Dexmedetomidine combined with SGB reduces postoperative cognitive dysfunction and oxidative stress during cardiac valve replacement under extracorporeal circulation

This retrospective study evaluates the efficacy of dexmedetomidine (Dex) combined with stellate ganglion block (SGB) in cardiac valve replacement under extracorporeal circulation. A total of 93 patients with cardiopulmonary bypass heart valve replacement were included between June 2021 and June 2023. The study group (n = 46) received SGB before anesthesia induction followed by Dex infusion, while the control group (n = 47) received Dex alone. Hemodynamics, cerebral oxygen metabolism (D(a-jv)O₂ and CERO₂), serum biomarkers (S100β, neuron-specific enolase, malondialdehyde, superoxide dismutase), postoperative cognitive dysfunction (POCD), and anesthesia-related adverse events were compared. Repeated-measures ANOVA revealed significant differences in mean arterial pressure (MAP) trends between groups ( P < .05). The study group exhibited higher MAP during anesthesia induction and extracorporeal circulation but lower MAP postoperatively versus controls (all P < .05). D(a-jv)O₂ and CERO₂ were significantly lower in the study group at extracorporeal circulation initiation and cessation ( P < .05). At 24 hours post-surgery, the control group showed elevated S100β, neuron-specific enolase, and malondialdehyde levels ( P < .05) and reduced superoxide dismutase ( P < .05) compared to the study group. The incidence of POCD in the study group was significantly lower at postoperative day 3 (10.87% vs 29.79%) and day 5 (4.35% vs 14.89%) ( P < .05). Anesthesia-related adverse events were reduced in the study group (15.22% vs 36.17%, P < .05). Preoperative Dex combined with SGB stabilizes hemodynamics, mitigates oxidative stress, and reduces risks of POCD and anesthesia complications in cardiac valve replacement surgery.