The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass

Abstract

SummaryCardiac surgery with cardiopulmonary bypass is associated with the development of a systemic inflammatory response that can often lead to dysfunction of major organs. We hypothesised that the highly selective a 2 -adrenergic agonist, dexmedetomidine, attenuates the systemic inflammatory response. Forty-two patients were randomly assigned to receive dexmedetomidine or saline after aortic cross-clamping). The mean (SD) levels of the nuclear protein plasma high-mobility group box 1 increased significantly from 5.1 (2.2) ng.ml À1 during (16.6 (7.3) ng.ml À1) and after (14.3 (8.2) ng.ml À1 ) cardiopulmonary bypass in the saline group. In the dexmedetomidine group, the levels increased significantly only during cardiopulmonary bypass (4.0 (1.9) ng.ml À1 baseline vs 10.8 (2.7) ng.ml À1 ) but not after (7.4 (3.8) ng.ml À1). Dexmedetomidine infusion also suppressed the rise in mean (SD) interleukin-6 levels after cardiopulmonary bypass (a rise of 124.5 (72.0) pg.ml À1 vs 65.3 (30.9) pg.ml À1 ). These suppressive effects of dexmedetomidine might be due to the inhibition of nuclear factor kappa B activation and suggest that intra-operative dexmedetomidine may beneficially inhibit inflammatory responses associated with ischaemia-reperfusion injury during cardiopulmonary bypass.

Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery

“…7,20 In addition, dexmedetomidine was found to reduce systemic inflammatory responses in various conditions, thereby diminishing major organ injury. [21][22][23][24] In clinical settings, however, evidence in that regard is scarce with inconsistent results. Prospective studies showed that dexmedetomidine affected urine output but not postoperative creatinine clearance 25 or exerted no effect on either parameter in patients undergoing coronary artery bypass graft surgery.…”

“…6,21 In this study, dexmedetomidine The composite morbidity end points consisted of permanent stroke, acute kidney injury, prolonged ventilator care (448 h), hemostatic reoperation, and deep sternal wound infection.…”

Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery

“…Dexmedetomidine is a selective α 2 -agonist and a sedative with anti-inflammatory, 8,9 analgesic, 10,11 and antiemetic effects, 12 and its use for procedural sedation during endoscopy 13 or ablation for atrial fibrillation has been increasing. 14 It is also used for sedation in the intensive care unit.…”

Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation

“…1 Also, dexmedetomidine has been investigated as a possible opioid-reducing technique 2 and might attenuate perioperative inflammatory responses. 3 For sedation in intensive care units, a slow titration to effect, with or without a loading dose, is acceptable, because a fast onset of effect is often not necessary. However, during procedural sedation or in the operating room, a faster onset of effect is often desired.…”