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The effect of dexmedetomidine premedication on postoperative systemic inflammatory response in children undergoing hernia repair surgery: A randomized controlled trial
Author(s) -
Du Zhen,
Wei SiWei,
Zhang XiYing,
Xiang Zhen,
Qu ShuangQuan
Publication year - 2021
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.14189
Subject(s) - medicine , dexmedetomidine , premedication , anesthesia , midazolam , randomized controlled trial , abdominal surgery , saline , surgery , sedation
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.