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Determining whether dexmedetomidine provides a reno-protective effect in patients receiving laparoscopic radical prostatectomy: a pilot study

  • Shan Wu
  • Hui Yao
  • Nan Cheng
  • Na Guo
  • Jiaxin Chen
  • Mian Ge
  • Jun CaiEmail author
Urology - Original Paper
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Abstract

Purpose

This study aims to determine whether perioperative treatment with dexmedetomidine (DEX) during laparoscopic radical prostatectomy (LRP) can provide a reno-protective effect.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Acute kidney injury Dexmedetomidine Estimated glomerular filtration rate Laparoscopic radical prostatectomy 

Notes

Acknowledgements

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.

Author contributions

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.

References

  1. 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
  2. 2.
    Lee BR, Cadeddu JA, Molnar-Nadasdy G, Enriquez D, Nadasdy T, Kavoussi LR, Ratner LE (1999) Chronic effect of pneumoperitoneum on renal histology. J Endourol 13(4):279–282.  https://doi.org/10.1089/end.1999.13.279 CrossRefGoogle Scholar
  3. 3.
    Miki Y, Iwase K, Kamiike W, Taniguchi E, Sakaguchi K, Sumimura J, Matsuda H, Nagai I (1997) Laparoscopic cholecystectomy and time-course changes in renal function. The effect of the retraction method on renal function. Surg Endosc 11(8):838–841CrossRefGoogle Scholar
  4. 4.
    Chekan EG, Nataraj C, Clary EM, Hayward TZ, Brody FJ, Stamat JC, Fina MC, Eubanks WS, Westcott CJ (1999) Intraperitoneal immunity and pneumoperitoneum. Surg Endosc 13(11):1135–1138CrossRefGoogle Scholar
  5. 5.
    Miyano G, Nakamura H, Seo S, Sueyoshi R, Okawada M, Doi T, Koga H, Lane GJ, Yamataka A (2016) Pneumoperitoneum and hemodynamic stability during pediatric laparoscopic appendectomy. J Pediatr Surg 51(12):1949–1951.  https://doi.org/10.1016/j.jpedsurg.2016.09.016 CrossRefGoogle Scholar
  6. 6.
    Sodha S, Nazarian S, Adshead JM, Vasdev N, Mohan SG (2016) Effect of pneumoperitoneum on renal function and physiology in patients undergoing robotic renal surgery. Curr Urol 9(1):1–4.  https://doi.org/10.1159/000442842 CrossRefGoogle Scholar
  7. 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
  8. 8.
    Chen Q, Yi B, Ma J, Ning J, Wu L, Ma D, Lu K, Gu J (2016) alpha2-Adrenoreceptor modulated FAK pathway induced by dexmedetomidine attenuates pulmonary microvascular hyper-permeability following kidney injury. Oncotarget 7(35):55990–56001.  https://doi.org/10.18632/oncotarget.10809 Google Scholar
  9. 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
  10. 10.
    Soliman R, Hussien M (2017) Comparison of the renoprotective effect of dexmedetomidine and dopamine in high-risk renal patients undergoing cardiac surgery: a double-blind randomized study. Ann Card Anaesth 20(4):408–415.  https://doi.org/10.4103/aca.ACA_57_17 CrossRefGoogle Scholar
  11. 11.
    Si Y, Bao H, Han L, Chen L, Zeng L, Jing L, Xing Y, Geng Y (2018) Dexmedetomidine attenuation of renal ischaemia-reperfusion injury requires sirtuin 3 activation. Br J Anaesth 121(6):1260–1271.  https://doi.org/10.1016/j.bja.2018.07.007 CrossRefGoogle Scholar
  12. 12.
    Yao H, Chi X, Jin Y, Wang Y, Huang P, Wu S, Xia Z, Cai J (2015) Dexmedetomidine inhibits TLR4/NF-kappaB activation and reduces acute kidney injury after orthotopic autologous liver transplantation in rats. Sci Rep 5:16849.  https://doi.org/10.1038/srep16849 CrossRefGoogle Scholar
  13. 13.
    Yu X, Chi X, Wu S, Jin Y, Yao H, Wang Y, Xia Z, Cai J (2016) Dexmedetomidine pretreatment attenuates kidney injury and oxidative stress during orthotopic autologous liver transplantation in rats. Oxid Med Cell Longev 2016:4675817.  https://doi.org/10.1155/2016/4675817 Google Scholar
  14. 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. 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
  16. 16.
    Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179–c184.  https://doi.org/10.1159/000339789 Google Scholar
  17. 17.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612CrossRefGoogle Scholar
  18. 18.
    Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X, Beijing Acute Kidney Injury Trial w (2014) A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care 18(4):R144.  https://doi.org/10.1186/cc13977 CrossRefGoogle Scholar
  19. 19.
    Cho JS, Shim JK, Soh S, Kim MK, Kwak YL (2016) Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery. Kidney Int 89(3):693–700.  https://doi.org/10.1038/ki.2015.306 CrossRefGoogle Scholar
  20. 20.
    Fuhrman DY, Kellum JA (2017) Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury. Curr Opin Anaesthesiol 30(1):60–65.  https://doi.org/10.1097/ACO.0000000000000412 Google Scholar
  21. 21.
    Hoste EAJ, Vandenberghe W (2017) Epidemiology of cardiac surgery-associated acute kidney injury. Best Pract Res Clin Anaesthesiol 31(3):299–303.  https://doi.org/10.1016/j.bpa.2017.11.001 CrossRefGoogle Scholar
  22. 22.
    Wang Y, Bellomo R (2017) Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol 13(11):697–711.  https://doi.org/10.1038/nrneph.2017.119 CrossRefGoogle Scholar
  23. 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. 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. 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
  26. 26.
    Soeters PB (2017) The enhanced recovery after surgery (ERAS) program: benefit and concerns. Am J Clin Nutr 106(1):10–11.  https://doi.org/10.3945/ajcn.117.159897 CrossRefGoogle Scholar
  27. 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. 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

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Shan Wu
    • 1
  • Hui Yao
    • 1
    • 2
  • Nan Cheng
    • 1
  • Na Guo
    • 1
  • Jiaxin Chen
    • 1
    • 3
  • Mian Ge
    • 1
  • Jun Cai
    • 1
    Email author
  1. 1.Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  2. 2.Department of AnesthesiologyGuangdong Second Provincial General HospitalGuangzhouChina
  3. 3.Department of AnesthesiologyThe Seventh Affiliated Hospital of Sun Yat-sen UniversityShenzhenChina

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