Impact of a Dexmedetomidine Intravenous Infusion in Septic Dogs: Preliminary Study

Simple Summary Sepsis is a widespread concern in human and veterinary medicine. Over the past several years, numerous strategies have been implemented to try to combat it; however, mortality remains high in all species. The use of dexmedetomidine, an alpha-two agonist drug with sedative and analgesic properties, is gaining popularity as a synergistic treatment strategy in the management of sepsis, thanks to its anti-apoptotic and neuroprotective properties and its ability to preserve hemodynamic function. We therefore hypothesized that a continuous rate infusion of dexmedetomidine in septic patients, undergoing emergency surgery, could decrease the requirement for vasopressors. The results of this study show that an infusion of 1 mcg/kg/h of dexmedetomidine decreases intraoperative vasopressor use and improves 28-day mortality. However, given the small sample size, a larger prospective study should be undertaken to confirm these findings.Abstract The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer's lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4-2 mcg/kg/min) than the DEX group (0.12, 0-0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs.