Avaliação hemodinâmica e metabólica da infusão contínua de dexmedetomidina e de remifentanil em colecistectomia videolaparoscópica: estudo comparativo

Background: stereotactic frame-based brain biopsy is a minimally invasive neurosurgical procedure. Dexmedetomidine, an alpha-2 adrenergic agonist decreases heart rate, blood pressure, and stress response. Remifentanil is a short-acting opioid receptor agonist. In this study, we aim to compare the effects of dexmedetomidine and remifentanil on sedation, hemodynamic alterations, analgesia, and recovery profile of patients who underwent stereotactic brain biopsy. Method: a single-blind clinical trial was conducted. Forty patients with American society of anesthesiology(ASA) class II were included. Initially, local anesthesia was administered and stereotactic frames were installed, then patients were transferred for magnetic resonance imaging (MRI) evaluations. Afterward, patients were randomly divided into two groups: The R group which received remifentanil, and the D group which received dexmedetomidine. Blood pressure, oxygen saturation, heart rate, and Ramsay sedation scale (RSS) of all included cases were recorded throughout the operation. After transferring to the post-anesthesia care unit (PACU), the visual analog score (VAS) and the amount of consumed morphine by each patient were measured. The statistical analysis was conducted using SPSS version 22. Descriptive analysis, analysis of variance (ANOVA), and independent t-test were performed. A P-value less than 0.05 was considered to be statistically significant. Results: forty consecutive patients consisting of 22 males and 18 females were included. Patients were randomly divided into two equal groups. After conducting statistical analysis, it was revealed that RSS was higher in the R group. Indicating a higher level of sedation. Heart rate, systolic blood pressure, and diastolic blood pressure were all higher in the D group. Furthermore, the VAS and consumed morphine were lower in the D group. Conclusion: The RSS was higher in the R group, indicating a higher level of sedation in patients who received remifentanil. All recorded vital signs were higher in the D group. implicating that the vital signs were more stable during the operation in patients who received dexmedetomidine. In addition, the VAS and dose of consumed morphine in PACU were lower in the D group. Trial registration: the current study was registered in The Iranian registry clinical trial (code =IRCT20210415050983N2).

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“…The SBP and DBP were higher in the D group. Despite the current study, they found no statistical difference in HR between D and R groups (37).…”

Section: Discussioncontrasting

confidence: 95%

Comparison of the effects of dexmedetomidine and remifentanil in sedation, analgesia, and vital signs in patients undergoing stereotactic brain biopsy: a single-blind control trial

Behnaz

Asgari

Bazgir

et al. 2023

Preprint

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“…This result suggests that no combination of remifentanil and propofol affects the changes in HR response to tracheal intubation. This result was consistent with that of an earlier report [19].…”

Section: Discussionsupporting

confidence: 94%

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

Goyagi¹,

Yoshimoto²

2012

OJAnes

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Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventyfive patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg); the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg); and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.

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Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis

Wang

et al. 2019

British Journal of Anaesthesia

231

161

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Background: Dexmedetomidine (DEX) is a highly selective alpha2 adrenoceptor agonist with broad pharmacological effects, including sedation, analgesia, anxiolysis, and sympathetic tone inhibition. Here we report a systematic review and meta-analysis of its effects on stress, inflammation, and immunity in surgical patients during the perioperative period. Methods: We searched MEDLINE, METSTR, Embase, and Web of Science for clinical studies or trials to analyse the effects of DEX on perioperative stress, inflammation, and immune function. Results: Sixty-seven studies (including randomised controlled trials and eight cohort studies) with 4842 patients were assessed, of which 2454 patients were in DEX groups and 2388 patients were in control (without DEX) groups. DEX infusion during the perioperative period inhibited release of epinephrine, norepinephrine, and cortisol; decreased blood glucose, interleukin (IL)-6, tumour necrosis factor-a, and C-reactive protein; and increased interleukin-10 in surgical patients. In addition, the numbers of natural killer cells, B cells, and CD4 þ T cells, and the ratios of CD4 þ :CD8 þ and Th1:Th2 were significantly increased; CD8 þ T-cells were decreased in the DEX group when compared with the control group. Conclusions: DEX, an anaesthesia adjuvant, can attenuate perioperative stress and inflammation, and protect the immune function of surgical patients, all of which may contribute to decreased postoperative complications and improved clinical outcomes.

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Avaliação hemodinâmica e metabólica da infusão contínua de dexmedetomidina e de remifentanil em colecistectomia videolaparoscópica: estudo comparativo

Abstract: In the conditions of our study, dexmedetomidine has inhibited catecholamine release during tracheal intubation and pneumoperitoneum, however, has not prevented blood pressure increase in response to peritoneal inflation.

Cited by 3 publications

References 17 publications

Comparison of the effects of dexmedetomidine and remifentanil in sedation, analgesia, and vital signs in patients undergoing stereotactic brain biopsy: a single-blind control trial

Comparison of the effects of dexmedetomidine and remifentanil in sedation, analgesia, and vital signs in patients undergoing stereotactic brain biopsy: a single-blind control trial

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis

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