Effects of intravenous dexmedetomidine on hemodynamic stability, inflammatory factors, and brain injury biomarkers in patients with Moyamoya disease undergoing revascularization surgery

OBJECTIVE: To evaluate the effects of dexmedetomidine (DEX) on perioperative hemodynamic stability, inflammatory response, and brain injury markers in patients with moyamoya disease (MMD) undergoing revascularization procedures. METHODS: A total of 68 patients with confirmed MMD were enrolled in this single-institution, randomized, placebo-controlled, prospective trial and were randomized into either the DEX group or the placebo group (34 patients each). The DEX group received a loading dose of 1 µg/kg DEX and a continuous infusion at 0.4 µg/kg/h throughout the surgery. Instead, the control group was given the same volume of saline with the same dosing regimen. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP), were recorded at six defined time points: before induction (T0), during tracheal intubation (T1), at the moment of surgical incision (T2), immediately after surgery (T3), before extubation (T4), and during extubation (T5). Additionally, fluctuation amplitudes for heart rate variability (HR-V), systolic blood pressure variability (SBP-V), and mean arterial pressure variability (MAP-V) were calculated from data collected during T0-T5. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), the neural injury marker S100 beta protein (S100β) and neuron-specific enolase (NSE) were obtained at four different time points: prior to anesthesia induction, after reperfusion, immediately after surgery, and 24 hours postoperatively. Adverse events and neurological complications within 24 hours postoperatively were also documented. RESULTS: > 0.05). CONCLUSIONS: Intraoperative infusion of DEX enhances perioperative hemodynamic stability, mitigated postoperative inflammatory response, and lowers serum S100β levels associated with brain injury in MMD patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery.