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The effect of dexmedetomidine premedication on postoperative systemic inflammatory response in children undergoing
Zhen Du1, Si-Wei Wei1, Xi-Ying Zhang1
1Department of Anesthesiology, Hunan Children' Hospital, Changsha, China.
Insights
Preoperative dexmedetomidine infusion in children undergoing surgery significantly reduced postoperative inflammation and anxiety. This finding suggests dexmedetomidine is effective in mitigating surgical stress responses in pediatric patients.
Area of Science:
- Anesthesiology and Pain Management
- Pediatric Surgery
- Immunology
Background:
- Surgery induces systemic inflammation, impacting the central nervous system and potentially altering mood and behavior.
- Previous research indicated dexmedetomidine premedication reduced postoperative anxiety in children compared to midazolam.
Purpose of the Study:
- To evaluate if pre-hernia repair dexmedetomidine infusion alleviates postoperative systemic inflammation in children.
- To determine the association between postoperative anxiety and systemic inflammation in pediatric patients.
Main Methods:
- Prospective, double-blind, randomized controlled trial involving 120 children undergoing elective hernia repair.
- Participants received intravenous dexmedetomidine (0.5 µg/g), midazolam (0.08 mg/kg), or normal saline before anesthesia.
- Postoperative plasma inflammatory cytokine levels and anxiety scores (m-YPAS) were measured and correlated with inflammatory markers.
Main Results:
- Dexmedetomidine group showed significantly lower plasma levels of tumor necrosis factor-alpha, interleukin-6, and neutrophils-to-lymphocyte ratio compared to the control group.
- Dexmedetomidine also resulted in lower levels of these inflammatory markers compared to the midazolam group.
- Postoperative anxiety scores positively correlated with plasma levels of pro-inflammatory cytokines.
Conclusions:
- A single preoperative intravenous dose of dexmedetomidine effectively reduces postoperative systemic inflammation in children undergoing same-day surgery.
- Dexmedetomidine demonstrates superior anti-inflammatory effects compared to midazolam in this pediatric surgical population.
Background:
Surgery results in systemic inflammation, which can affect the central nervous system, leading to changes in mood, emotion, and behavior. Our previous study has shown that compared to midazolam, dexmedetomidine premedication effectively decreased children's postoperative anxiety.
Aim:
To investigate whether dexmedetomidine infusion before hernia repair alleviates postoperative systemic inflammation in children and whether postoperative anxiety may be associated with postoperative inflammation.
Methods:
This prospective double-blind randomized controlled trial was conducted in 120 children scheduled to undergo elective hernia repair. Before anesthesia induction, all children received an intravenous infusion consisted of dexmedetomidine (n = 40; 0.5 µg/g, group D), midazolam (n = 40; 0.08 mg/kg, group M), or normal saline (n = 40; group C). One-way ANOVA with least significant difference multiple comparison test was used for multigroup comparisons of postoperative plasma levels of inflammatory cytokines and m-YPAS scores. Spearman rank correlation tests were used for analyzing m-YPAS scores with postoperative plasma levels of inflammatory cytokines.
Results:
Plasma levels of tumor necrosis factor-alpha (7.0 ± 1.6 vs. 8.1 ± 1.6, mean difference [95% CI]: 1.19 [0.26-2.11], p = .008) (pg/ml) and of interleukin-6 (1.8 ± 1.2 vs. 3.3 ± 1.6, mean difference [95% CI]: 1.49 [0.74-2.25], p < .001) (pg/ml) and neutrophils-to-lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.7, mean difference [95% CI]: 0.48 [0.17-0.78], p < .001) were significantly lower in group D than in group C. Furthermore, compared to group M, group D showed significantly lower plasma tumor necrosis factor-alpha levels (7.0 ± 1.6 vs. 7.9 ± 1.9, mean difference [95% CI]: 0.96 [0.04-1.88], p = .04) (pg/ml) and interleukin-6 levels (1.8 ± 1.2 vs. 2.9 ± 1.5, mean difference [95% CI]: 1.06 [0.31-1.81], p = .004) (pg/ml), and neutrophil-to-lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.6, mean difference [95% CI]: 0.42 [0.11-0.72], p = .004). Anxiety scores at postoperative 2 and 4 h in the three groups positively correlated with plasma levels of proinflammatory cytokines.
Conclusion:
A single preoperative intravenous dexmedetomidine dose in children undergoing same-day surgery reduces postoperative systemic inflammation.
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