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Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 282-290

Renal protective effects of dexmedetomidine in patients undergoing radical nephrectomy

Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
Rania AA Sabra
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, University of Alexandria, Alexandria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_57_16

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Background Acute kidney injury (AKI) after radical nephrectomy is a serious complication that increases morbidity and mortality rates. Early detection and prevention of this complication are very important. A novel biomarker named neutrophil gelatinase-associated lipocalin (NGAL) can play an important role in early diagnosis of AKI. Recent studies have been published on the favorable effects of dexmedetomidine on renal functions. Objective The aim was to evaluate the possible renal protective effects of dexmedetomidine regarding urine output, creatinine clearance, serum cystatine C, NGAL in patients undergoing radical nephrectomy. Patients and methods A randomized double-blind, placebo-controlled study was conducted on 30 adult patients scheduled for radical nephrectomy. The patients were randomly allocated into two equal groups. Dexmedetomidine group (D group) received dexmedetomidine 0.8 µg/kg intravenously over 10 min as a loading dose, and then it was infused at a rate of 0.4 µg/kg/h. Placebo group (P group) received normal saline instead of dexmedetomidine in the same volume (ml) and rate (ml/h). In both groups, fentanyl (0.5 µg/kg) boluses were given if blood pressure or heart rate (HR) showed 20% increase from the baseline reading to control the hemodynamics. Vital signs [HR and mean arterial blood pressure (MABP)] were recorded before induction, after induction, after intubation, intraoperatively every 10 min till the end of surgery, and postoperatively every 2 h during the first 24 h. Urine output was assessed intraoperatively every 1 h and postoperatively every 4 h in the first 48 h. Serum creatinine, urinary creatinine, and creatinine clearance were assessed 24 h before surgery, 24 h after urinary catheter insertion after induction of anesthesia, and 24–48 h postoperatively. Cystatine C and NGAL were assessed after induction of anesthesia and after 24 h and 48 h postoperatively. Sedation was assessed during the first 5, 15, 30, and 60 min in the recovery room by the investigator using a five-point sedation scale. Postoperative pain was assessed using the visual analog scale, based on 0–10 points, every hour in the first 4 h postoperatively and then every 4 h in the first postoperative day. Results There was a significant decrease in HR and MABP in the dexmedetomidine group compared with placebo group. Urine output showed significant difference between the two groups in all studied periods except for the first hour. Urine output was higher in dexmedetomidine group, and seven patients in the placebo group needed lasix. Serum creatinine values, creatinine clearance, and cystatine C showed no statistically significant difference between the two groups in the three studied periods. NGAL values were similar after induction but were significantly different between the two groups after 24 and 48 h, with values higher in the placebo group. Sedation was different between the two groups in all studied periods except after 5 min. Patients in dexmedetomidine group were more sedated compared with the placebo group. Dexmedetomidine had postoperative analgesic effect represented by low visual analog scale score. Conclusion Dexmedetomidine proved to be effective in the prophylaxis of postoperative AKI after radical nephrectomy in terms of NGAL values but did not affect renal functions in terms of serum creatinine, creatinine clearance, and cystatine C. Dexmedetomidine in the used dose did not have adverse effects on MABP and HR. In addition to renal protection, dexmedetomidine proved to have sedative and analgesic properties.

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