Perioperative dexmedetomidine reduces the risk of postoperative complications in high-risk patients undergoing non-cardiac surgery: A randomized controlled trial.

backgroundDexmedetomidine may suppress the surgery-induced inflammatory response, which is considered the underlying mechanism of postoperative complications. This study was designed to investigate whether perioperative dexmedetomidine could decrease the risk of postoperative complications among high-risk patients.

methodsThis multicenter randomized controlled trial is a superiority trial. Central randomization was used. Elderly patients (age ≥60 years) with revised cardiac risk index (RCRI) ≥3 and scheduled for major non-cardiac surgery were enrolled. Patients in dexmedetomidine group received intraoperative dexmedetomidine (a loading dose of 0.5 μg/kg followed by 0.3 μg·kg -1 ·h -1 ) as adjuvant to general anesthesia and postoperative dexmedetomidine (2 μg/h for 72 h) as supplementation to patient-controlled analgesia with sufentanil. Patients in the control group received an equivalent dose of normal saline as placebo during anesthesia and sufentanil only for postoperative analgesia. The primary outcome was the incidence of major postoperative complications including neurologic, cardiovascular, renal, pulmonary coagulation, infectious, and gastrointestinal systems within postoperative 30 days. Secondary outcomes included pain intensity, sleep quality, postoperative length of in-hospital stay, and medical expenses during hospitalization. Neutrophil-to-lymphocyte ratio (NLR) was used to monitor inflammatory response.

resultsThis study included 272 patients, with similar median age (70 years vs . 69 years) and median RCRI (both 3) between dexmedetomidine and control groups. The incidence of major postoperative complications in the dexmedetomidine group was significantly lower than that in the control group (38.2% [52/136] vs . 52.9% [72/136], relative risk [RR] = 0.722, 95% confidence interval (CI) 0.554-0.942, P = 0.015). Postoperative in-hospital stay was shorter in the dexmedetomidine group than that in the control group (mean difference [MD] = -1 day, 95% CI: -2 to 0 days, P = 0.013). Other secondary outcomes were comparable between the two groups. The highest NLR within postoperative first 3 days in the dexmedetomidine group was lower than that in the control group (MD = -2.1, 95% CI: -4.1 to -0.3, P = 0.037). The proportion of all drug-related adverse events were comparable between the two groups.

conclusionDexmedetomidine, infused from the beginning of anesthesia to postoperative 72 h, decreased the risk of postoperative complications in high-risk elderly patients undergoing non-cardiac surgery.

trial registrationNo. ChiCTR2000030566 at www.chictr.org.cn.