Can dexmedetomidine protect against surgical stress response?

Abstract

Surgical stress, pain, and complications are associated with postoperative morbidity and mortality. 1 Various strategies have been implemented to reduce the stress response, 2 for which anesthetics/techniques in attenuating perioper-ative stress and improving outcomes have been reported in several clinical settings. 2 Recently, the effectiveness of dexmedetomidine on perioperative stress response as well as on short-and long-term outcomes have been well documented. 3,4 In the current issue, Zhang and his co-workers 5 reported a randomized controlled trial (RCT) investigating the effects of dexmedetomidine against peri-operative stress response during and after thoracic surgery. Total 135 patients underwent lung surgery were randomly divided into three groups, general anesthesia alone, general anesthesia combined with thoracic paravertebral block (TPVB) mixed with dexmedetomidine, and placebo. They found that, when compared to TPVB with 0.5% ropi-vacaine alone, TPVB in combination with dexmedeto-midine significantly decreased the inflammatory mediators of IL-6 and TNF-α, decreased apoptosis index and lung injury score of lung tissue, and promoted favorable changes of various proteins (HIF-1a, Tom20, Bcl-2, and others) in an additive or synergistic manner. Additionally, they also found that, when compared to general anesthesia alone, TPVB or thoracic epidural anesthesia maintained better immune function. Several strengths of this study were noticed: (1) mul-timeasurements and time points and (2) direct evidence This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.