BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provi...BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provide clinical data for improving the postoperative analgesic effect,reducing the risk of cognitive impairment,and decreasing the circulating levels of serum inflammatory factors and stress hormones.AIM To assess the impact of DEX plus ropivacaine-enabled TAPB on pain,postoperative cognitive dysfunction(POCD),and inflammatory/stress factors.METHODS Our patient cohort was randomly divided into control and observation groups(60/group).The observation group used a DEX plus ropivacaine-enabled TAPB,while the control group employed a ropivacaine-enabled TAPB.The pain score[Visual Analogy Scale(VAS),Montreal Cognitive Assessment(MoCA)],serum inflammatory factor level(C-reactive protein,interleukin-6 and tumor necrosis factor-α),serum stress hormone levels(cortisol and adrenaline)and postoperative adverse reactions were compared between the two groups.RESULTS The observation group VAS scores were lower than those of the control group(better analgesic effect,P<0.05).The MoCA and POCD scores decreased post-surgery in the observation group(P<0.05).In the elderly,the overall VAS and MoCA scores were significantly reduced compared with the young group.The C-reactive protein,interleukin-6,tumor necrosis factor-α,cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery(P<0.05).There was no significant difference in adverse reactions between the two groups post-surgery,but the incidence of adverse reactions in the observation group was still lower.DEX continuously inhibited p65-phosphorylation levels in the nuclear factorκB pathway at multiple time points,and its inhibitory effect became more significant over time.CONCLUSION DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels,and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.展开更多
This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging i...This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.展开更多
Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60...Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.展开更多
BACKGROUND Postoperative gastrointestinal recovery affects hospital stay time and patient’s quality of life.Studies suggest that the use of dexmedetomidine during the perioperative period can promote post operational...BACKGROUND Postoperative gastrointestinal recovery affects hospital stay time and patient’s quality of life.Studies suggest that the use of dexmedetomidine during the perioperative period can promote post operational recovery of gastrointestinal function.AIM To evaluate the efficacy and safety of different doses of dexmedetomidine on postoperative gastrointestinal function recovery after laparoscopic colorectal surgery.METHODS In this large-sample,retrospective study,879 patients undergoing laparoscopic colorectal surgery were categorized into three groups:A control group receiving no dexmedetomidine(n=281),a low-dose group receiving an intraoperative bolus of 0.5μg/kg dexmedetomidine followed by a continuous infusion of 0.2μg/kg/hour(n=313),and a high-dose group receiving a 1.0μg/kg bolus followed by a 0.5μg/kg/hour infusion(n=285).Time to postoperative first flatus,feces,and regular diet,and the intake,feeling nauseated,emesis,physical examination,and duration of symptoms score were evaluated.RESULTS Multiple linear regression analysis showed that age,gender,body mass index,American Society of Anesthesi-ologists classification,comorbidities and surgical site were not related to the time to first flatus(all P>0.05).The times to postoperative first flatus,first feces,and regular diet were earlier in both dexmedetomidine groups than the control group(both P<0.05).More patients in the control group experienced postoperative gastrointestinal intolerance(both P<0.05).There was no significant difference between the high-and the low-dose groups(P>0.05).The incidence of intraoperative bradycardia in the high-dose group was higher than that in the control group(19.15%vs 8.19%,P<0.05).CONCLUSION Both low-and high-dose dexmedetomidine regimens enhance postoperative gastrointestinal recovery after laparo-scopic colorectal surgery.The low-dose regimen demonstrates superior safety,supporting its integration into multimodal enhanced recovery pathways.展开更多
Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for in...Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for intraoperative controlled hypotension.Randomized controlled trials were retrieved from PubMed,EMBASE,and the Cochrane Library,and hemodynamic parameters,surgical field score,blood loss,intraoperative fentanyl consumption,operation time,recovery period,emergence time,and adverse events were pooled using R version 4.0.2,with results expressed as standardized mean differences(SMDs)or odds ratios(ORs)with 95%confidence intervals(CIs).Nine RCTs involving 478 patients were included.Compared with esmolol,DEX significantly reduced intraoperative fentanyl requirements(SMD=−5.96,95%CI[−8.48,−3.43],p<0.0001)but was associated with a longer emergence time(SMD=3.11,95%CI[1.93,4.29],p<0.0001).No significant differences were observed in hemodynamic stability,surgical field quality,blood loss,operation time,recovery period,or adverse events.Overall,DEX and esmolol provide comparable hemodynamic control,bleeding conditions,operative duration,and recovery profiles during controlled hypotension,while DEX is associated with reduced intraoperative analgesic requirements and prolonged postoperative sedation.展开更多
Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combinat...Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combination is commonly used in Japan.However,medetomidine is a racemic mixture containing the inactive Renantiomer,which may reduce anesthetic predictability and safety.Objective:The aim of the study was to evaluate the efficacy and safety of a modified anesthetic combination(d MMB),in which dexmedetomidine replaces medetomidine,across three commonly used mouse strains(ICR,C57BL/6,BALB/c).Methods:Male and female mice were administered either MMB or d MMB subcutaneously.Anesthetic depth,recovery profiles,heart rate,SpO_(2),body temperature,ocular opacity,and blood glucose levels were assessed.Atipamezole was used to reverse anesthesia,and thermoregulatory recovery was monitored postinjection.Results:d MMB produced similar anesthetic depth to MMB,with faster and more consistent recovery,particularly in males.Body temperature recovery was significantly enhanced in d MMB-treated B6 males.No significant differences in side effects(ocular opacity or blood glucose levels)were observed between protocols,though strainspecific glucose elevations were noted in d MMB-treated males.Conclusion:d MMB is a safe,effective,and ketamine-free injectable anesthetic protocol,offering advantages in recovery and thermoregulation.It may be a valuable alternative in research settings where ketamine is restricted and medetomidine may become unavailable.展开更多
BACKGROUND The vascular endothelial glycocalyx(VEG)plays a critical role in maintaining vascular barrier integrity,regulating inflammation,and ensuring microcirculatory homeostasis.Surgical stress and systemic inflamm...BACKGROUND The vascular endothelial glycocalyx(VEG)plays a critical role in maintaining vascular barrier integrity,regulating inflammation,and ensuring microcirculatory homeostasis.Surgical stress and systemic inflammation can disrupt the glycocalyx,leading to endothelial dysfunction,impaired microcirculation,and adverse postoperative outcomes.dexmedetomidine(DEX),anα2-adrenergic agonist with anti-inflammatory and organ-protective properties,has been suggested in preclinical and clinical studies to mitigate glycocalyx degradation,yet evidence in gastrointestinal cancer surgery remains limited.AIM To determine whether perioperative DEX attenuates surgical inflammation-induced VEG degradation and preserves endothelial barrier function in patients undergoing gastrointestinal cancer resection.METHODS This was a prospective,single-center,randomized,double-blind,placebo-controlled trial conducted at the First Affiliated Hospital of University of Science and Technology of China.A total of 110 patients undergoing elective gastric or colorectal tumor resection were randomly assigned(1:1)to receive intraoperative DEX or saline placebo.Anesthesia and analgesia were standardized across groups.The primary outcome was plasma syndecan-1 concentration,a marker of endothelial glycocalyx injury,measured at four perioperative timepoints(T0-T3).Secondary outcomes included inflammatory biomarkers[interleukin-6(IL-6),tumor necrosis factor-alpha,C-reactive protein,heparan sulfate],microcirculatory parameters[perfused vessel density(PVD),flow index,P(v-a)CO_(2),lactate],and clinical endpoints[extubation time,opioid use,Visual Analog Scale(VAS)scores,Quality of Recovery-15 Questionnaire(QoR-15),length of stay,and 30-day complications].Postoperative complications were defined by Clavien-Dindo criteria and adjudicated by blinded investigators.The trial was registered prospectively(ChiCTR^(2)500109633)and powered to detect a clinically meaningful difference in syndecan-1 levels.RESULTS A total of 110 patients were randomized equally to the DEX or control group,with well-balanced baseline characteristics.Compared with controls,DEX significantly reduced postoperative infections(7%vs 16%)and intensive care unit admissions(7%vs 13%),shortened extubation time(13.1±3.0 minutes vs 18.4±4.0 minutes;P<0.001),and decreased opioid use(23.1±5.0 mg vs 27.3±6.0 mg;P=0.004)and VAS pain scores(P=0.002).At abdominal closure,DEX attenuated endothelial glycocalyx injury,as evidenced by lower plasma syndecan-1(44.72±7.10 ng/mL vs 48.73±6.26 ng/mL;P=0.002)and heparan sulfate levels(P=0.001).IL-6 was significantly reduced at 24 hours(110.77±29.72 pg/mL vs 138.86±35.95 pg/mL;P<0.0001)and positively correlated with syndecan-1(r=0.71).Microcirculatory function improved with DEX,including higher PVD(21.40±3.50 mm/mm^(2)vs 19.94±2.93 mm/mm^(2);P=0.019),increased flow index,lower P(v-a)CO_(2)(P<0.001),and reduced lactate(P=0.003).DEX also improved recovery outcomes,with higher QoR-15 scores(P=0.001),shorter hospital stays(6.49±1.29 days vs 7.29±1.59 days;P=0.005),and fewer overall 30-day complications(12.7%vs 30.9%;P=0.036).Receiver operating characteristic analysis identified syndecan-1>45 ng/mL at abdominal closure as a potential predictor of postoperative complications(area under the curve=0.68,95%CI:0.59-0.76),and multivariable analysis showed a near-significant association(OR=2.88,P=0.057).Subgroup analyses demonstrated consistent anti-inflammatory and endothelial-protective effects of DEX across age and surgical approach strata.CONCLUSION Perioperative administration of DEX confers significant endothelial-protective effects by mitigating glycocalyx degradation,suppressing systemic inflammation,and promoting enhanced postoperative recovery.These findings support its clinical utility as a valuable adjunctive therapy in the perioperative management of patients undergoing oncologic gastrointestinal surgery.展开更多
BACKGROUND Colorectal surgery is often associated with a high risk of anastomotic leakage.Intraoperative administration of dexmedetomidine(DEX)can improve postoperative gastrointestinal function.AIM To investigate the...BACKGROUND Colorectal surgery is often associated with a high risk of anastomotic leakage.Intraoperative administration of dexmedetomidine(DEX)can improve postoperative gastrointestinal function.AIM To investigate the effects of DEX on anastomotic healing in a rat model of intestinal anastomosis(IA).METHODS Rats were randomly divided into three groups:Sham(underwent abdominal only opening and closure),IA,and IA+DEX.In the IA+DEX group,DEX(5μg/kg)was administered via tail vein infusion one day before and after anesthesia.Intestinal function,inflammation,and barrier integrity were measured based on intestinal propulsion,anastomotic burst pressure,histopathological analysis,immunohistochemical staining,enzyme-linked immunosorbent assay,and Western blotting.In vitro,IEC-6 cells faced lipopolysaccharide-induced injury.DEX(4.8μmol/L)effects on viability,apoptosis,and tight junction proteins were tested with/without the Wnt pathway inhibitor dickkopf-1(DKK-1)(20 ng/mL).β-catenin,glycogen synthase kinase-3 beta(GSK-3β),claudin-1,and zonula occludens-1(ZO-1)were assessed by Western blot.RESULTS Compared with IA,IA+DEX showed a non-significant increase in intestinal propulsion on postoperative day 6 and a significant rise in anastomotic burst pressure on day 7.Histology indicated reduced inflammation and submucosal injury.Serum tumor necrosis factor-alpha and diamine oxidase decreased,while tight junction proteins(claudin-1,ZO-1)increased in IA+DEX.High-throughput sequencing and Western blotting suggested activation of the Wnt/β-catenin pathway as a potential mechanism.In vitro,DEX pretreatment attenuated lipopolysaccharide-induced downregulation of claudin-1 and ZO-1 and reduced apoptosis in IEC-6 cells.These protective effects were reversed by DKK-1,which abolished DEX-mediated Wnt/β-catenin activation(decreasedβ-catenin,increased GSK-3β)and nullified the benefits of DEX on tight junction protein expression.CONCLUSION DEX enhances anastomotic healing and barrier function after IA,partly via Wnt/β-catenin activation,indicating therapeutic potential to improve postoperative outcomes.展开更多
Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected a...Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.展开更多
Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine v...Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.展开更多
Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controll...Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.展开更多
AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection(ESD) between dexmedetomidine-remifentanil and propofolremifentanil.METHODS: Fifty-nine patients scheduled for ESD were...AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection(ESD) between dexmedetomidine-remifentanil and propofolremifentanil.METHODS: Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidineremifentanil(DR) group or a propofol-remifentanil(PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer's Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety.RESULTS: Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group("very easy" 24.1% vs 56.7%, P = 0.010), gastric motility was moresuppressed in the DR group("no + mild" 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group("very good + good" 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group(P = 0.477). CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.展开更多
Traumatic brain injury induces potent inflammatory responses that can exacerbate secondary blood-brain barrier（BBB） disruption, neuronal injury, and neurological dysfunction. Dexmedetomidine is a novel α2-adrenergi...Traumatic brain injury induces potent inflammatory responses that can exacerbate secondary blood-brain barrier（BBB） disruption, neuronal injury, and neurological dysfunction. Dexmedetomidine is a novel α2-adrenergic receptor agonist that exert protective effects in various central nervous system diseases. The present study was designed to investigate the neuroprotective action of dexmedetomidine in a mouse traumatic brain injury model, and to explore the possible mechanisms. Adult male C57 BL/6 J mice were subjected to controlled cortical impact. After injury, animals received 3 days of consecutive dexmedetomidine therapy（25 μg/kg per day）. The modified neurological severity score was used to assess neurological deficits. The rotarod test was used to evaluate accurate motor coordination and balance. Immunofluorescence was used to determine expression of ionized calcium binding adapter molecule-1, myeloperoxidase, and zonula occluden-1 at the injury site. An enzyme linked immunosorbent assay was used to measure the concentration of interleukin-1β（IL-1β）, tumor necrosis factor α, and IL-6. The dry-wet weight method was used to measure brain water content. The Evans blue dye extravasation assay was used to measure BBB disruption. Western blot assay was used to measure protein expression of nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3（NLRP3）, caspase-1 p20, IL-1β, nuclear factor kappa B（NF-κB） p65, occluding, and zonula occluden-1. Flow cytometry was used to measure cellular apoptosis. Results showed that dexmedetomidine treatment attenuated early neurological dysfunction and brain edema. Further, dexmedetomidine attenuated post-traumatic inflammation, up-regulated tight junction protein expression, and reduced secondary BBB damage and apoptosis. These protective effects were accompanied by down-regulation of the NF-κB and NLRP3 inflammasome pathways. These findings suggest that dexmedetomidine exhibits neuroprotective effects against acute（3 days） post-traumatic inflammatory responses, potentially via suppression of NF-κB and NLRP3 inflammasome activation.展开更多
This study aims to elucidate the mechanisms by which dexmedetomidine alleviates pulmonary edema in rats with acute lung injury induced by lipopolysaccharide （LPS）. Male Wistar rats were randomly divided into five gr...This study aims to elucidate the mechanisms by which dexmedetomidine alleviates pulmonary edema in rats with acute lung injury induced by lipopolysaccharide （LPS）. Male Wistar rats were randomly divided into five groups： normal saline control （NS） group, receiving intravenous 0.9% normal saline （5 mL/kg）; LPS group, receiving intravenous LPS （10 mg/kg）; small-dose dexmedetomidine （S） group, treated with a small dose of dexmedetomidine （0.5 μg·kg^-1·h^-1）; medium-dose dexmedetomidine （M） group, treated with a medium dose of dexmedetomidine （2.5 μg·kg^-1·h^-1）; high-dose dexmedetomidine （H） group, treated with a high dose of dexmedetomidine （5μg·kg^-1·h^-1）. The rats were sacrificed 6 h after intravenous injection of LPS or NS, and the hmgs were removed for evaluating histological characteristics and determining the lung wet/dry weight ratio （W/D）. The levels of tumor necrosis factor-alpha （TNF-α） and interleukin-1β （IL-1β） in the lung tissues were assessed by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expression levels of aquaporin-1 （AQP1） and aquaporin-5 （AQP5） were detected by RT-PCR, immunohistochemistry, and Western blot- ting. The lung tissues from the LPS groups were significantly damaged, which were less pronounced in the H group but not in the small-dose dexmedetomidine group or medium-dose dexmedetomidine group. The W/D and the concentrations of TNF-α and IL-1β in the pulmonary tissues were increased in the LPS group as compared with those in NS group, which were reduced in the H group but not in S group or M group （P〈0.01）. The expression of AQP1 and AQP5 was lower in the LPS group than in the NS group, and significantly increased in the H group but not in the S group or M group （P〈0.01）. Our findings suggest that dexmedetomidine may alleviate pulmonary edema by increasing the expression of AQP-1 and AQP-5.展开更多
Dexmedetomidine is a selective α2-adrenoceptor agonist that is used because of its sedative,anxiolytic,and analgesic effects.Dexketoprofen,which is used as an analgesic,is a nonselective nonsteroidal anti-inflammator...Dexmedetomidine is a selective α2-adrenoceptor agonist that is used because of its sedative,anxiolytic,and analgesic effects.Dexketoprofen,which is used as an analgesic,is a nonselective nonsteroidal anti-inflammatory drug (NSAID).The use of dexmedetomidine and dexketoprofen as adjuvants to local anesthetics for the peripheral nerve is gradually increasing.In this study,we aimed to investigate the effects of different doses of dexmedetomidine and dexketoprofen on conduction block of rat sciatic nerve.The isolated sciatic nerve from adult rats was transferred to a nerve chamber.The compound action potentials (CAPs) were recorded from stimulated nerve with electrophysiological methods.Dexmedetomidine (n = 8) and dexketoprofen (n = 8) were administered in the chamber with cumulative concentrations of 10–9 to 10–5 M,and the CAPs were recorded for 5 and 10 minutes.The CAP parameters were calculated.Both dexmedetomidine and dexketoprofen significantly depressed all CAP parameters in a dose-dependent manner compared with the control group,i.e.,the group in which rats did not receive treatment.CAP parameters showed there was no significant difference in nerve conduction inhibition between dexmedetomidine and dexketoprofen.Higher doses of dexmedetomidine suppressed the conduction in the fast-conducting fibers;however,dexketoprofen was found to suppress the conduction in the slow-conducting fibers in a time-dependent manner and suppress the conduction in the medium- and slow-conducting fibers in a dose-dependent manner.These findings suggest that dexmedetomidine and dexketoprofen exhibit better anesthetic effects on peripheral nerve through different ways of action.The experimental procedures were approved by the Necmettin Erbakan University on January 30,2013 (approval No.2013-024).展开更多
Objective To explore the protective effects of dexmedetomidine(Dex)against high glucose-induced epithelial-mesenchymal transition in HK-2 cells and relevant mechanisms.Methods HK-2 cells were exposed to either glucose...Objective To explore the protective effects of dexmedetomidine(Dex)against high glucose-induced epithelial-mesenchymal transition in HK-2 cells and relevant mechanisms.Methods HK-2 cells were exposed to either glucose or glucose+Dex for 6 h.The production of ROS,morphology of HK-2 cells,and cell cycle were detected.Moreover,the expression of AKT,p-AKT,ERK,pERK,PI3 K,E-Cadherin,Claudin-1,andα-SMA were determined and compared between HK-2 cells exposed to glucose and those exposed to both glucose and Dex with or without PI3 K/AKT pathway inhibitor LY294002 and ERK pathway inhibitor U0126.Results Compared with HK-2 cells exposed to high level of glucose,the HK-2 cells exposed to both high level of glucose and Dex showed:(1)lower level of ROS production;(2)cell morphology was complete;(3)more cells in G1 phase;(4)lower expression of p-AKT,p-ERK andα-SMA,higher expression of ECadherin and Claudin-1.PI3 K/AKT inhibitor LY294002 and ERK inhibitor U0126 decreased the expression of p-AKT,p-ERK andα-SMA,and increased the expression of E-Cadherin and Claudin-1.Conclusion Dex can attenuate high glucose-induced HK-2 epithelial-mesenchymal transition by inhibiting AKT and ERK.展开更多
BACKGROUND: Dexmedetomidine has already been used in septic patients as a new sedative agent, few studies have examined its effects on immunomodulation. Therefore, the authors have designed a controlled experimental s...BACKGROUND: Dexmedetomidine has already been used in septic patients as a new sedative agent, few studies have examined its effects on immunomodulation. Therefore, the authors have designed a controlled experimental study to characterize the immunomodulation effects of dexmedetomidine in the cecal ligation and puncture(CLP) model in rats. METHODS: After CLP, 48 Wistar rats were randomly allocated into four groups:(1) CLP group;(2) small-dose treatment group(2.5 g·kg^(-1)·h^(-1));(3) medium-dose treatment group(5.0 g·kg^(-1)·h^(-1)); and(4) large-dose treatment group(10.0 g·kg^(-1)·h^(-1)). HLA-DR and plasma cytokine(IL-4, IL-6, IL-10 and TNF-α) levels were measured, and the mean arterial blood pressure(MAP), heart rate(HR), arterial blood gases, lactate concentrations and mortality were also documented. RESULTS: The HLA-DR level, inflammatory mediator levels, MAP and HR had no obvious changes among Dexmedetomidine treatment groups(DEX groups). Compared with the CLP group, the DEX groups exhibited decreased HLA-DR levels(P_(group)=0.0202) and increased IL-6 production, which was increased at 3 h(P= 0.0113) and was then attenuated at 5 h; additionally, the DEX groups exhibited decreased HR(P<0.001) while maintaining MAP(P_(group)=0.1238), and remarkably improving lactate(P<0.0001). All of these factors led to a significant decrease in the mortality, with observed rates of 91.7%, 66.7%, 25% and 18% for the CLP, DEX2.5, DEX5.0, DEX10.0 groups, respectively.CONCLUSION: Dexmedetomidine treatment in the setting of a CLP sepsis rat model has partially induced immunomodulation that was initiated within 5 h, causing a decreased HR while maintaining MAP, remarkably improving metabolic acidosis and improving mortality dosedependently.展开更多
Summary:Dexmedetomidine(DEX),a potent and highly selective agonist for a2-adrenergic receptors(a2AR),exerts neuroprotective effects by reducing apoptosis through decreased neuronal Ca^2+influx.However,the exact action...Summary:Dexmedetomidine(DEX),a potent and highly selective agonist for a2-adrenergic receptors(a2AR),exerts neuroprotective effects by reducing apoptosis through decreased neuronal Ca^2+influx.However,the exact action mechanism of DEX and its effects on oxygen-glucose deprivation-reoxygenation(OGD/R)injury in vitro are unknown.We demonstrate that DEX pretreatment reduced OGD/R injury in PC12 cells,as evidenced by decreased oxidative stress,autophagy,and neuronal apoptosis.Specifically,DEX pretreatment decreased the expression levels of stromal interaction molecule 1(STIM1)and calcium release-activated calcium channel protein 1(Orail),and reduced the concentration of intracellular calcium pools.In addition,variations in cytosolic calcium concentration altered apoptosis rate of PC12 cells after exposure to hypoxic conditions,which were modulated through STIM 1/Orail signaling.Moreover,DEX pretreatment decreased the expression levels of Beclin-1 and microtubule-associated protein 1A/1B-light chain 3(LC3),hallmark markers of autophagy,and the formation of autophagosomes.In conclusion,these results suggested that DEX exerts neuroprotective effects against oxidative stress,autophagy,and neuronal apoptosis afier OGD/R injury via modulation of Caf-STIM1/Orai1 signaling.Our results offer insights into the molecular mechanisms of DEX in protecting against neuronal ischemia-reperfusion injury.展开更多
BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extr...BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.40.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.展开更多
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
文摘BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provide clinical data for improving the postoperative analgesic effect,reducing the risk of cognitive impairment,and decreasing the circulating levels of serum inflammatory factors and stress hormones.AIM To assess the impact of DEX plus ropivacaine-enabled TAPB on pain,postoperative cognitive dysfunction(POCD),and inflammatory/stress factors.METHODS Our patient cohort was randomly divided into control and observation groups(60/group).The observation group used a DEX plus ropivacaine-enabled TAPB,while the control group employed a ropivacaine-enabled TAPB.The pain score[Visual Analogy Scale(VAS),Montreal Cognitive Assessment(MoCA)],serum inflammatory factor level(C-reactive protein,interleukin-6 and tumor necrosis factor-α),serum stress hormone levels(cortisol and adrenaline)and postoperative adverse reactions were compared between the two groups.RESULTS The observation group VAS scores were lower than those of the control group(better analgesic effect,P<0.05).The MoCA and POCD scores decreased post-surgery in the observation group(P<0.05).In the elderly,the overall VAS and MoCA scores were significantly reduced compared with the young group.The C-reactive protein,interleukin-6,tumor necrosis factor-α,cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery(P<0.05).There was no significant difference in adverse reactions between the two groups post-surgery,but the incidence of adverse reactions in the observation group was still lower.DEX continuously inhibited p65-phosphorylation levels in the nuclear factorκB pathway at multiple time points,and its inhibitory effect became more significant over time.CONCLUSION DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels,and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.
文摘This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.
文摘Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.
基金Supported by the Natural Science Foundation of Fujian Province,No.2021J011438。
文摘BACKGROUND Postoperative gastrointestinal recovery affects hospital stay time and patient’s quality of life.Studies suggest that the use of dexmedetomidine during the perioperative period can promote post operational recovery of gastrointestinal function.AIM To evaluate the efficacy and safety of different doses of dexmedetomidine on postoperative gastrointestinal function recovery after laparoscopic colorectal surgery.METHODS In this large-sample,retrospective study,879 patients undergoing laparoscopic colorectal surgery were categorized into three groups:A control group receiving no dexmedetomidine(n=281),a low-dose group receiving an intraoperative bolus of 0.5μg/kg dexmedetomidine followed by a continuous infusion of 0.2μg/kg/hour(n=313),and a high-dose group receiving a 1.0μg/kg bolus followed by a 0.5μg/kg/hour infusion(n=285).Time to postoperative first flatus,feces,and regular diet,and the intake,feeling nauseated,emesis,physical examination,and duration of symptoms score were evaluated.RESULTS Multiple linear regression analysis showed that age,gender,body mass index,American Society of Anesthesi-ologists classification,comorbidities and surgical site were not related to the time to first flatus(all P>0.05).The times to postoperative first flatus,first feces,and regular diet were earlier in both dexmedetomidine groups than the control group(both P<0.05).More patients in the control group experienced postoperative gastrointestinal intolerance(both P<0.05).There was no significant difference between the high-and the low-dose groups(P>0.05).The incidence of intraoperative bradycardia in the high-dose group was higher than that in the control group(19.15%vs 8.19%,P<0.05).CONCLUSION Both low-and high-dose dexmedetomidine regimens enhance postoperative gastrointestinal recovery after laparo-scopic colorectal surgery.The low-dose regimen demonstrates superior safety,supporting its integration into multimodal enhanced recovery pathways.
文摘Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for intraoperative controlled hypotension.Randomized controlled trials were retrieved from PubMed,EMBASE,and the Cochrane Library,and hemodynamic parameters,surgical field score,blood loss,intraoperative fentanyl consumption,operation time,recovery period,emergence time,and adverse events were pooled using R version 4.0.2,with results expressed as standardized mean differences(SMDs)or odds ratios(ORs)with 95%confidence intervals(CIs).Nine RCTs involving 478 patients were included.Compared with esmolol,DEX significantly reduced intraoperative fentanyl requirements(SMD=−5.96,95%CI[−8.48,−3.43],p<0.0001)but was associated with a longer emergence time(SMD=3.11,95%CI[1.93,4.29],p<0.0001).No significant differences were observed in hemodynamic stability,surgical field quality,blood loss,operation time,recovery period,or adverse events.Overall,DEX and esmolol provide comparable hemodynamic control,bleeding conditions,operative duration,and recovery profiles during controlled hypotension,while DEX is associated with reduced intraoperative analgesic requirements and prolonged postoperative sedation.
文摘Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combination is commonly used in Japan.However,medetomidine is a racemic mixture containing the inactive Renantiomer,which may reduce anesthetic predictability and safety.Objective:The aim of the study was to evaluate the efficacy and safety of a modified anesthetic combination(d MMB),in which dexmedetomidine replaces medetomidine,across three commonly used mouse strains(ICR,C57BL/6,BALB/c).Methods:Male and female mice were administered either MMB or d MMB subcutaneously.Anesthetic depth,recovery profiles,heart rate,SpO_(2),body temperature,ocular opacity,and blood glucose levels were assessed.Atipamezole was used to reverse anesthesia,and thermoregulatory recovery was monitored postinjection.Results:d MMB produced similar anesthetic depth to MMB,with faster and more consistent recovery,particularly in males.Body temperature recovery was significantly enhanced in d MMB-treated B6 males.No significant differences in side effects(ocular opacity or blood glucose levels)were observed between protocols,though strainspecific glucose elevations were noted in d MMB-treated males.Conclusion:d MMB is a safe,effective,and ketamine-free injectable anesthetic protocol,offering advantages in recovery and thermoregulation.It may be a valuable alternative in research settings where ketamine is restricted and medetomidine may become unavailable.
文摘BACKGROUND The vascular endothelial glycocalyx(VEG)plays a critical role in maintaining vascular barrier integrity,regulating inflammation,and ensuring microcirculatory homeostasis.Surgical stress and systemic inflammation can disrupt the glycocalyx,leading to endothelial dysfunction,impaired microcirculation,and adverse postoperative outcomes.dexmedetomidine(DEX),anα2-adrenergic agonist with anti-inflammatory and organ-protective properties,has been suggested in preclinical and clinical studies to mitigate glycocalyx degradation,yet evidence in gastrointestinal cancer surgery remains limited.AIM To determine whether perioperative DEX attenuates surgical inflammation-induced VEG degradation and preserves endothelial barrier function in patients undergoing gastrointestinal cancer resection.METHODS This was a prospective,single-center,randomized,double-blind,placebo-controlled trial conducted at the First Affiliated Hospital of University of Science and Technology of China.A total of 110 patients undergoing elective gastric or colorectal tumor resection were randomly assigned(1:1)to receive intraoperative DEX or saline placebo.Anesthesia and analgesia were standardized across groups.The primary outcome was plasma syndecan-1 concentration,a marker of endothelial glycocalyx injury,measured at four perioperative timepoints(T0-T3).Secondary outcomes included inflammatory biomarkers[interleukin-6(IL-6),tumor necrosis factor-alpha,C-reactive protein,heparan sulfate],microcirculatory parameters[perfused vessel density(PVD),flow index,P(v-a)CO_(2),lactate],and clinical endpoints[extubation time,opioid use,Visual Analog Scale(VAS)scores,Quality of Recovery-15 Questionnaire(QoR-15),length of stay,and 30-day complications].Postoperative complications were defined by Clavien-Dindo criteria and adjudicated by blinded investigators.The trial was registered prospectively(ChiCTR^(2)500109633)and powered to detect a clinically meaningful difference in syndecan-1 levels.RESULTS A total of 110 patients were randomized equally to the DEX or control group,with well-balanced baseline characteristics.Compared with controls,DEX significantly reduced postoperative infections(7%vs 16%)and intensive care unit admissions(7%vs 13%),shortened extubation time(13.1±3.0 minutes vs 18.4±4.0 minutes;P<0.001),and decreased opioid use(23.1±5.0 mg vs 27.3±6.0 mg;P=0.004)and VAS pain scores(P=0.002).At abdominal closure,DEX attenuated endothelial glycocalyx injury,as evidenced by lower plasma syndecan-1(44.72±7.10 ng/mL vs 48.73±6.26 ng/mL;P=0.002)and heparan sulfate levels(P=0.001).IL-6 was significantly reduced at 24 hours(110.77±29.72 pg/mL vs 138.86±35.95 pg/mL;P<0.0001)and positively correlated with syndecan-1(r=0.71).Microcirculatory function improved with DEX,including higher PVD(21.40±3.50 mm/mm^(2)vs 19.94±2.93 mm/mm^(2);P=0.019),increased flow index,lower P(v-a)CO_(2)(P<0.001),and reduced lactate(P=0.003).DEX also improved recovery outcomes,with higher QoR-15 scores(P=0.001),shorter hospital stays(6.49±1.29 days vs 7.29±1.59 days;P=0.005),and fewer overall 30-day complications(12.7%vs 30.9%;P=0.036).Receiver operating characteristic analysis identified syndecan-1>45 ng/mL at abdominal closure as a potential predictor of postoperative complications(area under the curve=0.68,95%CI:0.59-0.76),and multivariable analysis showed a near-significant association(OR=2.88,P=0.057).Subgroup analyses demonstrated consistent anti-inflammatory and endothelial-protective effects of DEX across age and surgical approach strata.CONCLUSION Perioperative administration of DEX confers significant endothelial-protective effects by mitigating glycocalyx degradation,suppressing systemic inflammation,and promoting enhanced postoperative recovery.These findings support its clinical utility as a valuable adjunctive therapy in the perioperative management of patients undergoing oncologic gastrointestinal surgery.
基金Supported by the Fujian Province Natural Science Foundation,No.2021J011438Longyan City Science and Technology Plan Project,No.2022 LYF17099.
文摘BACKGROUND Colorectal surgery is often associated with a high risk of anastomotic leakage.Intraoperative administration of dexmedetomidine(DEX)can improve postoperative gastrointestinal function.AIM To investigate the effects of DEX on anastomotic healing in a rat model of intestinal anastomosis(IA).METHODS Rats were randomly divided into three groups:Sham(underwent abdominal only opening and closure),IA,and IA+DEX.In the IA+DEX group,DEX(5μg/kg)was administered via tail vein infusion one day before and after anesthesia.Intestinal function,inflammation,and barrier integrity were measured based on intestinal propulsion,anastomotic burst pressure,histopathological analysis,immunohistochemical staining,enzyme-linked immunosorbent assay,and Western blotting.In vitro,IEC-6 cells faced lipopolysaccharide-induced injury.DEX(4.8μmol/L)effects on viability,apoptosis,and tight junction proteins were tested with/without the Wnt pathway inhibitor dickkopf-1(DKK-1)(20 ng/mL).β-catenin,glycogen synthase kinase-3 beta(GSK-3β),claudin-1,and zonula occludens-1(ZO-1)were assessed by Western blot.RESULTS Compared with IA,IA+DEX showed a non-significant increase in intestinal propulsion on postoperative day 6 and a significant rise in anastomotic burst pressure on day 7.Histology indicated reduced inflammation and submucosal injury.Serum tumor necrosis factor-alpha and diamine oxidase decreased,while tight junction proteins(claudin-1,ZO-1)increased in IA+DEX.High-throughput sequencing and Western blotting suggested activation of the Wnt/β-catenin pathway as a potential mechanism.In vitro,DEX pretreatment attenuated lipopolysaccharide-induced downregulation of claudin-1 and ZO-1 and reduced apoptosis in IEC-6 cells.These protective effects were reversed by DKK-1,which abolished DEX-mediated Wnt/β-catenin activation(decreasedβ-catenin,increased GSK-3β)and nullified the benefits of DEX on tight junction protein expression.CONCLUSION DEX enhances anastomotic healing and barrier function after IA,partly via Wnt/β-catenin activation,indicating therapeutic potential to improve postoperative outcomes.
文摘Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.
文摘Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.
基金supported by the National Natural Science Foundation of China,No.81671891
文摘Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.
文摘AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection(ESD) between dexmedetomidine-remifentanil and propofolremifentanil.METHODS: Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidineremifentanil(DR) group or a propofol-remifentanil(PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer's Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety.RESULTS: Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group("very easy" 24.1% vs 56.7%, P = 0.010), gastric motility was moresuppressed in the DR group("no + mild" 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group("very good + good" 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group(P = 0.477). CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.
基金supported by the National Natural Science Foundation of China,No.81330029,81671380the Natural Science Foundation of Tianjin City of China,No.17JCZDJC35900
文摘Traumatic brain injury induces potent inflammatory responses that can exacerbate secondary blood-brain barrier（BBB） disruption, neuronal injury, and neurological dysfunction. Dexmedetomidine is a novel α2-adrenergic receptor agonist that exert protective effects in various central nervous system diseases. The present study was designed to investigate the neuroprotective action of dexmedetomidine in a mouse traumatic brain injury model, and to explore the possible mechanisms. Adult male C57 BL/6 J mice were subjected to controlled cortical impact. After injury, animals received 3 days of consecutive dexmedetomidine therapy（25 μg/kg per day）. The modified neurological severity score was used to assess neurological deficits. The rotarod test was used to evaluate accurate motor coordination and balance. Immunofluorescence was used to determine expression of ionized calcium binding adapter molecule-1, myeloperoxidase, and zonula occluden-1 at the injury site. An enzyme linked immunosorbent assay was used to measure the concentration of interleukin-1β（IL-1β）, tumor necrosis factor α, and IL-6. The dry-wet weight method was used to measure brain water content. The Evans blue dye extravasation assay was used to measure BBB disruption. Western blot assay was used to measure protein expression of nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3（NLRP3）, caspase-1 p20, IL-1β, nuclear factor kappa B（NF-κB） p65, occluding, and zonula occluden-1. Flow cytometry was used to measure cellular apoptosis. Results showed that dexmedetomidine treatment attenuated early neurological dysfunction and brain edema. Further, dexmedetomidine attenuated post-traumatic inflammation, up-regulated tight junction protein expression, and reduced secondary BBB damage and apoptosis. These protective effects were accompanied by down-regulation of the NF-κB and NLRP3 inflammasome pathways. These findings suggest that dexmedetomidine exhibits neuroprotective effects against acute（3 days） post-traumatic inflammatory responses, potentially via suppression of NF-κB and NLRP3 inflammasome activation.
基金supported by a grant from Technical Research and Development Fund of Shenzhen(No.JCYJ20140416122812032)
文摘This study aims to elucidate the mechanisms by which dexmedetomidine alleviates pulmonary edema in rats with acute lung injury induced by lipopolysaccharide （LPS）. Male Wistar rats were randomly divided into five groups： normal saline control （NS） group, receiving intravenous 0.9% normal saline （5 mL/kg）; LPS group, receiving intravenous LPS （10 mg/kg）; small-dose dexmedetomidine （S） group, treated with a small dose of dexmedetomidine （0.5 μg·kg^-1·h^-1）; medium-dose dexmedetomidine （M） group, treated with a medium dose of dexmedetomidine （2.5 μg·kg^-1·h^-1）; high-dose dexmedetomidine （H） group, treated with a high dose of dexmedetomidine （5μg·kg^-1·h^-1）. The rats were sacrificed 6 h after intravenous injection of LPS or NS, and the hmgs were removed for evaluating histological characteristics and determining the lung wet/dry weight ratio （W/D）. The levels of tumor necrosis factor-alpha （TNF-α） and interleukin-1β （IL-1β） in the lung tissues were assessed by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expression levels of aquaporin-1 （AQP1） and aquaporin-5 （AQP5） were detected by RT-PCR, immunohistochemistry, and Western blot- ting. The lung tissues from the LPS groups were significantly damaged, which were less pronounced in the H group but not in the small-dose dexmedetomidine group or medium-dose dexmedetomidine group. The W/D and the concentrations of TNF-α and IL-1β in the pulmonary tissues were increased in the LPS group as compared with those in NS group, which were reduced in the H group but not in S group or M group （P〈0.01）. The expression of AQP1 and AQP5 was lower in the LPS group than in the NS group, and significantly increased in the H group but not in the S group or M group （P〈0.01）. Our findings suggest that dexmedetomidine may alleviate pulmonary edema by increasing the expression of AQP-1 and AQP-5.
基金Scientific Committee Foundation(No.13102007) of Selcuk University,Konya,Turkey(to HB)
文摘Dexmedetomidine is a selective α2-adrenoceptor agonist that is used because of its sedative,anxiolytic,and analgesic effects.Dexketoprofen,which is used as an analgesic,is a nonselective nonsteroidal anti-inflammatory drug (NSAID).The use of dexmedetomidine and dexketoprofen as adjuvants to local anesthetics for the peripheral nerve is gradually increasing.In this study,we aimed to investigate the effects of different doses of dexmedetomidine and dexketoprofen on conduction block of rat sciatic nerve.The isolated sciatic nerve from adult rats was transferred to a nerve chamber.The compound action potentials (CAPs) were recorded from stimulated nerve with electrophysiological methods.Dexmedetomidine (n = 8) and dexketoprofen (n = 8) were administered in the chamber with cumulative concentrations of 10–9 to 10–5 M,and the CAPs were recorded for 5 and 10 minutes.The CAP parameters were calculated.Both dexmedetomidine and dexketoprofen significantly depressed all CAP parameters in a dose-dependent manner compared with the control group,i.e.,the group in which rats did not receive treatment.CAP parameters showed there was no significant difference in nerve conduction inhibition between dexmedetomidine and dexketoprofen.Higher doses of dexmedetomidine suppressed the conduction in the fast-conducting fibers;however,dexketoprofen was found to suppress the conduction in the slow-conducting fibers in a time-dependent manner and suppress the conduction in the medium- and slow-conducting fibers in a dose-dependent manner.These findings suggest that dexmedetomidine and dexketoprofen exhibit better anesthetic effects on peripheral nerve through different ways of action.The experimental procedures were approved by the Necmettin Erbakan University on January 30,2013 (approval No.2013-024).
文摘Objective To explore the protective effects of dexmedetomidine(Dex)against high glucose-induced epithelial-mesenchymal transition in HK-2 cells and relevant mechanisms.Methods HK-2 cells were exposed to either glucose or glucose+Dex for 6 h.The production of ROS,morphology of HK-2 cells,and cell cycle were detected.Moreover,the expression of AKT,p-AKT,ERK,pERK,PI3 K,E-Cadherin,Claudin-1,andα-SMA were determined and compared between HK-2 cells exposed to glucose and those exposed to both glucose and Dex with or without PI3 K/AKT pathway inhibitor LY294002 and ERK pathway inhibitor U0126.Results Compared with HK-2 cells exposed to high level of glucose,the HK-2 cells exposed to both high level of glucose and Dex showed:(1)lower level of ROS production;(2)cell morphology was complete;(3)more cells in G1 phase;(4)lower expression of p-AKT,p-ERK andα-SMA,higher expression of ECadherin and Claudin-1.PI3 K/AKT inhibitor LY294002 and ERK inhibitor U0126 decreased the expression of p-AKT,p-ERK andα-SMA,and increased the expression of E-Cadherin and Claudin-1.Conclusion Dex can attenuate high glucose-induced HK-2 epithelial-mesenchymal transition by inhibiting AKT and ERK.
基金supported by grants from NSFC(National Natural Science Foundation of China,grant number81160232)CMA(Chinese Medical Association Intensive Scientific Research Fund project,grant number 13091520537)the First Affiliated Hospital of Xinjiang Medical University Natural Science Fund project(grant number 2013ZRQN11)
文摘BACKGROUND: Dexmedetomidine has already been used in septic patients as a new sedative agent, few studies have examined its effects on immunomodulation. Therefore, the authors have designed a controlled experimental study to characterize the immunomodulation effects of dexmedetomidine in the cecal ligation and puncture(CLP) model in rats. METHODS: After CLP, 48 Wistar rats were randomly allocated into four groups:(1) CLP group;(2) small-dose treatment group(2.5 g·kg^(-1)·h^(-1));(3) medium-dose treatment group(5.0 g·kg^(-1)·h^(-1)); and(4) large-dose treatment group(10.0 g·kg^(-1)·h^(-1)). HLA-DR and plasma cytokine(IL-4, IL-6, IL-10 and TNF-α) levels were measured, and the mean arterial blood pressure(MAP), heart rate(HR), arterial blood gases, lactate concentrations and mortality were also documented. RESULTS: The HLA-DR level, inflammatory mediator levels, MAP and HR had no obvious changes among Dexmedetomidine treatment groups(DEX groups). Compared with the CLP group, the DEX groups exhibited decreased HLA-DR levels(P_(group)=0.0202) and increased IL-6 production, which was increased at 3 h(P= 0.0113) and was then attenuated at 5 h; additionally, the DEX groups exhibited decreased HR(P<0.001) while maintaining MAP(P_(group)=0.1238), and remarkably improving lactate(P<0.0001). All of these factors led to a significant decrease in the mortality, with observed rates of 91.7%, 66.7%, 25% and 18% for the CLP, DEX2.5, DEX5.0, DEX10.0 groups, respectively.CONCLUSION: Dexmedetomidine treatment in the setting of a CLP sepsis rat model has partially induced immunomodulation that was initiated within 5 h, causing a decreased HR while maintaining MAP, remarkably improving metabolic acidosis and improving mortality dosedependently.
基金This study was supported by grants from the National Natural Science Foundation of China(No.81801175 and No.81970722)the Fundamental Research Funds for the Central Universities(No.WK9110000044 and No.WK9110000036)+2 种基金China Scholarship Council(No.201706270155)the China Postdoctoral Science Foundation(No.2019M662179)the Anhui Province Postdoctoral Science Foundation(No.2019B324).
文摘Summary:Dexmedetomidine(DEX),a potent and highly selective agonist for a2-adrenergic receptors(a2AR),exerts neuroprotective effects by reducing apoptosis through decreased neuronal Ca^2+influx.However,the exact action mechanism of DEX and its effects on oxygen-glucose deprivation-reoxygenation(OGD/R)injury in vitro are unknown.We demonstrate that DEX pretreatment reduced OGD/R injury in PC12 cells,as evidenced by decreased oxidative stress,autophagy,and neuronal apoptosis.Specifically,DEX pretreatment decreased the expression levels of stromal interaction molecule 1(STIM1)and calcium release-activated calcium channel protein 1(Orail),and reduced the concentration of intracellular calcium pools.In addition,variations in cytosolic calcium concentration altered apoptosis rate of PC12 cells after exposure to hypoxic conditions,which were modulated through STIM 1/Orail signaling.Moreover,DEX pretreatment decreased the expression levels of Beclin-1 and microtubule-associated protein 1A/1B-light chain 3(LC3),hallmark markers of autophagy,and the formation of autophagosomes.In conclusion,these results suggested that DEX exerts neuroprotective effects against oxidative stress,autophagy,and neuronal apoptosis afier OGD/R injury via modulation of Caf-STIM1/Orai1 signaling.Our results offer insights into the molecular mechanisms of DEX in protecting against neuronal ischemia-reperfusion injury.
文摘BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.40.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.
