Abstract
Background: Hepatic inflow occlusion proceeded to reduce blood loss during hepatectomy induces ischemia-reperfusion (IR) injury in the remnant liver. Dexmedetomidine, a selective α2-adrenoceptor agonist used as an anesthetic adjuvant, has been shown to attenuate IR injury in preclinical and clinical studies. However, a meta-analysis is needed to systematically evaluate the protective effect of perioperative dexmedetomidine use on IR injury induced by hepatectomy. Methods: A prospectively registered meta-analysis following Cochrane and PRISMA guidelines concerning perioperative dexmedetomidine use on IR injury after hepatectomy was performed via searching Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Web of Science, CNKI, WanFang, and Sinomed for eligible randomized controlled trials up to 2021.3.31. The main outcome is postoperative liver function. Risk of bias was assessed by the Cochrane Risk of Bias tool. Review Manager 5.3 and Stata12.0 were applied to perform data analyses. Results: Eight RCTs enrolling 468 participants were included. Compared with 0.9% sodium chloride, dexmedetomidine decreased serum concentration of ALT (WMD = −66.54, 95% CI: −92.10–−40.98), AST (WMD= −82.96, 95% CI: −106.74–−59.17), TBIL (WMD = −4.51, 95% CI: −7.32–−1.71), MDA (WMD = −3.09, 95% CI: −5.17–−1.01), TNF-α (WMD = −36.54, 95% CI: −61.33–−11.95) and IL-6 (WMD = −165.05, 95% CI: −225.76–−104.34), increased SOD activity (WMD = 24.70, 95% CI: 18.09–31.30) within postoperative one day. There was no significant difference in intraoperative or postoperative recovery parameters between groups. Conclusions: Perioperative administration of dexmedetomidine can exert a protective effect on liver IR injury after hepatectomy. Additional studies are needed to further evaluate postoperative recovery outcomes of dexmedetomidine with different dosing regimens.
Highlights
Hepatic inflow occlusion by clamping the portal triad (Pringle maneuver), which is traditionally performed to reduce blood loss during hepatectomy, would cause ischemia-reperfusion (IR) injury of the remnant liver after the release of blood flow (Jarnagin et al, 2002; Gurusamy et al, 2009)
Eight studies enrolling 468 participants were included in this meta-analysis (Wang et al, 2014; Tan et al, 2016; Zhang et al, 2017; Ding et al, 2018; Jiang et al, 2018; Taman and Elhefnawy, 2019; Xing et al, 2020; Zhang et al, 2020)
Dexmedetomidine and control were given before or during the operation except for one study in which they were given during postoperative stay in anesthesia intensive care unit (AICU) (Jiang et al, 2018)
Summary
Hepatic inflow occlusion by clamping the portal triad (Pringle maneuver), which is traditionally performed to reduce blood loss during hepatectomy, would cause ischemia-reperfusion (IR) injury of the remnant liver after the release of blood flow (Jarnagin et al, 2002; Gurusamy et al, 2009). Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is generally used as an anesthetic adjuvant during surgery and a sedative agent in intensive care unit (ICU). It can offer satisfactory sedation without respiratory depression or hemodynamic instability and exhibit intraoperative anestheticsparing effect. Several clinical studies in recent years proved the hepatoprotective properties of dexmedetomidine against IR injury in patients receiving hepatectomy (Wang et al, 2014; Taman and Elhefnawy, 2019; Zhang et al, 2020) Most of these researches yield a positive outcome, a comprehensive meta-analysis is still needed to fully evaluate the protective effect of dexmedetomidine on hepatic IR injury. A meta-analysis is needed to systematically evaluate the protective effect of perioperative dexmedetomidine use on IR injury induced by hepatectomy
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