American journal of translational research · 2026
Effects of intravenous dexmedetomidine on hemodynamic stability, inflammatory factors, and brain injury biomarkers in patients with Moyamoya disease undergoing revascularization surgery.
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Feng Yujing, Bao Rong, Zhang Liyang, Gong Zhan, Chen Weidong
Аннотация
OBJECTIVE: To evaluate the effects of dexmedetomidine (DEX) on perioperative hemodynamic stability, inflammatory response, and brain injury markers in patients with moyamoya disease (MMD) undergoing revascularization procedures.
METHODS: A total of 68 patients with confirmed MMD were enrolled in this single-institution, randomized, placebo-controlled, prospective trial and were randomized into either the DEX group or the placebo group (34 patients each). The DEX group received a loading dose of 1 µg/kg DEX and a continuous infusion at 0.4 µg/kg/h throughout the surgery. Instead, the control group was given the same volume of saline with the same dosing regimen. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP), were recorded at six defined time points: before induction (T0), during tracheal intubation (T1), at the moment of surgical incision (T2), immediately after surgery (T3), before extubation (T4), and during extubation (T5). Additionally, fluctuation amplitudes for heart rate variability (HR-V), systolic blood pressure variability (SBP-V), and mean arterial pressure variability (MAP-V) were calculated from data collected during T0-T5. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), the neural injury marker S100 beta protein (S100β) and neuron-specific enolase (NSE) were obtained at four different time points: prior to anesthesia induction, after reperfusion, immediately after surgery, and 24 hours postoperatively. Adverse events and neurological complications within 24 hours postoperatively were also documented.
RESULTS: Compared with control group, DEX group exhibited significantly lower SBP, MAP, and DBP at time points T1, T2, T4, and T5 (all P < 0.05) and significantly lower HR throughout T1 to T5 (all P < 0.05). The DEX-treated patients also demonstrated reduced HR variability (HR-V; 37.39 ± 12.29 vs. 45.15 ± 12.18, P < 0.05), SBP variability (SBP-V; 18.04 ± 6.60 vs. 21.41 ± 6.94, P < 0.05), and MAP variability (MAP-V; 23.12 ± 7.67 vs. 27.46 ± 9.68, P < 0.05). Additionally, serum levels of IL-6, TNF-α, and S100β were significantly lower in the DEX group at post-reperfusion, surgery completion, and 24-hour post-operation compared to the control group (all P < 0.05). The incidence of neurological complications in the DEX group was lower than that in the control group, although the difference did not reach statistical significance (P = 0.099). The overall incidence of adverse events was comparable between groups (P > 0.05).
CONCLUSIONS: Intraoperative infusion of DEX enhances perioperative hemodynamic stability, mitigated postoperative inflammatory response, and lowers serum S100β levels associated with brain injury in MMD patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery.
METHODS: A total of 68 patients with confirmed MMD were enrolled in this single-institution, randomized, placebo-controlled, prospective trial and were randomized into either the DEX group or the placebo group (34 patients each). The DEX group received a loading dose of 1 µg/kg DEX and a continuous infusion at 0.4 µg/kg/h throughout the surgery. Instead, the control group was given the same volume of saline with the same dosing regimen. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP), were recorded at six defined time points: before induction (T0), during tracheal intubation (T1), at the moment of surgical incision (T2), immediately after surgery (T3), before extubation (T4), and during extubation (T5). Additionally, fluctuation amplitudes for heart rate variability (HR-V), systolic blood pressure variability (SBP-V), and mean arterial pressure variability (MAP-V) were calculated from data collected during T0-T5. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), the neural injury marker S100 beta protein (S100β) and neuron-specific enolase (NSE) were obtained at four different time points: prior to anesthesia induction, after reperfusion, immediately after surgery, and 24 hours postoperatively. Adverse events and neurological complications within 24 hours postoperatively were also documented.
RESULTS: Compared with control group, DEX group exhibited significantly lower SBP, MAP, and DBP at time points T1, T2, T4, and T5 (all P < 0.05) and significantly lower HR throughout T1 to T5 (all P < 0.05). The DEX-treated patients also demonstrated reduced HR variability (HR-V; 37.39 ± 12.29 vs. 45.15 ± 12.18, P < 0.05), SBP variability (SBP-V; 18.04 ± 6.60 vs. 21.41 ± 6.94, P < 0.05), and MAP variability (MAP-V; 23.12 ± 7.67 vs. 27.46 ± 9.68, P < 0.05). Additionally, serum levels of IL-6, TNF-α, and S100β were significantly lower in the DEX group at post-reperfusion, surgery completion, and 24-hour post-operation compared to the control group (all P < 0.05). The incidence of neurological complications in the DEX group was lower than that in the control group, although the difference did not reach statistical significance (P = 0.099). The overall incidence of adverse events was comparable between groups (P > 0.05).
CONCLUSIONS: Intraoperative infusion of DEX enhances perioperative hemodynamic stability, mitigated postoperative inflammatory response, and lowers serum S100β levels associated with brain injury in MMD patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery.