|Table of Contents|

Effects of continuous intraoperative infusion of dexmedetomidine on perioperative stress and inflammation in patients undergoing general anesthesia:A Meta-analysis

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2021 02
Page:
315-322
Research Field:
Publishing date:

Info

Title:
Effects of continuous intraoperative infusion of dexmedetomidine on perioperative stress and inflammation in patients undergoing general anesthesia:A Meta-analysis
Author(s):
WU MenggeXU JianWU ChangshuaiZHANG BaohuiWANG Kun
Department of Anesthesiology,Harbin Medical University Cancer Hospital,Heilongjiang Harbin 150000,China.
Keywords:
dexmedetomidinestressinflammationsurgical patientsMeta-analysis
PACS:
R730.7
DOI:
10.3969/j.issn.1672-4992.2021.02.029
Abstract:
Objective:To review the effects of perioperative intravenous injection of dexmedetomidine on inflammation and stress response in patients undergoing general anesthesia with meta-analysis approach.Methods:We searched five databases with PubMed,EMBASE,MEDLINE,and Web of Science.A total of 30 randomized controlled trials were collected to evaluate the effects of perioperative intraoperative intravenous infusion of dexmedetomidine on inflammatory and stress responses in patients undergoing general anesthesia.Outcomes included the level of epinephrine,norepinephrine,cortisol,blood glucose,IL-6,TNF-α,CRP,IL-10,IL-1β and WBC.Standard mean difference (SMD) and 95% confidence intervals (CI) were used as combined statistics for continuous outcomes.Results:Dexmedetomidine infusion during anaesthesia inhibited the release of epinephrine,norepinephrine,cortisol,and decreased blood glucose,IL-6,TNF-α,IL-1β and WBC of surgical patients.There was no significant difference in the level of CRP and IL-10.Conclusion:As an anesthetic adjuvant,dexmetomidine can significantly reduce perioperative stress (epinephrine,norepinephrine,plasma cortisol,blood glucose) and inflammation (IL-6,TNF-α,IL-1β and WBC) response,helping to improve the clinical efficacy of patients.But there was no significant difference in the level of CRP and IL-10.

References:

[1] JIANG L,HU M,LU Y,et al.The protective effects of dexmedetomidine on ischemic brain injury:A meta-analysis[J].J Clin Anesth,2017,40:25-32.
[2] LI Y,WANG B,ZHANG L,et al.Dexmedetomidine combined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique[J].Anesth Analg,2016,122(4):1202-1210.
[3] PRIEBE HJ.Pharmacological modification of the perioperative stress response in noncardiac surgery[J].Best Pract Res Clin Anaesthesiol,2016,30(2):171-189.
[4] BEKKER A,HAILE M,KLING R,et al.The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery[J].J Neurosurg Anesthesiol,2013,25(1):16-24.
[5] GOUIN JP,KIECOIT-GIASER JK.The impact of psychological stress on wound healing:methods and mechanisms[J].Crit Care Nurs Clin North Am,2012,24(2):201-213.
[6] LEE C,KIM M.Effects of preanesthetic dexmedetomidine on hemodynamic responses to endotracheal intubation in elderly patients undergoing treatment for hypertension:a randomized,double-blinded trial[J].Korean J Anesthesiol,2017,70(1):39-45.
[7] XIA M,JI NN,DUAN ML,et al.Dexmedetomidine regulate the malignancy of breast cancer cells by activating α2-adrenoceptor/ERK signaling pathway[J].Eur Rev Med Pharmacol Sci,2016,20(16):3500-3506.
[8] SHAMSEER L,MOHER D,CLARKE M,et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015:elaboration and explanation[J].BMJ,2015,349:g7647.
[9] HIGGINS JP,AITMAN DG,GTZSCHE PC,et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[10] HOZO SP,DJULBEGOVIC B,HOZO I.Estimating the mean and variance from the median,range,and the size of a sample[J].BMC Med Res Methodol,2005,5:13.
[11] AMMAR AS,MAHMOUD KM,KASEMY ZA,et al.Cardiac and renal protective effects of dexmedetomidine in cardiac surgeries:A randomized controlled trial[J].Saudi J Anaesth,2016,10(4):395-401.
[12] BULOW NMH,COLPO E,PEREIRA RP,et al.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass[J].Braz J Med Biol Res,2016,49(4):e4646.
[13] CHAVES TP,GOMES JMA,PEREIRA FEC.Hemodynamic and metabolic evaluation of dexmedetomidine and remifentanil continuous infusion in videolaparoscopic cholecystectomy[J].Comparative Study.Rev Bras Anestesiol,2003,53(4):419-430.
[14] CHEN S,HUA F,LU J.Effect of dexmedetomidine on myocardial ischemia-reperfusion injury[J].Int J Clin Exp Med,2015,8(11):21166-21172.
[15] DING L,ZHANG H,MI W,et al.Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy[J].Int J Clin Exp Med,2015,8(7):11388-11395.
[16] DONG W,CHEN MH,YANG YH,et al.The effect of dexmedetomidine on expressions of inflammatory factors in patients with radical resection of gastric cancer[J].Eur Rev Med Pharmacoll Sci,2017,21(15):3510-3515.
[17] EL-MONEIM NMA,SAMY MA,EBRAHIM WA,et al.Effect of morphine versus low and high dose dexmedetomidine on postoperative stress response in patients undergoing cancer surgeries[J].Med J Cairo Univ,2015,83(2):41-46.
[18] GU H,ZHANG M,CAI M,et al.Comparison of adrenal suppression between etomidate and dexmedetomidine in children with congenital heart disease[J].Med Sci Monit,2015,21:1569-1576.
[19] HAN C,JIANG W,GE Z,et al.Effect of dexmedetomidine vs midazolam vs propofol on cytokines production in esophagectomy patients under TIVA:A randomized,controlled clinical study[J].Int J Clin Exp Med,2017,10(11):15755-15761.
[20] HARSOOR SS,DEVIKA RD,LATHASHREE S,et al.Effect of intraoperative dexmedetomidine infusion on sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia[J].J Anaesthesiol Clin Pharmacol,2014,30(1):25-30.
[21] HUANG J,LIU W,ZHAN Y,et al.The effects of dexmedetomidine on inflammatory responses in patients undergoing valve replacement surgery with cardiopulmonary bypass[J].Int J Clin Exp Med,2017,10(4):6482-6488.
[22] JIANG W,HAN C,JIANG W,et al.A comparion of the effects of dexmedetomedine and propofol on stress response in patients undergoing open esophagectomy under total intravenous anesthesia:a randomized controlled trail[J].Int J Clin Exp Med,2016,9(3):6545-6550.
[23] KANG SH,KIM YS,HONG TH.Effects of dexmedetomidine on inflammatory responses in patients undergoing laparoscopic cholecystectomy[J].Acta Anaesthesiol Scand,2013,57(4):480-487.
[24] LEE C,LEE CH,LEE G,et al.The effect of the timing and dose of dexmedetomidine on postoperative delirium in elderly patients after laparoscopic major non-cardiac surgery:A double blind randomized controlled study[J].J Clin Anesth,2018,47:27-32.
[25] LI YH,HE R,CHEN S,et al.Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy[J].Exp Ther Med,2015,10(5):1635-1642.
[26] MUKHTAR AM,OBAYAH EM,HASSONA AM.The use of dexmedetomidine in pediatric cardiac surgery[J].Anesth Analg,2006,103(1):52-56.
[27] REN J,ZHANG H,HUANG L,et al.Protective effect of dexmedetomidine in coronary artery bypass grafting surgery[J].Exp Ther Med,2013,6(2):497-502.
[28] SHAMIM R,SRIVASTAVA S,RASTOGI A,et al.Effect of two different doses of dexmedetomidine on stress response in laparoscopic pyeloplasty:A randomized prospective controlled study[J].Anesth Essays Res,2017,11(4):1030-1034.
[29] SHU A,LIU X,WANG Q,et al.Study on cerebral protective effect of dexmedetomidine during anesthesia in cardiac valve replacement surgery[J].Int J Clin Exp Med,2017,10(1):1066-1072.
[30] SHU A,WANG Q,CHEN X,et al.Study on the cerebral protective effects of dexmedetomidine during anesthesia for surgical correction of congenital heart disease with cardiopulmonary bypass[J].Int J Clin Exp Med,2017,10(12):16562-16568.
[31] SUN Y,YE H,XIA Y,et al.Clinical efficacy of dexmedetomidine in the diminution of fentanyl dosage in pediatric cardiac surgery[J].Minerva Pediatrica,2017,69(3):181-187.
[32] SUN Y,LIU J,YUAN X,et al.Effects of dexmedetomidine on emergence delirium in pediatric cardiac surgery[J].Minerva Pediatrica,2017,69(3):165-173.
[33] UEKI M,KAWASAKI T,HABE K,et al.The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass[J].Anaesthesia,2014,69(7):693-700.
[34] WANG Y,XU X,LIU H,et al.Effects of dexmedetomidine on patients undergoing radical gastrectomy[J].J Surg Res,2015,194(1):147-153.
[35] WANG ZX,HUANG CY,HUA YP,et al.Dexmedetomidine reduces intestinal and hepatic injury after hepatectomy with inflow occlusion under general anaesthesia:A randomized controlled trial[J].Br J Anaesth,2014,112(6):1055-1064.
[36] WU CY,LU YF,WANG ML,et al.Effects of dexmedetomidine infusion on inflammatory responses and injury of lung tidal volume changes during one-lung ventilation in thoracoscopic surgery:a randomized controlled trial[J].Mediators Inflamm,2018,2018:1-8.
[37] XU L,HU Z,SHEN J,et al.Does dexmedetomidine have a cardiac protective effect during non-cardiac surgery? A randomised controlled trial[J].Clin Exp Pharmacol Physiol,2014,41(11):879-883.
[38] YACOUT AG,OSMAN HA,ABDEI-DAEM MH,et al.Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines,stress hormones and recovery profile in major abdominal surgery[J].Alexandria Journal of Medicine,2012,48(1):3-8.
[39] ZHOU H,LU J,SHEN Y,et al.Effects of dexmedetomidine on CD42a+/CD14+,HLADR+/CD14+ and inflammatory cytokine levels in patients undergoing multilevel spinal fusion[J].Clin Neurol Neurosurg,2017,160:54-58.
[40] DESBOROUGH JP.The stress response to trauma and surgery[J].Br J Anaesth,2000,85(1):109-117.
[41] GOUIN JP,KIECOLT-GLASER JK.The impact of psychological stress on wound healing:Methods and mechanisms[J].Crit Care Nurs Clin North Am,2012,24(2):201-213.
[42] BARTOLONI A,POLATI E,FINCO G,et al.The neuroendocrine and metabolic response to surgical stress[J].Chir Ital,1995,47(6):3-11.
[43] SCOTT MJ,MILLER TE.Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes[J].Anesthesiol Clin,2015,33(1):79-91.
[44] HERRMANN A,EBERT AD,GALAZKY I,et al.Neurobehavioral outcome prediction after cardiac surgery:Role of neurobiochemical markers of damage to neuronal and glial brain tissue[J].Stroke,2000,31(3):645-650.
[45] MCBRIDE WT,ARMSTRONG MA,MCBRIDE SJ.Immunomodulation:An important concept in modern anaesthesia[J].Anaesthesia,1996,51(5):465-473.
[46] 魏雅念,王龙,熊琼,等.右美托咪定对小儿心脏手术血流动力学及应激反应影响的Meta分析[J].山西医科大学学报,2017,48(3):287-291. WEI YN,WANG L,XIANG Q,et al.Effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients undergoing cardiac surgery:A meta-analysis[J].J Shanxi Med Univ,2017,48(3):287-291.
[47] O'DWYER MJ,OWEN HC,TORRANCE HD.The perioperative immune response[J].Curr Opin Crit Care,2015,21(4):336-342.
[48] SCHIETROMA M,ROSSI M,FRAIOLI F,et al.Inflammatory markers after laparoscopy versus laparotomy cholecystectomy[J].Ann Ital Chir,2001,72(4):477-482;discussion 482-483.
[49] LI S,YANG Y,YU C,et al.Dexmedetomidine analgesia effects in patients undergoing dental implant surgery and its impact on postoperative inflammatory and oxidative stress[J].Oxid Med Cell Longev,2015,2015:186736.
[50] HUANG Y,LU Y,ZHANG L,et al.Perineural dexmedetomidine attenuates inflammation in rat sciatic nerve via the NF-kappaB pathway[J].Int J Mol Sci,2014,15(3):4049-4059.
[51] WU Y,LIU Y,HUANG H,et al.Dexmedetomidine inhibits inflammatory reaction in lung tissues of septic rats by suppressing TLR4/NF-κB pathway[J].Mediators Inflamm,2013,2013:562154.
[52] CAN M,GUL S,BEKTAS S,et al.Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury[J].Acta Anaesthesiol Scand,2009,53(8):1068-1072.
[53] HOFER S,STEPPAN J,WAGNER T,et al.Central sympatholytics prolong survival in experimental sepsis[J].Crit Care,2009,13(1):R11.

Memo

Memo:
-
Last Update: 1900-01-01