Effects Of Dexmedetomidine Hydrochloride On Blood TNF-α And IL-6during Operations In Patients With One-lung Ventilation

objective: The effects of dexmedetomidine hydrochloride onblood TNF-α and IL-6during operations in patients with one-lungventilation (OLV) were explored through giving1.0μg/kg dexme-detomidine hydrochloride ten minutes prior to anesthesia induction,followed by the infusion rate of0.3μg/kg/h to closing chest. Methods:This trial was a prospective, randomized, double-blind, controlled design.Thirty patients scheduled for radical surgery for esophageal carcinoma,the American Society of Anesthesiologists (ASA) classification gradeⅠ-Ⅱ, aged44to71,were enrolled in this study. By means of therandom number table, they were divided into dexmedetomidine group(group D) and control group (group C). The main operations of anesthesiawere done by the same person. During the trial, double-blinding wasexecuted, i.e. before anesthesia, a superior anesthesiologist who was notinvolved in the anesthesia and the statistical analysis prepared two pipesof dexmedetomidine hydrochloride and saline (both50ml), the majoroperator of anesthesia randomly took one pipe of test solution into thetrial, and the patient was also unaware of the type of the test solution used;after operation, the superior anesthesiologist, who had prepared the testsolutions, revealed which test solution used in the surgery was dexmedetomidine hydrochloride or saline. All anesthesia operations, datarecordings and sample collections were completed by the major operatorof anesthesia. Analysis of venous blood samples was done by a professorof Nuclear Medicine. All patients after entering operating room receivedroutine monitoring of NIBP, ECG, SpO2and BIS. The initial mean arterialpressure (MAP)(non-invasive), HR, RR, SpO2and BIS values wererecorded as basic values. Patients in Group D were infused intravenouslywith dexmedetomidine hydrochloride (the concentration of dexmede-tomidine was4μg/ml) at a load of1μg/kg10min before induction ofanesthesia, followed by0.3μg/kg/h continuous infusion to closing chest.Patients in Group C were infused with the same volume of saline by thesame method. Anesthesia of both groups was induced by propofol1.5-2.5mg/kg, sufentanil0.3-0.5μg/kg and cis atracurium0.2-0.3mg/kg. Cisatracurium was administered as0.06-0.12μg/kg/h intravenously tomaintain muscular relaxation. Sevoflurane1%-3%was inhaled andsufentanil0.2-0.4μg/kg was intermittently injected intravenously tomaintain anesthesia and brain bispectral index (BIS) values at40-60.Moreover, drug dosages was adjusted according to the hemodynamicindex and BIS values. Venous blood was collected to detect theconcentrations of TNF-αand IL-6, and arterial blood was collected tomonitor pH, PaO2and PaCO2, respectively at three time points, namely,before one-lung ventilation (To),1hour after one-lung ventilation (T1) and at the end of one-lung ventilation (T2). Simultaneously, at each timepoint, MAP (invasive), HR, SpO2, PETCO2, RR, Ppeak and BIS valueswere recorded, as well as intraoperative uses of atropine and dopamine.There were follow-up patients visiting at the first, second and third dayafter surgery, the highest body temperature （T）, RR, HR and immaturewhite blood cell counts or neutrophil counts of that day being recorded.In total, thirty patients completed the study, of whom18cases were inGroup D and12cases in Group C. Results:1. There were no statisticaldifferences between the two groups in age, sex, weight, ASAclassification, location of the chest opening and some related indicatorsbefore anesthesia (Hb, MAP, HR, RR, SpO2, BIS)(P>0.05).2. Therewere no statistical differences between the two groups in MAP, HR, SpO2,PETCO2, RR, Ppeak and BIS values, respectively at three time points of T0,T1and T2(P>0.05).3. There were no statistical differences between thetwo groups in arterial pH, PaO2and PaCO2, respectively at three timepoints of T0, T1and T2(P>0.05).4. The comparison of the two groups inthe concentrations of plasma TNF-α and IL-6at each time point: withineach group, both have statistical differences in the concentrations ofplasma TNF-α and IL-6of each group at T1compared with T0, T2with T0and T2with T1(P <0.05); between the two groups, at T0time point: therewere no statistical differences in two groups in the concentrations ofplasma TNF-α and IL-6(P>0.05); at T1and T2time points: there were statistical differences in the two groups in the concentrations of plasmaTNF-α and IL-6(P<0.05).5. There were no statistical differencesbetween the two groups in the correlative indexes of SIRS at the first,second and third day after surgery (P>0.05). Conclusion: Thedexmedetomidine hydrochloride can inhibit the elevations of the plasmaTNF-α and IL-6levels during operations in patients with one-lungventilation, but has no effects on correlative indexes of SIRS afteroperations.