Effet Of Dexmedetomidine With Different Dosage On Perioperative Renal Function In Patients Undergoing Laparoscopic Resection Surgery For Gynecological Malignant Tumors

Objective Laparoscopic surgery with carbon dioxide(CO2) pneumoperitoneum is common used for the gynecological malignant tumor resection. Long time CO2 pneumoperitoneum may activate the sympathetic nervous system and lead to stress response which may cause unstable hemodynamics and insufficient kidney flood. Dexmedetomidine has been shown to possess potent sedative, analgesic and anti-sympathetic effect, which may exert protective effect on the kidney function. The present study was aimed to explore the effect of different dose of dexmedetomidine on the perioperative renal function in patients undergoing resection surgery for gynecologic malignant tumors.Methods The study was designed as a prospective, randomized, controlled, single blind clinical study. One hundred consecutive patients were recruited from October 2012 to November 2014, and were assigned randomly into 4 groups(n=25): control group, study group 1, study group 2, and study group 3. Patients in the study groups were administered 0.4 μg.kg-1.h-1 of dexmedetomidine for 10 min during the anesthesia induction, and were infused intravenously with dexmedetomidine at 0.1 μg.kg-1.h-1(study group 1), 0.2 μg.kg-1.h-1(study group 2), 0.4 μg.kg-1.h-1(study group 3) until the surgery completed. No treatment was administered in control group. The values of HR and MAP before anesthesia, after anesthesia, 5 min after pneumoperitoneum construction, 30 min after pneumoperitoneum construction, 60 min after pneumoperitoneum construction, 30 min after surgery, 60 min after surgery and 120 min after surgery was recorded. Urine volume during the 120 min after after pneumoperitoneum construction and during the 120 min after surgery was recorded. The concentrations of neutrophil gelatinase associated lipocalin(NGAL) in plasma,serum creatinine(Scr), and cystatin C(Cys C) before surgery, 2h after surgery, 24 h after surgery and 48 h after surgery were recorded.Results(1) The HR and MAP have significant difference among time points; the HR of patients in the study group 3 at 5 min as well as 30 min after the pneumoperitoneum construction was lower than that in the control groups(P=0.031, P=0.001, respectively), no significant difference was found at other time points among the four groups; the MAP of patients in the study group 3 at 5 min after the pneumoperitoneum construction was lower than that in the control groups(P>0.05).(2)Urine volume during 120 min after the pneumoperitoneum inflation in study group 2 and study group 3 were higher than in study group 1 and control group, and that in study group 3 was higher than in study group 2(P<0.001). Urine volume during 120 min after the surgery completeness in study group 3 was higher than in other three groups, and no difference was found in urine volume among the control group, study group 1 and study group 2.(3)NGAL in study group 2 and study group 3 were higher than in study group 1 and control group(P<0.001), and there was no difference between the study group 2 and study group 3 as well as between study group 1 and control group.Conclusion In patients undergoing laparoscopic resection surgery for gynecologic malignant tumors, dexmedetomidine could improve the intraoperative hemodynamic response as well as perioperative renal function indicated by promoting urine production, and this effect is in a manner of dose dependent.