic heart valve replacement surgery. However, Dex perfusion during the whole surgery was more effective than Dex preconditioning treatment. The study was registered with the Chinese Clinical Trial Registry (ChiCTR; no. ChiCTR-INR-17011955).

Glutathione system enhancement for cardiac protection: pharmacological options against oxidative stress and ferroptosis

“… [ 228 ] DEX Patients undergoing cardiac valve replacement 0.5 μg/kg/h, pumping injection, before induction of anesthesia to the end of surgery Reducing cardiac troponin I and MDA levels and decreasing the incidence of arrhythmias. [ 234 , 235 ] Patients who underwent cardiac surgery 0.24 to 0.6 μg/kg/h, IV, after cardiopulmonary bypass and continued for <24 h postoperatively Reducing postoperative in-hospital, 30-day and 1-year mortality. [ 236 ] Captopril Type 2 diabetes patients 12.5 mg/day, P.O for 3 months Improving the reduced plasma level of GSH.…”

“…In the same year, Wang et al showed that DEX increased the expression levels of SLC7A11 and GPX4 and protected H9C2 cells from hypoxia/reoxygenation injury through the AMPK/GSK-3β/Nrf2 axis [ 233 ]. Moreover, DEX treatment (0.5 μg/kg/h, pumping injection, before induction of anesthesia to the end of surgery) has been reported to reduce cardiac troponin I and MDA levels and to decrease the incidence of arrhythmias in patients undergoing cardiac valve replacement [ 234 , 235 ]. A previous clinical study also showed that perioperative DEX (0.24 to 0.6 μg/kg/h, IV, after cardiopulmonary bypass and continued for <24 hours postoperatively) reduced postoperative in-hospital, 30-day and 1-year mortality in patients who underwent cardiac surgery [ 236 ].…”

Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

“…However, it reduces pain and prolongs analgesia (Wang et al 2018 ). Meanwhile, DEX preconditioning provides cardiac protection through reduced myocardial injury and inflammatory stress response in cardiac surgery (Chen et al 2021 ).…”

Amelioration of myocardial ischemia/reperfusion injury in diabetes: A narrative review of the mechanisms and clinical applications of dexmedetomidine

“…DEX has been recommended to be used as an auxiliary sedative for cardiac patients. For those who underwent cardiac surgery with cardiopulmonary bypass (CPB), a loading dose of 1 μg/kg DEX with a continued infusion at 0.5 μg/kg/h could reduce intraoperative myocardial injury and attenuate inflammatory responses and oxidative stress, as evidenced by decreases in CK-MB, inflammatory factors and MDA ( Bayram et al, 2014 ; Chen et al, 2021 ). A retrospective study of 2,068 cardiac surgery patients showed that DEX pretreatment was associated with a better cardiac outcome and a 7% increase in 5-year patient survival ( Peng et al, 2021 ) ( Table 1 ).…”