The cardioprotective effect of dexmedetomidine on elderly patients with cervical cancer in the Trendelenburg position

Objectives: To investigate the cardioprotective effect of dexmedetomidine(DEX) on elderly patients with cervical cancer in the Trendelenburg position (TP).

Methods: Eighty patients with cervical cancer presenting with laparoscopic radical hysterectomy (or with laparoscopic pelvic lymphadenectomy) were randomly assigned to the control group (Group C) or the DEX group (Group D), with a total of 40 patients per group. Patients in Group D were given dexmedetomidine, whereas normal saline was administered as placebo in Group C. The data collected for this study included general information (age, body mass index [BMI], anesthesia time, operation time, extubation time and hospital stay), hemodynamic parameters (Heart rate [HR] and mean arterial pressure [MAP]), concentrations of markers of myocardial injury (cardiac troponin I [cTnI] , creatine kinase MB [CK-MB]) and inflammatory factors (Tumor necrosis factor α [TNF-α] , interleukin 6 [IL-6], and C-reactive protein [CRP]) before entering the operating room (T0), 6 h after the surgery(T9) and 24 h after the surgery (T10).

Results: Compared to T0, cTnI, CK-MB, TNF-α, IL-6 and CRP were significantly higher at T9 and T10, while cTnI, CK-MB, IL-6 and CRP were significantly lower in group D than those of group C at T9 and T10. Whilst there was no significant difference in TNF-α between the two groups at T9 (P = 0.821), TNF-α concentrations were significantly lower in group D compared to group C at T10 (P = 0.022). Extubation time (P = 0.009) and hospital stay (P = 0.014) were significantly lower in group D, than in group C. There was no significant difference in the adverse reactions between the two groups (P = 0.263).

Conclusions: In elderly patients with cervical cancer, TP may cause perioperative myocardial damage. DEX could mitigate the damaging effects and show good hemodynamic stability, which is conducive to rapid postoperative resuscitation, and anti-inflammatory mechanism may play an important role.

Dexmedetomidine; Trendelenburg position; Cervical cancer; Myocardial protection

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