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Dexmedetomidine May Improve Kidney Function After Chest Surgery: Presented at ASA

By Michael Smith

LAS VEGAS, NV -- October 25, 2004 -- Many patients are at risk of developing kidney problems following surgeries that involve opening the chest, say researchers.

There are nearly 200,000 such surgeries performed every year in the United States, according to findings reported October 24^th, at the annual scientific meeting of the American Society of Anesthesiologists. In his presentation, Staffan Wahlander, MD, of the Columbia University Medical Center in New York, New York, said that dexmedetomine, a selective alpha-2 agonist, appears to improve post-surgery kidney function following these surgeries.

Patients who undergo chest-opening surgery, Dr. Wahlander said, are getting "older and sicker." Many have diabetes or other conditions that might predispose them to kidney problems after surgery. As well, anesthesiologists tend to use less replacement fluids; "We tend to keep them dry," he said.

Dr. Wahlander and colleagues studied the use of dexmedetomine to relieve post-operative pain in 28 patients. The study was prospective and randomized, with 14 patients getting 0.4 microg per kilogram of body weight per hour of dexmedetomine or the equivalent infusion of saline.

After that study was over, the researchers realized they also had the data to look at kidney function, Dr. Wahlander said. Since there are data from animal studies to suggest the drug improves kidney function, the researchers undertook a post-hoc analysis.

This analysis showed that serum creatinine was lower in the dexmedetomine group over the 7 days following surgery. The difference was statistically significant at the P < .05 confidence level.

The researchers also analyzed the percentage change in serum creatinine and found it was also significantly lower in the dexmedetomine group at the P = .0007 confidence level. The change was defined as the difference between the post-op peak serum creatinine minus the pre-op value, divided by the pre-op value and all multiplied by 100.

The study does imply that dexmedetomine helps to improve kidney function after surgery, he pointed out, at least in terms of laboratory markers.

However, he said, "the clinical relevance is still up in the air." He pointed out that all of the subjects had normal kidney function going into surgery; if there is a benefit, it may be of greatest value in patients whose kidneys are already performing poorly.

A full, formal randomized study will be needed to confirm the results, said Dr. Wahlander, and such a study is under way at his hospital.


[Presentation title: Effects of Intravenous Dexmedetomidine on Serum Creatinine Following Thoracic Surger. No abstract number]

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