Dexmedetomidine Attenuates Inflammation in Elderly Patients Following Major Hepatobiliary and Pancreatic Surgery: A Randomized Clinical Trial

Figures & data

Table 1 Comparisons of Baseline Information Between Two Groups

Items	Placebo Group (n=43)	Dex Group (n=43)	All Enrolled Patients (n=86)	P value
Patient’s characteristics
Male/Female, n	26/17	25/18	51/35	0.826
Age (years)	66.28 ± 3.76	67.42 ± 3.75	66.85 ± 3.78	0.163
Height (cm)	158.91 ± 8.17	159.95 ± 10.52	159.43 ± 9.38	0.608
Weight (kg)	57.33 ± 9.82	56.58 ± 11.25	56.95 ± 10.51	0.745
ASA classification (n, II/III)	41/2	35/8	76/10	0.044*
Smoking history, n (%)	13 (30.23%)	15 (34.88%)	28 (32.56%)	0.645
ARISCAT (Canet) scores (medium-/high- risk) and its anticipated incidence of ALI (%)	33/10, 23.26%	30/13, 30.23%	63/23, 27.71%	0.465
CTP classification of liver function (n, A level/B level)	31/12	38/5	69/17	0.058
Complications
Hypertension (%)	16 (37.21%)	13 (30.23%)	29 (33.72%)	0.494
Diabetes (%)	7 (16.28%)	3 (6.98%)	10 (11.63%)	0.178
Involving surgery type, n (%)
Liver surgery	19 (44.19%)	27 (62.79%)	46 (53.49%)	0.084
Biliary surgery	23 (53.49%)	19 (44.19%)	42 (48.84%)	0.388
Pancreatic surgery	18 (41.86%)	10 (23.26%)	28 (32.56%)	0.066

Notes: *Compared with the Control group, P<0.05. Data are expressed as mean ± standard deviation (SD), median (quartile), n (ratio, or rate). P values were results of comparisons between the Placebo group and the Dex group.

Abbreviations: Dex, Dexmedetomidine; ASA, American Society of Anesthesiologists; CTP, Child-Turcotte-Pugh; ARISCAT, Assess Respiratory Risk in Surgical Patients in Catalonia.

Table 2 Comparisons of Intraoperative Information Between Two Groups

Items	Placebo Group (n=43)	Dex Group (n=43)	All Enrolled Patients (n=86)	P value
Intraoperative information
Operation time (minutes)	380.23 ± 116.52	376.16 ± 82.82	378.20 ± 100.51	0.852
Anesthesia time (minutes)	404.74 ± 110.95	397.63 ± 78.08	401.19 ± 95.43	0.732
Intraoperative fluid intake and output
Crystalloid (mL)	1700 [1250 to 2200]	1700 [1300 to 2000]	1700 [1300 to 2000]	0.742
Colloid (mL)	500 [500 to 1000]	500 [500 to 1000]	500 [500 to 1000]	0.803
Urine output (mL)	700 [300 to 1000]	500 [400 to 1100]	600 [400 to 1000]	0.979
Blood loss volume (mL)	300 [300 to 600]	300 [200 to 400]	300 [275 to 425]	0.436
Blood transfusion rate, n (%)	17 (39.53%)	10 (23.26%)	27 (31.40%)	0.104
Diuretic usage, n (%)	21 (48.84%)	8 (18.61%)	29 (33.72%)	0.003*
Hepatic occlusion rate, n (%)	19 (44.19%)	10 (23.26%)	29 (33.72%)	0.084
Norepinephrine dosage (mg)	1 [0.5 to 2]	1 [1 to 2]	1 [0.875 to 2]	0.238
Dexamethasone usage rate, n (%)	9 (20.93%)	18 (41.86%)	27 (31.40%)	0.037*

Notes: *Compared with the Control group, P<0.05. Data are expressed as mean ± standard deviation (SD), median (quartile), n (ratio, or rate). P values were results of comparisons between the Placebo group and the Dex group.

Abbreviations: Dex, Dexmedetomidine; ASA, American Society of Anesthesiologists; CTP, Child-Turcotte-Pugh; ARISCAT, Assess Respiratory Risk in Surgical Patients in Catalonia.

Figure 1 The CONSORT flow diagram.

Figure 2 Changes in interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) levels (primary outcomes).

Notes: The distribution of (A) IL-6 and (B) TNF-α in the placebo group (blue points) and the Dex group (yellow points) of all individuals are shown with violin plots (n=43 patients per group). Data are presented as violin plots with overlaid box plots. The bounds of the box show the interquartile range, and the centre line of the box shows the median. Vertical endpoints represent the 5th and 95th percentiles. Data are analyzed with the repeated measures analysis of variance (RMANOVA) followed by the LSD test for multi-comparison. *Significant difference with P<0.05 compared with the baseline in the Placebo group. **Significant difference with P<0.05 compared with the baseline in the Dex group. ^#Significant difference with P<0.05 compared with the Dex group at the corresponding time.

Table 3 Postoperative Clinical Outcomes in the Two Groups

Items	Placebo Group (n=43)	Dex Group (n=43)	All Enrolled Patients (n=86)	P value
Postoperative oxygen therapy time (days)	4 [3 to 8]	4 [2 to 5]	4 [3 to 6]	0.265
Postoperative pulmonary complications, n (%)	34 (79.07%)	31 (72.09%)	65 (75.58%)	0.451
Pleural effusion, n (%)	34 (79.07%)	30 (69.77%)	64 (74.42%)	0.323
Atelectasis, n (%)	9 (20.93%)	5 (11.63%)	14 (16.28%)	0.243
Respiratory infection, n (%)	12 (27.91%)	13 (30.23%)	25 (29.07%)	0.812
Incidence of postoperative ALI, n (%)	10 (23.26%)	10 (23.26%)	20 (23.26%)	>0.999
Incidence of postoperative AKI, n (%)	4 (9.30%)	2 (4.65%)	6 (6.98%)	0.338
Total hospital stays (days)	25 [17 to 36]	23 [17 to 29]	23 [17 to 30]	0.337
Postoperative hospital stays (days)	15 [11 to 23]	15 [11 to 18]	15 [11 to 22]	0.343

Notes: Data are expressed as median (quartile), and n (ratio). P values were results of comparisons between the Placebo group and the Dex group.

Figure 3 Assessment of renal function, pulmonary complications, and other biomarkers.

Notes: The distribution of (A) Crea, (B) BUN, (C) NGAL showing renal function, and (D) Horowitz Index and (E) cLac reflecting pulmonary complications, as well as other biomarkers of (F) CA, (G) Cor, and (H) Ach in the placebo group (blue points) and the Dex group (yellow points) of all individuals are shown with violin plots (n=43 patients per group). Data are presented as violin plots with overlaid box plots. The bounds of the box show the interquartile range, and the centre line of the box shows the median. Vertical endpoints represent the 5th and 95th percentiles. Data are analysed with the repeated measures analysis of variance (RMANOVA) followed by the LSD test for multi-comparison. *Significant difference with P<0.05 compared with the baseline in the placebo group. **Significant difference with P<0.05 compared with the baseline in the Dex group. ⁺Significant difference with P<0.05 compared with the placebo group at the corresponding time. ⁺⁺Significant difference with P<0.05 compared with the Dex group at the corresponding time. ^$Significant difference with P<0.05 compared with the other 3 time points (Baseline, Intra 2 hrs, and Post 24 hrs) in the Placebo group.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.