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THE IMPORTANCE OF DEXMEDETOMIDINE IN OPTIMIZING
INTENSIVE THERAPY IN CHILDREN FOLLOWING NEURO-
ONCOLOGICAL SURGERY
S.Sh. Joniev
, I. Togayev, A.Fazilov, T.Yuldashev
1
Samarkand State Medical University , Uzbekistan, Samarkand
Abstract:
Intensive therapy in the postoperative period following neuro-
oncological surgeries aims to reduce cerebral edema and protect cells from hypoxia
and oxidative damage. This article provides a comprehensive analysis of the
neuroprotective properties of dexmedetomidine, sodium oxybutyrate, and
osmodiuretics, as well as their application and combined effectiveness.
Dexmedetomidine, with its sympatholytic and anti-inflammatory effects, contributes
to improved cerebral blood circulation. The efficacy of dexmedetomidine in lowering
arterial pressure and providing neuronal protection further broadens its application.
Considering its role in strengthening the blood-brain barrier, its use in neurosurgery
marks a new dimension of its efficacy. The clinical advantages of dexmedetomidine in
reducing postoperative complications are highly valued due to the aforementioned
factors. This article presents a detailed analysis of the outcomes of using
dexmedetomidine, sodium oxybutyrate, and osmodiuretics in intensive therapy
following neuro-oncological surgery.
Keywords:
dexmedetomidine, sodium oxybutyrate, osmodiuretics, cerebral
edema, intracranial pressure, neuroprotection, neuro-oncological surgery.
Article Text:
Neuro-oncological surgeries, particularly those related to brain tumors, are critical
for saving patients' lives. However, increased intracranial pressure and the
development of cerebral edema during and after surgery can worsen the patient's
condition and lead to mortality. Therefore, intensive therapy in the postoperative period
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ
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must fulfill key objectives: reducing cerebral edema, managing hypoxia and oxidative
stress, and ensuring neuroprotection. Choosing effective treatment methods for
postoperative recovery and complication management is crucial. Drugs such as
dexmedetomidine and mannitol, or combinations like sodium oxybutyrate and
mannitol, are widely used for these purposes.
Dexmedetomidine's neuroprotective properties are highly effective due to its
sedative and sympatholytic effects, improvement of cerebral blood circulation, and
anti-inflammatory action (Kress et al., 2017, Journal of Clinical...). Furthermore,
osmodiuretics (e.g., mannitol) are recognized as an effective means of rapidly reducing
intracranial pressure and cerebral edema. These agents provide rapid and effective
action in reducing cerebral edema, which is a crucial factor in preventing postoperative
complications. Concurrently, numerous studies have shown the effectiveness of
combined use of dexmedetomidine and mannitol in reducing cerebral edema and
enhancing neuroprotective effects.
Study Objective:
The primary objective of this study is to enhance the effectiveness of intensive
therapy following neuro-oncological surgeries by utilizing dexmedetomidine and
sodium oxybutyrate.
Methods and Techniques:
This study was conducted at the multidisciplinary clinic of Samarkand State
Medical University, in the neurosurgery and neuroreanimation departments, involving
a total of 75 patients who underwent surgery for brain tumors. According to the study
aims and objectives, patients were divided into two groups: Group 1 (main group),
consisting of 33 patients, received dexmedetomidine and mannitol for postoperative
intensive therapy and sedation. Group 2 (control group), consisting of 32 patients,
received a combination of sodium oxybutyrate and mannitol in intensive therapy. In
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both groups, the described drug combinations were used during intensive therapy to
reduce intracranial pressure and enhance neuroprotection. Infusion methods and
dosages were precisely defined for each combination.
Dexmedetomidine, an alpha-2 adrenergic agonist, exerts sedative and
sympatholytic effects. In this study, the dexmedetomidine infusion dosage was
determined as follows:
•
Dexmedetomidine:
0.5
–1 µg/kg/patient div weight for infusion.
•
Infusion rate:
0.1
–0.2 µg/kg/hour.
•
Mannitol:
0.25
–
0.5 g/kg/patient div weight for infusion.
•
Infusion rate:
60
–
120 ml/hour.
Mannitol was used as an effective osmodiuretic to rapidly reduce intracranial
pressure. During infusion, dexmedetomidine provided sedation, calming patients, and
further reduced intracranial pressure with its sympatholytic properties.
For Group 2 patients, sodium oxybutyrate, a GABA A receptor activator primarily
used in anesthesia, was administered at the following dosage:
•
Sodium oxybutyrate:
1
–
2 mg/kg/patient div weight for infusion.
•
Infusion rate:
0.05
–
0.1 mg/kg/hour.
•
Mannitol:
Infused at the same dosage as above (0.25
–
0.5 g/kg/patient
div weight).
Sodium oxybutyrate helps to sedate patients and maintain an anesthetic state. Its
effect on cerebral edema contributes to reducing intracranial pressure and enhancing
neuroprotection.
The effectiveness of the infusions was assessed by measuring intracranial pressure
(ICP) and mean arterial blood pressure (MAP). Additionally, neurosonography, blood
oxygen saturation, central hemodynamic parameters (systolic arterial blood pressure
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(SBP), diastolic arterial blood pressure (DBP), mean arterial pressure (MAP)), and
hourly urine output were used to evaluate the effectiveness of intensive therapy.
Results and Discussion:
In comparing the effectiveness of dexmedetomidine and sodium oxybutyrate in
reducing cerebral edema, the sedative and sympatholytic effects of dexmedetomidine
and the osmodiuretic effect of sodium oxybutyrate were studied to determine the
efficacy of these combinations in reducing cerebral edema. It was found that
osmodiuretics lower intracranial pressure by reducing cerebral edema. The combined
use of dexmedetomidine and mannitol, along with its sedative and analgesic properties,
confirmed its effectiveness in reducing cerebral edema in intensive therapy.
Neuroprotective properties were identified by controlling intracranial pressure and
edema during intensive therapy with agents like dexmedetomidine and sodium
oxybutyrate.
The results of this study helped to compare the effectiveness of using
dexmedetomidine and sodium oxybutyrate in optimizing intensive therapy methods. In
Group 1, the combination of dexmedetomidine and mannitol effectively reduced
intracranial pressure and enhanced neuroprotection in patients. Dexmedetomidine, as
an alpha-2 adrenergic agonist with sedative and sympatholytic effects, demonstrated
positive results in reducing cerebral edema and managing intracranial pressure. The
combination of sodium oxybutyrate and mannitol was also effective for patients in
Group 2, but its effectiveness in reducing cerebral edema was slightly lower compared
to dexmedetomidine. Neurosonography further aided in the accurate measurement of
cerebral edema and pressure, providing a modern and effective approach to monitoring
patient health during intensive therapy.
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Conclusion:
The study results indicated the superior effectiveness of the dexmedetomidine and
mannitol combination in reducing cerebral edema and enhancing neuroprotection.
While the sodium oxybutyrate and mannitol combination can also be effective, the
benefits of using dexmedetomidine in combination are more pronounced.
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