Article Data

  • Views 540
  • Dowloads 148

Original Research

Open Access

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

  • Jia-Qi Duan1
  • Hou-Gang Huang1
  • Chun-Ling Shui1
  • Wei Jiang1
  • Xi Luo1

1Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Yongchuan, Chongqing province, P. R. China

DOI: 10.22514/sv.2021.007 Vol.17,Issue 5,September 2021 pp.117-121

Submitted: 12 November 2020 Accepted: 14 December 2020

Published: 08 September 2021

*Corresponding Author(s): Hou-Gang Huang E-mail: hhg11112@163.com

Abstract

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.


Keywords

Dexmedetomidine; Trendelenburg position; Cervical cancer; Myocardial protection


Cite and Share

Jia-Qi Duan,Hou-Gang Huang,Chun-Ling Shui,Wei Jiang,Xi Luo. The cardioprotective effect of dexmedetomidine on elderly patients with cervical cancer in the Trendelenburg position. Signa Vitae. 2021. 17(5);117-121.

References

[1] Ward ZJ, Grover S, Scott AM, Woo S, Salama DH, Jones EC, et al. The role and contribution of treatment and imaging modalities in global cervical cancer management: survival estimates from a simulation-based analysis. The Lancet Oncology. 2020; 21: 1089-1098.

[2] Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database of Systematic Reviews. 2014; CD004638.

[3] Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017; 135: 700-710.

[4] Arvizo C, Mehta ST, Yunker A. Adverse events related to Trendelenburg position during laparoscopic surgery. Current Opinion in Obstetrics and Gynecology. 2018; 30: 272-278.

[5] Naqvi SEH, Zaka-Ur-Rab A, Islam N, Ali E. A prospective study of altered inflammatory response and its clinical outcome following laparoscopic and open cholecystectomy. Iranian Journal of Medical Sciences. 2017; 42: 347-353.

[6] Wu XM, Xue ZG, Ma H. Expert consensus on clinical application of dexmedetomidine. Journal of Anesthesiology. 2018; 34: 820-823.

[7] Xu L, Hu Z, Shen J, McQuillan PM. Does dexmedetomidine have a cardiac protective effect during non-cardiac surgery? A randomised con-trolled trial. Clinical and Experimental Pharmacology and Physiology. 2014; 41: 879-883.

[8] Zhou H, Zhou D, Lu J, Wu C, Zhu Z. Effects of pre-cardiopulmonary bypass administration of dexmedetomidine on cardiac injuries and the inflammatory response in valve replacement surgery with a sevoflurane postconditioning protocol. Journal of Cardiovascular Pharmacology. 2019; 74: 91-97.

[9] Funai Y, Pickering AE, Uta D, Nishikawa K, Mori T, Asada A, et al. Systemic dexmedetomidine augments inhibitory synaptic transmission in the superficial dorsal horn through activation of descending noradrenergic control: an in vivo patch-clamp analysis of analgesic mechanisms. Pain. 2014; 155: 617-628.

[10] Sinikoglu NS, Gumus F, Sanli N, Totoz T, Alagol A, Turan N. Cardiac and liver marker alterations after laparoscopic gynaecologic operations. Turkish Journal of Anesthesia and Reanimation. 2015; 43: 73-77.

[11] Xia Z, Tang C, Li J, Zhang Z, Zhao B, Wang S, et al. Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization. Neural Regeneration Research. 2018; 13: 280-288.

[12] Miao M, Xu Y, Li B, Chang E, Zhang L, Zhang J. Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: a meta-analysis of randomized controlled trials. Journal of Clinical Anesthesia. 2020; 65: 109849.

[13] Chen JB, Chen GY, Wei SD, Sun JJ, Liu GB, Xie ZT, et al. Inflammatory factor in donor liver and its effect on recipient myocardial injury after liver transplantation. European Review for Medical and Pharmacological Sciences. 2017; 21: 4362- 4368.

[14] Wu YJ, Wang J. Relationship between IL-6 level and myocardial remodelling in patients with CHF. Chinese Journal of General Practice. 2014; 12: 378-379.

[15] Rodondi N, Marques-Vidal P, Butler J, Sutton-Tyrrell K, Cornuz J, Satterfield S, et al. Markers of atherosclerosis and inflammation for prediction of coronary heart disease in older adults. American Journal of Epidemiology. 2010; 171: 540-549.

[16] Miao Z, Wu P, Wang J, Zhou FC, Lin Y, Lu XY, et al. Whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia for patients with lung cancer undergoing thoracoscopic surgery: a randomized control trial. Pain Physician. 2020; 23: E185-E193.

[17] Xiang H, Hu B, Li Z, Li J. Dexmedetomidine controls systemic cytokine levels through the cholinergic anti-inflammatory pathway. Inflammation. 2014; 37: 1763-1770.

[18] Romero-Sandoval EA, McCall C, Eisenach JC. Alpha2-adrenoreceptor stimulation transforms immune responses in neuritis and blocks neuritis-induced pain. The Journal of Neuroscience. 2005; 25: 8988-8994.

[19] Zhang JJ, Peng K, Zhang J, Meng XW, Ji FH. Dexmedetomidine preconditioning may attenuate myocardial ischemia/reperfusion injury by down-regulating the HMGB1-TLR4-MyD88-NF-кB signaling pathway. PLoS ONE. 2017; 12: e0172006.

[20] Chen J, Jiang Z, Zhou X, Sun X, Cao J, Liu Y, et al. Dexmedetomidine preconditioning protects cardiomyocytes against hypoxia/reoxygenation-induced necroptosis by inhibiting HMGB1-mediated inflammation. Cardiovascular Drugs and Therapy. 2019; 33: 45-54.



Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top