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Effects of dexmedetomidine on inflammatory mediators after tourniquet-induced ischemia-reperfusion injury: a randomized, double-blinded, controlled study

 Seung H. KIM  ;  Do-Hyeong KIM  ;  Seokyung SHIN  ;  Seon J. KIM  ;  Tae L. KIM  ;  Yong S. CHOI 
 MINERVA ANESTESIOLOGICA, Vol.85(3) : 279-287, 2019 
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BACKGROUND: Tourniquet use during total knee arthroplasty (TKA) produces ischemia-reperfusion injury (IRI), with systemic release of inflammatory cytokines and reactive oxygen species upon tourniquet release. We conducted a randomized, placebo-controlled, double-blind trial to examine whether dexmedetomidine (DEX) as an adjunct during general anesthesia in patients undergoing unilateral TKA could attenuate the rise in inflammatory cytokines and oxidative stress.

METHODS: Sixty-eight patients were randomized to either the control or DEX group. DEX was administered at a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 μg/kg/h. We measured serum levels of malondialdehyde (biomarker of oxidative stress) and proinflammatory cytokines (interleukin-6 [IL-6] and tumour necrosis factor-α [TNF-α]) preinduction (baseline), 60 and 90 min post-tourniquet release. We also assessed hemodynamics, intraoperative remifentanil consumption, and postoperative pain scores and analgesic consumption.

RESULTS: Malondialdehyde was higher than baseline after tourniquet release in both groups (P≤0.001), but the levels were similar between groups at all times. TNF-α was significantly higher than baseline at 60 min post-tourniquet release only in the control group (P=0.009). Serum IL-6 increased significantly above baseline at 60 and 90 min post-tourniquet release in both groups (P<0.001). At 90 min, IL-6 was significantly lower in the dexmedetomidine group than in the control group (P=0.049). Remifentanil consumption, heart rate, and pain scores were significantly lower in the dexmedetomidine group.

CONCLUSIONS: Our results suggest that dexmedetomidine as an adjunct to general anesthesia attenuated the rise in proinflammatory cytokines, providing protective effects in tourniquet-induced IRI.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Hyeong(김도형) ORCID logo https://orcid.org/0000-0003-2018-8090
Kim, Seung Hyun(김승현) ORCID logo https://orcid.org/0000-0003-2127-6324
Kim, Tae Lim(김태림) ORCID logo https://orcid.org/0000-0001-9421-7486
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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