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Title: One-lung ventilation patients: Clinical context of administration of different doses of dexmedetomidine.
Author: Jiang H, Kang Y, Ge C, Zhang Z, Xie Y.
Journal: J Med Biochem; 2022 Apr 08; 41(2):230-237. PubMed ID: 35510198.
Abstract:
BACKGROUND: Open and endoscopic thoracic surgeries improve surgical exposure by One-lung ventilation (OLV). The aim of this study was to investigate the effects of different doses of dexmedetomidine on inflammatory response, oxidative stress, cerebral tissue oxygen saturation (SctO2) and intrapulmonary shunt in patients undergoing one-lung ventilation (OLV). METHODS: Seventy-five patients undergoing open pulmonary lobectomy in our hospital from January 2016 to December 2017 were enrolled and randomly divided into high-dose dexmedetomidine group (group D1, 1 mg/kg, n=25), low-dose dexmedetomidine group (group D2, 0.5 mg/kg, n=25) and control group (group C, n=25). Then, arterial blood and internal jugular venous blood were taken before anesthesia induction (T0) and at 15 min after twolung ventilation (T1) and 5 min (T2) and 30 min (T3) after OLV for later use. Next, the changes in hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2)] of patients were observed in each group. Enzyme-linked immunosorbent assay (ELISA) was carried out to detect serum inflammatory factors such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and oxidative stress indicators [superoxide dismutase (SOD) and malondialdehyde (MDA)]. The changes in SctO2, arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt Qs/Qt (a measurement of pulmonary shunt: right-to-left shunt fraction) were observed. Additionally, the changes in lung function indicators like lung dynamic compliance (Cdyn) and airway peak pressure (P_peak) were determined. RESULTS: There were no statistically significant differences in the MAP, HR and SpO2 among three groups at each observation time point (P>0.05). At T2 and T3, the levels of serum IL-6, TNF-α and IL-8 were obviously decreased in group D1 and D2 compared with those in group C (P<0.05), and the decreases in group D1 were overtly larger than those in group D2, and the decreases at T3 were markedly greater than those at T2 (P<0.05). In comparison with group C, group D1 and D2 had notably reduced levels of serum reactive oxygen species (ROS) and MDA (P<0.05) and remarkably increased SOD content (P<0.05) at T2 and T3, and the effects were markedly better in group D1 than those in group D2. Besides, they were significantly superior at T3 to those at T2 (P<0.05). The SctO2 in group D1 and D2 was evidently lowered at T2 and T3 compared with that at T0, and the decrease in group D1 was distinctly smaller than that in group D2 (P<0.05). The Qs/Qt was significantly lower in group D1 and D2 than that in group C at T2 and T3 (P<0.05), while the PaO2 content was notably raised (P<0.05), and the decrease and increase were significantly larger in group D1 than those in group D2, and they were obviously greater at T3 to those at T2 (P<0.05). At T0 and T1, no significant differences were detected in the Cdyn, Pplat and Ppeak among three groups. At T2 and T3, the Cdyn was significantly elevated, while the Pplat and Ppeak overtly declined (P<0.05), and group D1 had greater changes in comparison with group D2, and the changes were obviously more evident at T3 to those at T2 (P<0.05). CONCLUSIONS: Dexmedetomidine effectively ameliorates inflammatory response and oxidative stress, lowers oxygenation, Qs/Qt and the decrease in SctO2 and improves lung function during OLV, with good efficacy. UVOD: Otvorene i endoskopske torakalne operacije poboljšavaju hirurško izlaganje pomoću ventilacije jednog plućnog krila (OLV). Cilj ove studije je bio da se ispitaju efekti različitih doza deksmedetomidina na inflamatorni odgovor, oksidativni stres, zasićenost cerebralnog tkiva kiseonikom (SctO2) i intrapulmonalni šant kod pacijenata koji su podvrgnuti ventilaciji jednog pluća (OLV). METODE: Sedamdeset pet pacijenata koji su bili podvrgnuti otvorenoj plućnoj lobektomiji u našoj bolnici od januara 2016. do decembra 2017. godine upisani su i nasumično podeljeni u grupu sa visokim dozama deksmedetomidina (grupa D1, 1 mg/kg, n=25), niskom dozom deksmedetomidina (grupa D2), 0,5 mg/kg, n=25) i kontrolna grupa (grupa C, n=25). Zatim su uzete arterijska krv i unutrašnja jugularna venska krv pre indukcije u anesteziju (T0) i 15 min nakon ventilacije sa dva plućna krila (T1) i 5 min (T2) i 30 min (T3) nakon OLV za kasniju upotrebu. Zatim su uočene promene hemodinamskih parametara [srednji arterijski pritisak (MAP), broj otkucaja srca (HR) i pulsna zasićenost kiseonikom (SpO2)] pacijenata u svakoj grupi. Enzimski imunosorbentni test (ELISA) je sproveden da bi se otkrili serumski inflamatorni faktori kao što su interleukin-6 (IL-6) i faktor nekroze tumora-alfa (TNF-a) i indikatori oksidativnog stresa [superoksid dismutaza (SOD) i malondialdehid (MDA)]. Uočene su promene u SctO2), arterijskom parcijalnom pritisku kiseonika (PaO2) i intrapulmonalnom šantu Ks/Kt (merenje plućnog šanta: frakcija šanta zdesna nalevo). Pored toga, određene su promene u indikatorima plućne funkcije kao što su dinamika plućne usklađenosti (Cdin) i vršni pritisak u disajnim putevima (Ppeak). REZULTATI: Nije bilo statistički značajnih razlika u MAP, HR i SpO2 između tri grupe u svakoj vremenskoj tački posmatranja (P>0,05). Na T2 i T3, nivoi serumskih IL-6, TNF-a i IL-8 su očigledno bili smanjeni u grupi D1 i D2 u poređenju sa onima u grupi C (P<0,05), a smanjenje u grupi D1 je bilo očigledno veće od oni u grupi D2, a smanjenja na T3 bila su značajno veća od onih u T2 (P<0,05). U poređenju sa grupom C, grupe D1 i D2 su imale značajno smanjene nivoe serumskih reaktivnih vrsta kiseonika (ROS) i MDA (P<0,05) i značajno povećan sadržaj SOD (P<0,05) na T2 i T3, a efekti su bili znatno bolji u grupi D1 od onih u grupi D2. Osim toga, oni su bili značajno bolji na T3 u odnosu na one na T2 (P<0,05). SctO2 u grupi D1 i D2 je evidentno sma - njen na T2 i T3 u poređenju sa onim u T0, a smanjenje u grupi D1 je bilo znatno manje nego u grupi D2 (P<0,05). Ks/Kt je bio značajno niži u grupi D1 i D2 nego u grupi C na T2 i T3 (P<0,05), dok je sadržaj PaO2 bio značajno povišen (P<0,05), a smanjenje i povećanje su značajno veće u grupi. D1 od onih u grupi D2, i očigledno su bili veći na T3 u odnosu na one u T2 (P<0,05). Na T0 i T1, nisu otkrivene značajne razlike u Cdin, Pplat i Ppeak između tri grupe. Na T2 i T3, Cdin je bio značajno povišen, dok su Pplat i Ppeak izrazito opali (P<0,05), a grupa D1 je imala veće promene u poređenju sa grupom D2, a promene su očigledno bile očiglednije na T3 u odnosu na one na T2 ( P<0,05). ZAKLJUČAK: Deksmedetomidin efikasno ubla'ava inflamatorni odgovor i oksidativni stres, smanjuje oksigenaciju, Ks/Kt i smanjenje SctO2 i poboljšava funkciju pluća tokom OLV, sa dobrom efikasnošću.

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