The Cardioprotective Effect Of Dexmedetomidine On Elderly Patients With Cervical Cancer In The Trendelenburg Position

Objective: Cervical cancer is the fourth most common cancer among women worldwide,laparoscopic surgical resection is the main treatment currently,with patients placed in a special Trendelenburg position(TP)or head down supine position.TP can increase cardiac preload and afterload,cardiac oxygen consumption,and the potential of arrhythmias.However,elderly patients may be at greater risk of myocardial damage due to their poor physical fitness.DEX has been shown to effectively inhibit stress and maintain hemodynamic stability,which could reduce myocardial ischemia-reperfusion injury from patients undergoing cardiac surgery.And animal experiments showed that the protective mechanism may be related to the down-regulation of inflammatory cytokines.Reports related to DEX and TP mainly focus on ocular pressure effects and pulmonary or brain protection,with few clinical studies of cardioprotective effects in cervical cancer patients.In this study,markers of myocardial injury and inflammatory factors were measured at predefined time points to investigate the cardioprotective effect of DEX and its potential relationship with anti-inflammatory pathways.Methods: Eighty patients with cervical cancer presenting with laparoscopic radical hysterectomy and pelvic lymphadenectomy were randomly assigned to the control group(Group C)or the DEX group(Group D),with a total of 40 patients per group.Patients in Group D were given dexmedetomidine,whereas normal saline was administered as placebo in Group C with eqaul capacity and rate.Heart rate(HR)and mean arterial pressure(MAP)were collected from T0 to T8(T0: entering the operating room;T1: start of anesthesia;T2: start of surgery;T3: change of supine position to TP;T4: TP 30min;T5: TP 60min;T6: return to supine position;T7: end of surgery;T8: extubation);and concentrations of cardiac troponin I(cTnI),creatine kinase MB(CK-MB)and tumor necrosis factor α(TNF-α),interleukin 6(IL-6),and C-reactive protein(CRP)were measured at T0,6 h after the surgery(T9)and 24 h after the surgery(T10).Observe the incidence of adverse reactions during the awakening period of general anesthesia in patients.Results: Compared to T0,cTnI,CK-MB,TNF-α,IL-6 and CRP were significantly higher at T9 and T10(P<0.05),whilst there was no significant difference in TNF-α between the two groups at T9(P=0.821),it was significantly lower at T10(P<0.05),and cTnI,CK-MB,IL-6 and CRP were significantly lower in group D than in group C at T9 and T10.HR and MAP were significantly lower in group D than in group C from T1 to T8(P<0.05),and they fluctuated less in group D.During the awakening period of general anesthesia,there was no significant difference between the two groups in the rate of adverse reactions(P=0.263).Conclusions: In elderly patients with cervical cancer,TP may cause perioperative myocardial damage.DEX showed good hemodynamic stability,which is conducive to rapid postoperative resuscitation,and may mitigate the damaging effects,and anti-inflammatory mechanism may play an important role.