Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1169-1177
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1169
Influences of dexmedetomidine on stress responses and postoperative cognitive and coagulation functions in patients undergoing radical gastrectomy under general anesthesia
Xiang-Fei Ma, Shi-Jia Lv, Shen-Qiao Wei, Bing-Rong Mao, Xiu-Xia Zhao, Xiao-Qing Jiang, Fei Zeng, Xue-Ke Du
Xiang-Fei Ma, Shi-Jia Lv, Shen-Qiao Wei, Bing-Rong Mao, Xiu-Xia Zhao, Xiao-Qing Jiang, Fei Zeng, Xue-Ke Du, Department of Anesthesiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, Guangxi Zhuang Autonomous Region, China
Author contributions: Ma XF proposed the overall research goal and designed the research plan and model design; Ma XF, Lv SJ, Wei SQ and Mao BR conducted feasibility analysis, review and supervision of the experiment; Du XK, Zhao XX, and Jiang XQ collected clinical data; Ma XF, Zhao XX, and Zeng F conducted statistical processing and analysis of the data; Ma XF and Du XK are responsible for writing the first draft of the paper; Ma XF is responsible for the review, revision and quality control of the paper; all authors determined the final draft of the paper.
Supported by Project of Guangxi Health and Health Commission, No. Z20201268.
Institutional review board statement: The study was reviewed and approved by The Second Affiliated Hospital of Guangxi Medical University Institutional Review Board [Approval No. 2020(KY-0141)].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Ke Du, DSc, Medical Assistant, Department of anesthesiology, The second affiliated hospital of guangxi medical university, No. 166 Daxuedong Road, Nanning 530007, Guangxi Zhuang Autonomous Region, China. mxf17031861@126.com
Received: March 6, 2023
Peer-review started: March 6, 2023
First decision: March 14, 2023
Revised: March 22, 2023
Accepted: April 19, 2023
Article in press: April 19, 2023
Published online: June 27, 2023
Processing time: 101 Days and 4 Hours
Abstract
BACKGROUND

Radical gastrectomy (RG) is commonly used in the treatment of patients with gastric cancer (GC), but this procedure may lead to stress responses, postoperative cognitive dysfunction, and blood coagulation abnormalities in patients.

AIM

To investigate the influences of dexmedetomidine (DEX) on stress responses and postoperative cognitive and coagulation functions in patients undergoing RG under general anesthesia (GA).

METHODS

One hundred and two patients undergoing RG for GC under GA from February 2020 to February 2022 were retrospectively reviewed. Of these, 50 patients had received conventional anesthesia intervention [control group (CG)] and 52 patients had received DEX in addition to routine anesthesia intervention [observation group (OG)]. Inflammatory factor (IFs; tumor necrosis factor-α, TNF-α; interleukin-6, IL-6), stress responses (cortisol, Cor; adrenocorticotropic hormone, ACTH), cognitive function (CF; Mini-Mental State Examination, MMSE), neurological function (neuron-specific enolase, NSE; S100 calcium-binding protein B, S100B), and coagulation function (prothrombin time, PT; thromboxane B2, TXB2; fibrinogen, FIB) were compared between the two groups before surgery (T0), as well as at 6 h (T1) and 24 h (T2) after surgery.

RESULTS

Compared with T0, TNF-α, IL-6, Cor, ACTH, NSE, S100B, PT, TXB2, and FIB showed a significant increase in both groups at T1 and T2, but with even lower levels in OG vs CG. Both groups showed a significant reduction in the MMSE score at T1 and T2 compared with T0, but the MMSE score was notably higher in OG compared with CG.

CONCLUSION

In addition to a potent inhibitory effect on postoperative IFs and stress responses in GC patients undergoing RG under GA, DEX may also alleviate the coagulation dysfunction and improve the postoperative CF of these patients.

Keywords: Dexmedetomidine; Radical gastrectomy; General anesthesia; Inflammatory factors; Stress responses

Core Tip: Radical gastrectomy (RG), a minimally invasive procedure, is reported to be the optimal cure for gastric cancer (GC) with the advantages of lesser pain and faster recovery. Dexmedetomidine (DEX) is used in a wide range of clinical scenarios. Available evidence suggests that DEX can reduce perioperative inflammation and stress and exert a certain protective effect on cognitive function (CF) in elderly patients after laparoscopic cholecystectomy. In this study, we aimed to assess the influence of DEX on stress responses, CF, and coagulation function of GC patients undergoing RG under general anesthesia, with a view to contributing to the improvement of prognosis in these patients.