Comparative evaluation of different doses of intravenous dexmedetomidine on hemodynamic response during laryngoscopy and endotracheal intubation in geriatric patients undergoing spine surgeries: A prospective, double-blind study

Keshri, Ravi; Prasad, Mukesh Kumar; Choudhary, Amit Kumar; Jheetay, Gurdeep Singh; Singh, Yashowardhan; Kapoor, Kali

doi:10.4103/aer.aer_156_18

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…Whereas dexmedetomidine 1 µg/kg was bear significant attenuation of tracheal intubation-related cardiovascular responses, however declined BP and HR were also evident pre-and post intubation. In our study, hemodynamic parameters have shown no statistical difference between the saline group and DEX 0.5µ/kg group 16 .…”

Section: Discussioncontrasting

confidence: 58%

“…Therefore, the search for a perfect drug and its dose is still going on.Not only intravenous but intra-nasal route has also been tried to attenuate the hemodynamic stress response of LTI without significant variations in MAP between the groups 15 . During the recent decade, many authors compared dexmedetomidine @ 0.5and 1µ/kg 9,16,17 but we found only one study in which Sebastian et al compared dexmedetomidine 0.5 and 0.75µ/kg 18 .…”

Section: Introductionmentioning

confidence: 82%

“…Keshari et al described that 0.5μg/kg dexmedetomidine is valuable in obtunding pressor response 16 . Whereas dexmedetomidine 1 µg/kg was bear significant attenuation of tracheal intubation-related cardiovascular responses, however declined BP and HR were also evident pre-and post intubation.…”

Section: Discussionmentioning

confidence: 99%

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Role of Dexmedetomidine in Attenuation of Hemodynamic Response to Laryngoscopy - A Dose-Finding Study

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M,,

et al. 2023

PJMHS

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Aim: Determining efficacy of pre-operative bolus dose of dexmedetomidine 0.75 and 0.5µg/kg as an infusion and compare it with placebo in attenuation of hemodynamic response to laryngoscopy and tracheal intubation (LTI). Design: Double-blind randomized control. Place & duration: Sindh Institute of Urology & Transplantation, Karachi, Pakistan, from August 2019 to August 2021. Methodology: Patients were stratified into three groups. Group A received normal saline (NS), Group B received dexmedetomidine 0.5 μ/kg and Group C received dexmedetomidine 0.75 μ/kg as an infusion over 10 minutes followed by standardized general anaesthesia. Primary outcome measures were hemodynamic variables at 1, 3, 5 and 10 minutes post LTI. Secondary outcome measures were adverse effects related to dexmedetomidine. Results: Both dexmedetomidine groups showed better attenuation of hemodynamic response to LTI thansaline group. Dexmedetomidine 0.75 µg/kg attenuated hemodynamic response to LTIsignificantly better thandexmedetomidine 0.5 μ/kgand placebo without causing any statistically significant adverse effects. Practical implication: The function of dexmedetomidine in attenuating hemodynamic response to laryngoscopy has several practical implications, including improved patient safety, optimal dosing, reduced anaesthetic requirements, cost-effective treatment, and enhanced patient comfort. Conclusion: Dexmedetomidine 0.75 µg/kg efficient than 0.5 µg/kg and placebo in attenuating hemodynamic response to LTI when given as a pre-induction bolus. Keywords: Anesthesia; Dexmedetomidine, Laryngoscopy, Intubation, Stress Response.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 82%

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Role of Dexmedetomidine in Attenuation of Hemodynamic Response to Laryngoscopy - A Dose-Finding Study

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et al. 2023

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“…Some adverse effects of higher doses of anesthetic drugs may be catastrophic in the geriatric age group. Keshri et al 27 reported that a loading dose of 0.5 µg/kg intravenous dexmedetomidine has the minimum side effects in reducing the hemodynamic stress response in geriatric patients undergoing spine surgery when compared with 1 µg/kg dexmedetomidine. The dose of intratracheal dexmedetomidine was 1 µg/kg for patients aged 20 to 65 in our previous study, 16 and the intratracheal route of dexmedetomidine is rapidly absorbed through the bronchial and alveolar capillary network.…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Administration Routes of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Elective Spinal Surgery: A Prospective Randomized Double-Blinded Controlled Trial

Niu

Yang

Tao

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Intravenous dexmedetomidine has been reported to decrease the occurrence of postoperative delirium (POD) in elderly patients. Nevertheless, some previous studies have indicated that intratracheal dexmedetomidine and intranasal dexmedetomidine are also effective and convenient. The current study aimed to compare the effect of different administration routes of dexmedetomidine on POD in elderly patients. METHODS: We randomly allocated 150 patients (aged 60 years or more) scheduled for spinal surgery to receive intravenous dexmedetomidine (0.6 μg/kg), intranasal dexmedetomidine (1 μg/kg) before anesthesia induction, or intratracheal dexmedetomidine (0.6 µg/kg) after anesthesia induction. The primary outcome was the frequency of delirium during the first 3 postoperative days. The secondary outcomes were the incidence of postoperative sore throat (POST) and sleep quality. Adverse events were recorded, and routine treatment was performed. RESULTS: Compared with the intranasal group, the intravenous group had a significantly lower occurrence of POD within 3 days (3 of 49 [6.1%] vs 14 of 50 [28.0%]; odds ratio [OR], 0.17; 95% confidence intervals [CIs], 0.05–0.63; P < .017). Meanwhile, patients in the intratracheal group had a lower incidence of POD than those in the intranasal group (5 of 49 [10.2%] vs 14 of 50 [28.0%]; OR, 0.29; 95% CI, 0.10–0.89; P < .017). Whereas, there was no difference between the intratracheal and intravenous groups (5 of 49 [10.2%] vs 3 of 49 [6.1%]; OR, 1.74; 95% CI, 0.40–7.73; P > .017). The rate of POST was lower in the intratracheal group than that in the other 2 groups at 2 hours after surgery (7 of 49 [14.3%] vs 12 of 49 [24.5%] vs 18 of 50 [36.0%], P < .017, respectively). Intravenous dexmedetomidine had the lowest Pittsburgh Sleep Quality Index score on the second morning after surgery (median [interquartile range {IQR}]: 4 [3–5] vs 6 [4–7] vs 6 [4–7], P < .017, respectively). Compared with the intranasal group, the intravenous group had a higher rate of bradycardia and a lower incidence of postoperative nausea and vomiting (P < .017). The intranasal group was associated with the highest incidence of hypertension (P < .017). CONCLUSIONS: For patients aged ≥60 years undergoing spinal surgery, compared with the intranasal route of dexmedetomidine, intravenous and intratracheal dexmedetomidine reduced the incidence of early POD. Meanwhile, intravenous dexmedetomidine was associated with better sleep quality after surgery, and intratracheal dexmedetomidine resulted in a lower incidence of POST. Adverse events were mild in all 3 administration routes of dexmedetomidine.

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“…Previous studies have reported that dexmedetomidine combined with opioids could effectively attenuate haemodynamic responses to endotracheal intubation. 5,6 When co-administered with two or more drugs, it is necessary to consider their interaction to accurately predict the dose–response relationship. However, the pharmacodynamic interaction between opioids and dexmedetomidine has not been well-investigated.…”

Section: Introductionmentioning

confidence: 99%

A Response Surface Analysis of the Combination of Dexmedetomidine and Sufentanil for Attenuating the Haemodynamic Response to Endotracheal Intubation

Jia

et al. 2022

Dose-Response

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Purpose Dexmedetomidine combined with opioids has been extensively used to blunt cardiovascular responses to endotracheal intubation. To determine their interaction, we aimed to develop a response surface model between dexmedetomidine and sufentanil. Methods One hundred and twenty patients undergoing scheduled gynaecological surgery were recruited. According to a simulation of slice design, patients received different dose pairs of dexmedetomidine (0 to 1.1 μg/kg) and sufentanil (.1 to .5 μg/kg). The mean arterial blood pressure and heart rate of patients were recorded just before endotracheal intubation, immediately after intubation, and during the first 3 min after intubation. The primary outcomes were haemodynamic changes. The full dose–response relationship between dexmedetomidine and sufentanil was analysed using a logit model. Results This response surface model revealed that the interaction between dexmedetomidine and sufentanil was additive. The dose pairs that could effectively attenuate the haemodynamic response to endotracheal intubation primarily ranged from .3 to .4 μg/kg and .5 to 1.1 μg/kg for sufentanil and dexmedetomidine, respectively. Conclusion When used propofol as the main hypnotic drug during anaesthesia induction, dexmedetomidine could effectively reduce the requirement of sufentanil in an additive manner. However, it is not an effective drug for ablating the cardiovascular response to endotracheal intubation when used alone. The clinical trial registry. The trial registry name: Chinese Clinical Trial Registry. Registration number: ChiCTR1800015273. URL: http://www.chictr.org.cn

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Comparative evaluation of different doses of intravenous dexmedetomidine on hemodynamic response during laryngoscopy and endotracheal intubation in geriatric patients undergoing spine surgeries: A prospective, double-blind study

Cited by 7 publications

References 25 publications

Role of Dexmedetomidine in Attenuation of Hemodynamic Response to Laryngoscopy - A Dose-Finding Study

Role of Dexmedetomidine in Attenuation of Hemodynamic Response to Laryngoscopy - A Dose-Finding Study

Effect of Different Administration Routes of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Elective Spinal Surgery: A Prospective Randomized Double-Blinded Controlled Trial

A Response Surface Analysis of the Combination of Dexmedetomidine and Sufentanil for Attenuating the Haemodynamic Response to Endotracheal Intubation

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