Determining whether dexmedetomidine provides a reno-protective effect in patients receiving laparoscopic radical prostatectomy: a pilot study
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This study aims to determine whether perioperative treatment with dexmedetomidine (DEX) during laparoscopic radical prostatectomy (LRP) can provide a reno-protective effect.
This pilot study enrolled 89 patients between 60 and 79 years old, who underwent LRP. These patients were randomly allocated into two groups: group D (n = 44) and group C (n = 45). For patients in group D, 1 µg/kg of DEX was intravenously administered within 10 min, followed by 0.5 µg/kg/h of DEX infusion during the operation. This was stopped at 30 min before the end of surgery. For patients in group C, saline was administered at the same doses. The primary outcome was the incidence of acute kidney injury (AKI), and secondary outcomes included other postoperative variables.
The incidence of AKI in group D and C was 4.5% and 13.3%, respectively (P > 0.05). Compared with group C, patients in group D had significantly lower urea nitrogen levels at 6 h after surgery, lower creatinine levels at 6 and 48 h after surgery, and significantly lower CysC levels at 48 h after surgery. A significant decrease in VAS scores for pain and postoperative nausea and vomiting (PONV) at the second and third day after surgery was observed in patients in group D when compared to patients in group C.
Intraoperative DEX does not reduce the incidence of AKI, but provides a potential reno-protective effect, and alleviates postoperative pain and PONV in patients undergoing LRP.
KeywordsAcute kidney injury Dexmedetomidine Estimated glomerular filtration rate Laparoscopic radical prostatectomy
The authors thank Doctor Qianqian Zhu for the guidance of the statistics analyses in this manuscript, and we also thank Medjaden Bioscience Limited for editing and proofreading our manuscript.
SW and HY contributed to this work equally. SW and HY: clinical data collection, writing up of the first draft of the paper and data analysis; NC, NG and JXC: clinical anaesthesia for the patients; MG and JC: study design.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 1.Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F, European Association of U (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59(1):61–71. https://doi.org/10.1016/j.eururo.2010.10.039 CrossRefGoogle Scholar
- 7.Joo EY, Moon YJ, Yoon SH, Chin JH, Hwang JH, Kim YK (2016) Comparison of acute kidney injury after robot-assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a propensity score matching analysis. Medicine (Baltimore) 95(5):e2650. https://doi.org/10.1097/MD.0000000000002650 CrossRefGoogle Scholar
- 9.Kunisawa T, Nagata O, Nagashima M, Mitamura S, Ueno M, Suzuki A, Takahata O, Iwasaki H (2009) Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation. J Clin Anesth 21(3):194–199. https://doi.org/10.1016/j.jclinane.2008.08.015 CrossRefGoogle Scholar
- 14.Lee SH, Lee CY, Lee JG, Kim N, Lee HM, Oh YJ (2016) Intraoperative dexmedetomidine improves the quality of recovery and postoperative pulmonary function in patients undergoing video-assisted thoracoscopic surgery: a CONSORT-prospective, randomized, controlled trial. Medicine (Baltimore) 95(7):e2854. https://doi.org/10.1097/MD.0000000000002854 CrossRefGoogle Scholar
- 15.Wang ZX, Huang CY, Hua YP, Huang WQ, Deng LH, Liu KX (2014) Dexmedetomidine reduces intestinal and hepatic injury after hepatectomy with inflow occlusion under general anaesthesia: a randomized controlled trial. Br J Anaesth 112(6):1055–1064. https://doi.org/10.1093/bja/aeu132 CrossRefGoogle Scholar
- 23.Chen X, Ding X, Shen B, Teng J, Zou J, Wang T, Zhou J, Chen N, Zhang B (2017) Incidence and outcomes of acute kidney injury in patients with hepatocellular carcinoma after liver transplantation. J Cancer Res Clin Oncol 143(7):1337–1346. https://doi.org/10.1007/s00432-017-2376-8 CrossRefGoogle Scholar
- 24.Hilmi IA, Damian D, Al-Khafaji A, Planinsic R, Boucek C, Sakai T, Chang CC, Kellum JA (2015) Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes. Br J Anaesth 114(6):919–926. https://doi.org/10.1093/bja/aeu556 CrossRefGoogle Scholar
- 25.Pedziwiatr M, Pisarska M, Major P, Grochowska A, Matlok M, Przeczek K, Stefura T, Budzynski A, Klek S (2016) Enhanced recovery after surgery protocol (ERAS) combined with laparoscopic colorectal surgery diminishes the negative impact of sarcopenia on short-term outcomes. Clin Nutr ESPEN 12:e49. https://doi.org/10.1016/j.clnesp.2016.02.061 Google Scholar
- 27.Whittington RA, Virag L (2006) Dexmedetomidine-induced decreases in accumbal dopamine in the rat are partly mediated via the locus coeruleus. Anesth Analg 102(2):448–455. https://doi.org/10.1213/01.ane.0000195234.07413.5a CrossRefGoogle Scholar
- 28.Blaudszun G, Lysakowski C, Elia N, Tramer MR (2012) Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 116(6):1312–1322. https://doi.org/10.1097/ALN.0b013e31825681cb CrossRefGoogle Scholar