title: Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a risk factor that increases the incidence of postoperative cardiopulmonary morbidity and mortality after lung resection. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has been reported previously to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction.
  
  
  OBJECTIVE
  The objective is to determine whether dexmedetomidine improves oxygenation and lung mechanics in patients with moderate COPD during lung cancer surgery.
  
  
  METHODS
  A randomised, double-blinded, placebo-controlled study.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  Fifty patients scheduled for video-assisted thoracoscopic surgery who had moderate COPD. Patients were randomly allocated to a control group or a Dex group (n = 25 each).
  
  
  METHODS
  In the Dex group, dexmedetomidine was given as an initial loading dose of 1.0  μg  kg(-1) over 10  min followed by a maintenance dose of 0.5  μg  kg(-1)  h(-1) during OLV while the control group was administered a comparable volume of 0.9% saline. Data were measured at 30  min (DEX-30) and 60  min (DEX-60) after dexmedetomidine or saline administration during OLV.
  
  
  METHODS
  The primary outcome was the effect of dexmedetomidine on oxygenation. The secondary outcome was the effect of dexmedetomidine administration on postoperative pulmonary complications.
  
  
  RESULTS
  Patients in the Dex group had a significantly higher PaO2/FIO2 ratio (27.9 ± 5.8 vs. 22.5 ± 8.4 and 28.6 ± 5.9 vs. 21.0 ± 9.9 kPa, P < 0.05), significantly lower dead space ventilation (19.2 ± 8.5 vs. 24.1 ± 8.1 and 19.6 ± 6.7 vs. 25.3 ± 7.8%, P < 0.05) and higher dynamic compliance at DEX-30 and DEX-60 (P = 0.0001 and P = 0.0184) compared with the control group. In the Dex group, the PaO2/FIO2 ratio in the postoperative period was significantly higher (P = 0.022) and the incidence of ICU admission was lower than in the control group.
  
  
  CONCLUSIONS
  Dexmedetomidine administration may provide clinically relevant benefits by improving oxygenation and lung mechanics in patients with moderate COPD undergoing lung cancer surgery.
  
  
  BACKGROUND
  ClinicalTrial.gov identifier: NCT 02185430.
authors.affiliation: From the Department of Anaesthesiology and Pain Medicine (SHL, NK, MGB, YJO), Anaesthesia and Pain Research Institute (SHL, NK, YJO), Department of Thoracic and Cardiovascular Surgery (CYL), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Namo
authors.initials: N
authors.lastname: Kim
authors.forename: Chang Yeong
authors.initials: CY
authors.lastname: Lee
authors.forename: Min Gi
authors.initials: MG
authors.lastname: Ban
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Oh
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D056910:Republic of Korea; D015656:Respiratory Mechanics / Q000187:drug effects*; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D001993:Bronchodilator Agents; D020927:Dexmedetomidine