Department of Anesthesiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, ShaanXi Province, China.
Departments of Anesthesiology, Neurology, Psychiatry, Pharmaceutics, and Neuroscience, McKnight Brain Institute, Center for Translational Research in Neurodegenerative Disease.
J Neurosurg Anesthesiol. 2022 Apr 1;34(2):176-182. doi: 10.1097/ANA.0000000000000728.
Dexmedetomidine (DEX), an α2-adrenergic agonist, has been widely used for anesthesia, pain control, and intensive care unit sedation. Besides sleep-like sedation, DEX has many other beneficial effects, such as anti-inflammation, antioxidation, and anticell death. Subarachnoid hemorrhage (SAH), a severe and potentially fatal form of stroke, is a complex disease that is divided into 2 phases: early brain injury and delayed cerebral ischemia. In each phase, several pathologic changes are involved, including disturbed intracranial homeostasis, metabolic failure, blood-brain barrier damage, vasospasm, microthrombosis, and cortical spreading depolarization. DEX has been shown to have an effect on these SAH-related pathologic processes. Research shows that DEX could serve as a protective therapy for patients with SAH due to its ability to maintain stable intracerebral homeostasis, balance coagulation-fibrinolysis, repair a damaged blood-brain barrier as well as prevent vasospasm and suppress cortical spreading depolarization by anti-inflammatory, antioxidative, antiapoptotic, and vasoconstriction-dilation effects. In this scoping review, we critically assess the existing data on the potential protective effect of DEX after SAH. So far, only 1 retrospective clinical trial assessing the effect of DEX on clinical outcomes after SAH has been performed. Hence, more trials are still needed as well as translational research bringing results from bench to bedside.
右美托咪定（DEX），一种 α2-肾上腺素能激动剂，已广泛应用于麻醉、疼痛控制和重症监护病房镇静。除了类似睡眠的镇静作用外，DEX 还有许多其他有益的作用，如抗炎、抗氧化和抗细胞死亡。蛛网膜下腔出血（SAH）是一种严重且潜在致命的中风形式，是一种复杂的疾病，分为两个阶段：早期脑损伤和迟发性脑缺血。在每个阶段，都涉及到几个病理变化，包括颅内平衡失调、代谢衰竭、血脑屏障损伤、血管痉挛、微血栓形成和皮质扩散性去极化。DEX 已被证明对这些与 SAH 相关的病理过程有影响。研究表明，DEX 可以通过维持稳定的颅内平衡、平衡凝血-纤溶、修复受损的血脑屏障以及预防血管痉挛和抑制皮质扩散性去极化来发挥抗炎、抗氧化、抗凋亡和血管收缩-扩张作用，从而成为 SAH 患者的一种保护治疗方法。在本次范围性综述中，我们批判性地评估了 DEX 对 SAH 后潜在保护作用的现有数据。到目前为止，只有一项回顾性临床试验评估了 DEX 对 SAH 后临床结局的影响。因此，还需要更多的试验以及将实验室研究结果转化为临床应用的转化研究。
