The effect of dexmedetomidine premedication on postoperative systemic inflammatory response in children undergoing hernia repair surgery: A randomized controlled trial

Abstract

Background Surgery results in systemic inflammation, which can affect the central nervous system, leading to changes in mood, emotion, and behavior. Our previous study has shown that compared to midazolam, dexmedetomidine premedication effectively decreased children's postoperative anxiety. Aim To investigate whether dexmedetomidine infusion before hernia repair alleviates postoperative systemic inflammation in children and whether postoperative anxiety may be associated with postoperative inflammation. Methods This prospective double‐blind randomized controlled trial was conducted in 120 children scheduled to undergo elective hernia repair. Before anesthesia induction, all children received an intravenous infusion consisted of dexmedetomidine (n = 40; 0.5 µg/g, group D), midazolam (n = 40; 0.08 mg/kg, group M), or normal saline (n = 40; group C). One‐way ANOVA with least significant difference multiple comparison test was used for multigroup comparisons of postoperative plasma levels of inflammatory cytokines and m‐YPAS scores. Spearman rank correlation tests were used for analyzing m‐YPAS scores with postoperative plasma levels of inflammatory cytokines. Results Plasma levels of tumor necrosis factor‐alpha (7.0 ± 1.6 vs. 8.1 ± 1.6, mean difference [95% CI]: 1.19 [0.26–2.11], p = .008) (pg/ml) and of interleukin‐6 (1.8 ± 1.2 vs. 3.3 ± 1.6, mean difference [95% CI]: 1.49 [0.74–2.25], p < .001) (pg/ml) and neutrophils‐to‐lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.7, mean difference [95% CI]: 0.48 [0.17–0.78], p < .001) were significantly lower in group D than in group C. Furthermore, compared to group M, group D showed significantly lower plasma tumor necrosis factor‐alpha levels (7.0 ± 1.6 vs. 7.9 ± 1.9, mean difference [95% CI]: 0.96 [0.04–1.88], p = .04) (pg/ml) and interleukin‐6 levels (1.8 ± 1.2 vs. 2.9 ± 1.5, mean difference [95% CI]: 1.06 [0.31–1.81], p = .004) (pg/ml), and neutrophil‐to‐lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.6, mean difference [95% CI]: 0.42 [0.11–0.72], p = .004). Anxiety scores at postoperative 2 and 4 h in the three groups positively correlated with plasma levels of proinflammatory cytokines. Conclusion A single preoperative intravenous dexmedetomidine dose in children undergoing same‐day surgery reduces postoperative systemic inflammation.

Dexmedetomidine alleviates hippocampal neuronal loss and cognitive decline in rats undergoing open surgery under sevoflurane anaesthesia by suppressing CCAAT/enhancer‐binding protein beta

“…Studies have found that Dex injection during laparoscopic cholecystectomy reduces serum proinflammatory cytokines and the occurrence of POCD (Wu et al, 2022; Yu et al, 2022). Dex was shown to reduce the severity of neuroinflammation and neuronal apoptosis in animal models of systemic inflammatory response syndrome (SIRS) and surgical injury (Du et al, 2021; Wang et al, 2020). Further, Dex treatment decreased the expression of IL‐1β, IL‐6 and TNF‐α and inhibited the activation of astrocytes and microglia in the hippocampus, which in turn attenuated brain injury (Scott et al, 2022; Wu et al, 2020).…”

Effect of Intraoperative Dexmedetomidine Use on Postoperative Delirium in the Elderly After Laryngectomy: A Randomized Controlled Clinical Trial

“…Surgery elicits a systemic inflammatory response 33 that involves the pathophysiology of delirium. 34 Dexmedetomidine has been reported to exert its neuroprotective effect by inhibiting the expression and release of inflammatory factors.…”

Dexmedetomidine activates the PKA/CREB pathway and inhibits proinflammatory factor expression through β2 adrenergic receptors

“…Moreover, DEX has demonstrated the ability to protect against pituitary damage induced by X‐ray radiation by preventing cell apoptosis 5 . Additionally, DEX exhibits superior efficacy in managing mental symptoms such as anxiety and delirium following various surgical procedures, which may be attributed to its anti‐inflammatory properties 6 . Numerous studies have established that DEX can modulate cytokine secretion.…”

“… 5 Additionally, DEX exhibits superior efficacy in managing mental symptoms such as anxiety and delirium following various surgical procedures, which may be attributed to its anti‐inflammatory properties. 6 Numerous studies have established that DEX can modulate cytokine secretion. Notably, DEX significantly inhibits the release of inflammatory factors post‐surgery, including C‐reactive protein, interleukin‐1β, interleukin‐06 (IL‐6), and tumor necrosis factor‐alpha.…”