Comparison of dexmedetomidine versus propofol sedation on microcirculation and organ injuries in critically ill surgical patients: A randomized controlled pilot study

Article type: Research Article

Authors: Chen, Po-Yu^a | Huang, Hsing-Hao^a | Chan, Wing-Sum^b | Liu, Chih-Min^a | Wu, Tsung-Ta^c | Chen, Jyun-Han^a | Chao, Anne^a | Tien, Yu-Wen^d | Chiu, Ching-Tang^{a; *} | Yeh, Yu-Chang^{a; *}

Affiliations: [a] Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan | [b] Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei, Taiwan | [c] Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan | [d] Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

Correspondence: [*] Correspondence to: Ching-Tang Chiu and Yu-Chang Yeh, Department of Anesthesiology, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City 10002, Taiwan. E-mails: [email protected]; [email protected].

Abstract: BACKGROUND:Recent studies have shown that dexmedetomidine may improve microcirculation and prevent organ failure. However, most evidence was obtained from experimental animals and patients receiving cardiac surgery with cardiopulmonary bypass. This study aimed to investigate the effect of dexmedetomidine on microcirculation and organ injuries in critically ill general surgical patients. METHODS:In this prospective randomized trial, patients admitted to the surgical intensive care unit after general surgery were enrolled and randomly allocated to the dexmedetomidine or propofol groups. Patients received continuous dexmedetomidine or propofol infusions to meet their requirement of sedation according to their grouping. At each time point, sublingual microcirculation images were obtained using the incident dark field video microscope. RESULTS:Overall, 60 patients finished the trial and were analyzed. Microcirculation parameters did not differ significantly between two groups. Heart rate at 4 h after ICU admission and mean arterial pressures at 12 h and 24 h after ICU admission were lower in the dexmedetomidine group than in the propofol group. At 24 h, serum aspartate aminotransferase (41 (25–118) vs 86 (34–129) U/L, p = 0.035) and alanine aminotransferase (50 (26–160) vs 68 (35–172) U/L, p = 0.019) levels were significantly lower in the dexmedetomidine group than in the propofol group. CONCLUSION:Microcirculation parameters did not differ significantly between the dexmedetomidine and propofol groups. At 24 h after ICU admission, serum liver enzyme levels were lower in patients receiving dexmedetomidine as compared to propofol.

Keywords: Microcirculation, dexmedetomidine, propofol, surgery, critical care

DOI: 10.3233/CH-232093

Journal: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2024