Comparison of dexmedetomidine and propofol on serum neutrophil gelatinase-associated lipocalin levels of patients after thoracotomy

Behrooz Farzanegan; Seyed Bashir Mirtajani; Mohammadreza Hemmatyar; Kamal Fani; Ali Jabbari; Shahram Sayadi; Alireza Jahangirifard

doi:10.4103/jpdtsm.jpdtsm_101_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 2 | Issue : 1 | Page : 19-23

Comparison of dexmedetomidine and propofol on serum neutrophil gelatinase-associated lipocalin levels of patients after thoracotomy

Behrooz Farzanegan¹, Seyed Bashir Mirtajani², Mohammadreza Hemmatyar³, Kamal Fani³, Ali Jabbari⁴, Shahram Sayadi³, Alireza Jahangirifard²
¹ Critical Care Quality Improvement Research Center, SBMU, Tehran, Iran
² Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
³ Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
⁴ Department of Anesthesiology and Critical Care Medicine, Golestan University of Medical Sciences, Gorgan, Iran

Date of Submission	07-Nov-2022
Date of Decision	15-Dec-2022
Date of Acceptance	23-Feb-2023
Date of Web Publication	13-Mar-2023

Correspondence Address:
Alireza Jahangirifard
Masih Daneshvari Hospital, Darabad Avenue, Shahid Bahonar Roundabout, Tehran
Iran

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpdtsm.jpdtsm_101_22

Abstract

BACKGROUND: Acute kidney injury (AKI) is a well-known complication of surgery that increases the death rate and the side costs of postoperative care and treatment. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein that is emerging as a new marker in the early detection of kidney damage.
AIM AND OBJECTIVE: In this study, we try to compare the effect of propofol (Pro) and dexmedetomidine (Dex) on activity in patients undergoing thoracotomy by evaluating and measuring the amount of renal function evaluation factors similar to blood urea nitrogen (BUN), creatinine, and NGAL.
MATERIALS AND METHODS: All patients who underwent thoracotomy (with two types of anesthetics Dex and Pro) in the first 6 months of 2019 (April–September) in Masih Daneshvari Hospital were included in this study and the information obtained from all of them was based on a questionnaire design.
RESULTS: The BUN index in patients of the two groups was significantly different in three time periods before surgery, 2 h after surgery, and 24 h. Based on the available results, the NGAL index as a factor in assessing renal function was significantly different in the two groups of patients. However, the mean numerical values in all three intervals of NGAL levels were much lower in the patients of the Pro group. However, other indicators in the study did not show significant changes in terms of mean values in the two groups of patients.
CONCLUSION: Pro significantly reduced NGAL compared with Dex for thoracotomy surgery.

Keywords: Dexmedetomidine, neutrophil gelatinase-associated lipocalin, propofol, thoracotomy

How to cite this article:
Farzanegan B, Mirtajani SB, Hemmatyar M, Fani K, Jabbari A, Sayadi S, Jahangirifard A. Comparison of dexmedetomidine and propofol on serum neutrophil gelatinase-associated lipocalin levels of patients after thoracotomy. J Prev Diagn Treat Strategies Med 2023;2:19-23

How to cite this URL:
Farzanegan B, Mirtajani SB, Hemmatyar M, Fani K, Jabbari A, Sayadi S, Jahangirifard A. Comparison of dexmedetomidine and propofol on serum neutrophil gelatinase-associated lipocalin levels of patients after thoracotomy. J Prev Diagn Treat Strategies Med [serial online] 2023 [cited 2023 Mar 31];2:19-23. Available from: http://www.jpdtsm.com/text.asp?2023/2/1/19/371629

Introduction

Acute renal injury (AKI) is a well-known complication of surgery that increases mortality and postoperative costs of care and treatment.^[1] Thoracic surgery causes more damage to the renal system due to low fluid injection during the operation and the occurrence of ischemic-reperfusion injury (which is associated with the release of inflammatory factors).^[2] These injuries are of various causes (including hemodynamic, inflammatory, and nephrotic components)^[3] and so far no specific diet and medication to reduce the occurrence or their side effects have been identified.^[4] Propofol (Pro) is a common anesthetic used in many surgeries.^[5],[6] The use of this drug has several side effects such as pain during injection, hypertension, bradycardia, and respiratory disorders.^[7] Pro injection syndrome (although a rare complication) is also a side effect after injection of this drug. Therefore, finding and replacing other types of drugs with fewer side effects than conventional drugs is on the agenda of surgical teams.^[8] Dexmedetomidine (Dex) is a relatively new drug that is an alternative to γ-aminobutyric acid and Pro agonists.^[9]

By acting on the central nervous system, this drug exerts secondary effects after injection.^[10],[11] The positive effects of using this drug in reducing kidney damage have been observed in many similar surgeries (such as cardiovascular surgery). The use of drugs that have mild damage cannot be responsible for the process of dealing with possible injuries. Early and correct diagnosis of injuries is an important part of the prevention process. Performing kidney function tests such as urinary nitrogen, blood urea nitrogen (BUN), and creatinine (Cr) tests have been common methods from the past to the present. However, these methods, while being effective against various factors, will take longer to generate the warning message, because increasing their quantitative levels often occur in the later stages of kidney damage. Therefore, these factors cannot be considered appropriate factors for determining the timing of acute kidney injury.^[12]

Neutrophil gelatinase-associated lipocalin (NGAL) is a protein produced in neutrophils and epithelial cells of the complex tube near the kidneys and is a new marker in the early detection of kidney damage. In addition to early detection of kidney damage (2 h after injury), this marker is also used in the diagnosis of possible kidney tumors.^{[13],[14],[15]} In this study, we try to compare the effect of two drugs, Pro and Dex, on the activity and possible kidney damage in patients undergoing thoracotomy by examining and measuring the amount of renal function evaluation factors such as BUN, Cr, and NGAL.

Materials and Methods

Ethics

This cross-sectional study complies with the ethical standards of the Ethics Committee in Biomedical Research of Masih Daneshvari Hospital and with the 1975 Declaration of Helsinki, as revised in 2000 (available at https://www.wma.net/policies)

-post/wma-Helsinki Declaration of Ethical Principles for Medical Research Involving Human Subjects. These claims were confirmed by receiving the code (IR.SBMU.RETECH.REC.1397.618).

Type of sampling and study design

Since the study was designed as a cross-sectional method, sampling was done using all the available samples. Thus, 54 eligible patients were randomly divided into two groups Dex (under infusion of Dex + remifentanil) and Pro (under infusion of Pro + remifentanil).

Procedure

Lung isolation was performed with dose-limiting toxicity Weber according to standard criteria and fluids were administered according to the standard and standard treatment protocol. At the end of the surgery, all patients underwent thoracic surgery as an analgesic and a catheter was inserted. All patients were recovered at the end of the operation. NGAL biomarker was measured before surgery and 2 and 6 hours after surgery, while BUN and Cr were measured only 24 hours after surgery. The amount of urinary output was also recorded every hour.

All quantitative variables were expressed as mean and standard deviation, and qualitative variables were expressed as number (percentage). The normality of quantitative variables was evaluated by the Kolmogorov–Smirnov test and box diagrams and the probability of normal. Student's t-test and Mann–Whitney nonparametric test were used to compare quantitative variables between the two groups. All statistical tests were performed in two domains with a significance level of 5% and will be used to analyze SPSS 21 software (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp).

Results

The mean age of participants was 49.07 years (Dex group: 48.02 and Pro group: 49.9 years), whereas 62.96% (36 patients) were men and 37.04% (20 patients) were women [Figure 1].

Figure 1: Graph comparing the age and sex of patients participating in the study by groups

Click here to view

Examination of liver and kidney function factors in patients shows that BUN index in patients of the two groups in the three measured time periods (before surgery, 2 h after surgery, and 24 h) was significantly different. It should be noted that BUN levels in all three periods were higher in the group of patients receiving Pro. However, other indicators in the study did not show significant changes in terms of mean values in the two groups of patients [Table 1]. Based on the results in this table, the NGAL index as a factor in assessing renal function was significantly different in the two groups of patients. However, the mean numerical values in all three intervals of NGAL were significantly lower in the patients of the Pro group.

Table 1: Evaluation of renal and liver function indices in two groups of patients (patients undergoing thoracotomy)

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Discussion

Acute renal failure (ARF) is one of the major public health problems worldwide with more than 1 million kidney transplants.^[16] However, according to the results of published studies, this type of injury can be considered one of the most important and common complications after thoracotomy surgery.^[17] Different studies consider different factors to affect the extent of these adverse effects following surgery. The term ARF was used in the last decade, but today it is known as acute kidney injury (AKI) because acute renal damage must be detected in the early stages to lead to failure.^[18] The first reports of AKI in medical articles entitled war nephritis were published in 1917.^[19] ARF is a syndrome caused by a sudden decrease in glomerular filtration to the point of retention of nitrogenous wastes, disturbance of extracellular fluid volume, homeostasis of electrolytes, and acid and base in the body. The most common method of monitoring kidney function is usually to measure urinary output and serum Cr. Other factors monitoring kidney function include glomerular function, glomerular injury, proximal tubule function, and proximal tubule injury.^[20] NGAL is a protein produced in neutrophils and complex epithelial cells near the kidneys and is a new marker in the early detection of kidney damage. In addition to the early detection of kidney damage (2 h after injury), this marker is also used in the diagnosis of possible kidney tumors.^[21]

The results of the present study, based on the comparison of Dex and Pro on the serum NGAL level of patients after thoracotomy surgery, has been shown that the average duration of surgery performed in all participants was 3 h and 36 min, which is 3 h and 47 min for patients in the Dex group and 3 h and 26 min for the Pro group, respectively. These results, however, are approximately the same as for the duration of anesthesia. According to the mean duration of anesthesia of all participants (4 h and 21 min), patients in the Dex group with an average of 4 h and 35 min were under anesthesia longer than their counterparts in the Pro group with an average of 4 h and 7 min. Although both the duration of surgery and the duration of anesthesia were significantly higher in the Dex group than in the Pro group, however, these changes did not significantly improve the condition of patients receiving Pro (P = 0.156, P = 108).

Examination of patients to receive Lasix in two time periods (in the operating room and during the first 24 h after surgery) shows that a total of 5.5% (three patients) of the patients were eligible. Furthermore, all of these people were patients in the Pro group and during the period of surgery. Examination of the liver and renal function factors in patients shows that the BUN index in patients in the two groups was significantly different in three time periods (before surgery, 2 h after surgery, and 24 h). It should be noted that BUN levels in all three periods were higher in the group of patients receiving Pro.

Based on the results, the NGAL index as a factor evaluating renal function was significantly different in the two groups of patients. However, the mean of all three intervals of NGAL level measurement was lower in patients of the Pro group.

However, other indicators in the study do not have significant changes in terms of mean values in the two groups of patients. Various studies have emphasized the role of kidney damage in the outcome of surgeries. Epidemiological studies in other countries have shown a different prevalence of ARF after surgery so, in one study, the prevalence of AKI before cardiac bypass surgery was 23.8%.^[22]

In another study of 1299 patients undergoing surgery, the prevalence of AKI was reported to be 91%.^[23] If preoperative creation is more than 1.1 mg/DL, the risk of requiring postoperative dialysis is more than 94%.^[24] The amount of Cr before surgery and its increase after surgery will be directly related to mortality. The mortality of patients whose Cr is more than 2.1 before surgery is about 30%–50%.^[25] However, there is no accurate study to evaluate the extent of NGAL changes after thoracotomy surgery. However, this indicator can be considered a factor in informing the potential risk rate after such surgeries.

Conclusion

Based on the results, it can be said that the use of Pro significantly reduces NGAL compared to the use of Dex for high-risk surgeries such as thoracotomy. Therefore, due to the importance of the risks of kidney injury following such surgeries that increase mortality, the need to determine and explain the choice of appropriate medication with a postoperative risk reduction approach is very important.

Limitation of the study

The present study can be designed as a clinical trial. On the other hand, using a larger statistical population or conducting a multicenter study can provide more reliable results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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