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In oral and maxillofacial surgery with fibular
free flap reconstruction and tracheotomy patients, during the initial 7
postoperative days, clinicians should give DEX to mitigate PPCs occurrence.
In China, a clinical trial depicted that in patients (who are at intermediate-to-high risk of developing PPCs; postoperative pulmonary complications) undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy, a continuous infusion of DEX (Dexmedetomidine) could lower PPCs (postoperative pulmonary complications) incidence during the first 7 days after surgery. It minimized the length of hospital stay postoperative surgery and also did not elevate bradycardia or hypotension prevalence.
This prospective, randomized, double-blind, placebo-controlled, single-centered trial with two parallel arms recruited a total of 160 intermediate-to-high risks of PPCs patients undergoing oral and maxillofacial surgery. Subjects were randomly assigned to either DEX (n=80) or placebo/normal saline (n=80) group. As an initial dose, 0.4 μg/kg of DEX was administered over 10 mins.
This was followed by 0.4 μg/kg/h (maintaining dose) until the second day morning post-surgery. At the same time, a similar quantity of the normal saline was administered. The primary outcome to be ascertained was PPCs incidence within 7 days after surgery according to the Clavien-Dindo score.
Similar characteristics at baseline were witnessed in both groups. Within the first 7 days after surgery, PPCs occurred in 18 (22.5%) of 80 patients administered DEX, and in 32 (40.0%) of 80 patients administered placebo as depicted in Table 1:
In the first 7 days after surgery, the DEX group had a lower incidence of PPCs and a better postoperative survival probability as depicted by Kaplan-Meier curves (Figure 1).
Additionally, when the total DEX dose was more than 328 μg, it was found that PPCs were unlikely to occur in the patients. Thus, DEX can improve PPCs and lower postoperative length of stay in hospital.
BMC Anesthesiology
Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial
Yun Liu et al.
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