Safaric Oremus Zrinka, Bradic Nikola, Gospic Ivan, Presecki Ivana, Sakan Sanja, Sojcic Natasa, Oremus Kresimir, Baric Davor, Sotosek Vlatka, Rudez Igor
Department of Anaesthesiology, Reanimatology and Intensive Care Medicine, Dubrava University Hospital, 10000 Zagreb, Croatia.
Department of Anaesthesiology, Akromion Special Hospital for Orthopedic Surgery, 10000 Zagreb, Croatia.
Life (Basel). 2025 Mar 22;15(4):524. doi: 10.3390/life15040524.
Surgical aortic valve replacement (SAVR) remains an essential treatment option for patients with aortic stenosis (AS). Open-heart surgery requires the use of cardiopulmonary bypass (CPB), which triggers an inflammatory response that can lead to end-organ dysfunction and severe complications. Dexmedetomidine, a highly selective α2-adrenergic agonist, is widely used in anesthesia and intensive care medicine for its sedative, analgesic, and sympatholytic properties. This study aimed to investigate whether dexmedetomidine exerts a clinically relevant anti-inflammatory effect in patients undergoing open-heart surgery and to determine the optimal dose. A prospective, double-blind, placebo-controlled study was conducted, including 60 patients randomized into three groups according to dexmedetomidine dose. Inflammatory markers (IL-6, TNF-α), renal function, and other clinical parameters were analyzed at multiple time points. Statistical analyses were performed to assess differences between the groups. Dexmedetomidine administration significantly affected TNF-α levels 12 h after CPB ( = 0.033), while previously reported suppression of IL-6 was not observed. Dexmedetomidine was associated with lower opioid consumption before extubation and showed a tendency to reduce postoperative delirium. Diuresis was significantly increased on the first postoperative day in dexmedetomidine-treated patients ( = 0.003), with no significant changes in other renal parameters. The incidence of atrial fibrillation was highest in the control group and lowest in the high-dose dexmedetomidine group, though this difference was not statistically significant. These results suggest that dexmedetomidine influences inflammatory and clinical outcomes; however, further research is needed to confirm its long-term benefits and optimal dosing strategies.
外科主动脉瓣置换术（SAVR）仍然是主动脉瓣狭窄（AS）患者的重要治疗选择。心脏直视手术需要使用体外循环（CPB），这会引发炎症反应，进而导致终末器官功能障碍和严重并发症。右美托咪定是一种高度选择性的α2肾上腺素能激动剂，因其镇静、镇痛和解交感神经特性而广泛应用于麻醉和重症医学。本研究旨在探讨右美托咪定在接受心脏直视手术的患者中是否具有临床相关的抗炎作用，并确定最佳剂量。进行了一项前瞻性、双盲、安慰剂对照研究，包括60例患者，根据右美托咪定剂量随机分为三组。在多个时间点分析炎症标志物（IL-6、TNF-α）、肾功能和其他临床参数。进行统计分析以评估组间差异。CPB后12小时，右美托咪定给药显著影响TNF-α水平（P = 0.033），而未观察到先前报道的对IL-6的抑制作用。右美托咪定与拔管前较低的阿片类药物消耗量相关，并显示出降低术后谵妄的趋势。右美托咪定治疗的患者术后第一天尿量显著增加（P = 0.003），其他肾脏参数无显著变化。对照组房颤发生率最高，高剂量右美托咪定组最低，尽管这种差异无统计学意义。这些结果表明右美托咪定影响炎症和临床结局；然而，需要进一步研究以证实其长期益处和最佳给药策略。
