Dexmedetomidine use during orthotopic liver transplantation surgery on early allograft dysfunction: a randomized controlled trial.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2024-09-01 DOI:10.1097/JS9.0000000000001669

Liqun Yang, Ling Zhu, Bo Qi, Yin Zhang, Chenlu Ni, Yijue Zhang, Xiao Shi, Qiang Xia, Joe Masters, Daqing Ma, Weifeng Yu

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引用次数: 0

Abstract

Background: Previous studies have shown a protective effect of dexmedetomidine use in kidney transplantation. In contrast, it is not known whether intraoperative administration of dexmedetomidine can reduce early allograft dysfunction (EAD) incidence following liver transplantation.

Objective: To investigate the effect of dexmedetomidine use during surgery on EAD following orthotopic liver transplantation (OLT).

Study design: This is a single-center, double-blinded, placebo-controlled randomized clinical trial. Three hundred thirty adult patients undergoing OLT were enrolled from 14th January 2019 to 22nd May 2022. Patients received dexmedetomidine or normal saline during surgery. One year follow-ups were recorded.

Methods: Patients were randomized to two groups receiving either dexmedetomidine or normal saline intraoperatively. For patients in the dexmedetomidine group, a loading dose (1 μg/kg over 10 min) of dexmedetomidine was given after induction of anesthesia followed by a continuous infusion (0.5 μg/kg /h) until the end of surgery. For patients in the normal saline group, an equal volume loading dose of 0.9% saline was given after the induction of anesthesia followed by an equal volume continuous infusion until the end of surgery. The primary outcome was EAD. Secondary outcomes included primary graft nonfunction, acute kidney injury, and acute lung injury/acute respiratory distress syndrome.

Results: Of 330 patients included in the intention-to-treat analysis, 165 were in the dexmedetomidine group [mean (SD) age, 49 (10) years; 117 (70.9%) men], and 165 were in the normal saline group [mean SD age, 49 (9) years; 118 (74%) men]. 39 (24.4%) patients in the dexmedetomidine group and 31 (19.4%) in normal saline group developed EAD and the difference was statistically insignificant ( P =0.28). Secondary outcomes including primary graft nonfunction and acute kidney injury was similar between the two groups.

Conclusion: Intraoperative administration of dexmedetomidine did not reduce EAD rate after OLT.

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在正位肝移植手术中使用右美托咪定对早期同种异体功能障碍的影响：随机对照试验

背景：先前的研究表明，在肾移植中使用右美托咪定具有保护作用。相比之下，术中使用右美托咪定能否降低肝移植术后早期同种异体功能障碍的发生率尚不清楚：目的：研究在手术中使用右美托咪定对正位肝移植（OLT）后早期同种异体功能障碍的影响：这是一项单中心、双盲、安慰剂对照随机临床试验。2019年1月14日至2022年5月22日，330名接受正位肝移植的成年患者入组。患者在手术期间接受右美托咪定或生理盐水治疗。记录了1年的随访情况：患者被随机分为两组，术中接受右美托咪定或生理盐水。右美托咪定组患者在麻醉诱导后给予负荷剂量（1 μg/kg，10 分钟）右美托咪定，然后持续输注（0.5 μg/kg /h）直到手术结束。对于生理盐水组患者，在麻醉诱导后给予等量的 0.9% 生理盐水，然后持续输注等量的生理盐水，直至手术结束。主要结果是早期异体移植物功能障碍。次要结果包括主要移植物无功能、急性肾损伤和急性肺损伤/急性呼吸窘迫综合征：在纳入意向性治疗分析的 330 例患者中，右美托咪定组有 165 例（平均 [SD] 年龄 49 [10] 岁；男性 117 [70.9%]），生理盐水组有 165 例（平均 SD 年龄 49 [9] 岁；男性 118 [74%]）。右美托咪定组有 39 名（24.4%）患者和生理盐水组有 31 名（19.4%）患者出现早期移植物功能障碍，差异无统计学意义（P=0.28）。两组患者的次要结果（包括主要移植物无功能和急性肾损伤）相似：结论：术中使用右美托咪定不会降低正位肝移植术后早期同种异体功能障碍的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.