Effects of dexmedetomidine on hemodynamic, oxygenation, microcirculation, and inflammatory markers in a porcine model of sepsis

Author(s)

Paulo Carnicelli ^[1] ; Denise Aya Otsuki ^[2] ; Adalberto Monteiro Filho ^[3] ; Marcia Aparecida Portela Kahvegian ^[4] ; Keila Kazue Ida ^[5] ; José Otavio Costa Auler-Jr ^[6] ; Jean-Jacques Rouby ^[7] ; Denise Tabacchi Fantoni ^[8]

Affiliation

^[1] Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Surgery Department - Brasil

^[2] Universidade de São Paulo. Hospital das Clínicas da Faculdade de Medicina. LIM08-Laboratory of Anesthesiology - Brasil

^[3] Clínica Ufape. Veterinary Intensive Care Unit - Brasil

^[4] All Care Vet - Brasil

^[5] Texas A&M University. College of Veterinary Medicine and Biomedical Sciences. Department of Small Animal Clinical Sciences

^[6] Universidade de São Paulo. Hospital das Clínicas da Faculdade de Medicina. Laboratory of Anesthesiology - Brasil

^[7] Medicine Sorbonne University. La Pitié Salpêtrière Hospital. Department of Anaesthesiology and Critical Care - França

^[8] Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Surgery Department - Brasil

• Document type: Journal article
• Source: Acta Cirurgica Brasileira; v. 37, n. 7 2022-11-11.

Abstract

ABSTRACT Purpose: To determine whether dexmedetomidine aggravates hemodynamic, metabolic variables, inflammatory markers, and microcirculation in experimental septic shock. Methods: Twenty-four pigs randomized into: Sham group (n = 8), received saline; Shock group (n = 8), received an intravenous infusion of Escherichia coli O55 (3 × 109 cells/mL, 0.75 mL/kg, 1 hour); Dex-Shock group (n = 8), received bacteria and intravenous dexmedetomidine (bolus 0.5 mcg/kg followed by 0.7 mcg/kg/h). Fluid therapy and/ornorepinephrine were administered to maintain a mean arterial pressure > 65 mmHg. Hemodynamic, metabolic, oxygenation, inflammatory markers, and microcirculation were assessed at baseline, at the end of bacterial infusion, and after 60, 120, 180, and 240 minutes. Results: Compared to Shock group, Dex-Shock group presented a significantly increased oxygen extraction ratio at T180 (23.1 ± 9.7 vs. 32.5 ± 9.2%, P = 0.0220), decreased central venous pressure at T120 (11.6 ± 1 vs. 9.61 ± 1.2 mmHg, P = 0.0214), mixed-venous oxygen saturation at T180 (72.9 ± 9.6 vs. 63.5 ± 9.2%, P = 0.026), and increased plasma lactate (3.7 ± 0.5 vs. 5.5 ± 1 mmol/L, P = 0.003). Despite the Dex-Shock group having a better sublingual vessel density at T240 (12.5 ± 0.4 vs. 14.4 ± 0.3 mL/m2; P = 0.0003), sublingual blood flow was not different from that in the Shock group (2.4 ± 0.2 vs. 2.4 ± 0.1 mL/kg, P = 0.4418). Conclusions: Dexmedetomidine did not worsen the hemodynamic, metabolic, inflammatory, or sublingual blood flow disorders resulting from septic shock. Despite inducing a better sublingual vessel density, dexmedetomidine initially and transitorily increased the mismatch between oxygen supply and demand. (AU)