Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

Menda, Ferdi; Köner, Özge; Sayın, Murat; Türe, Hatice; Imer, Pinar; Aykaç, Bora

doi:10.4103/0971-9784.58829

Cited by 105 publications

(64 citation statements)

References 26 publications

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“…Mariappan et al showed similar hemodynamic profiles when they compared oral clonidine premedication and perioperative dexmedetomidine infusion [23]. Most studies showed that, compared to saline, dexmedetomidine as a premedication significantly decreased hypertensive and tachycardia responses that occur due to intubation [8, 24–26]. Becker et al reported that the dexmedetomidine infusion after intubation in craniotomy patients resulted in fewer antihypertensive requirements [27].…”

Section: Discussionmentioning

confidence: 99%

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Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

et al. 2014

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BackgroundPerioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.MethodsOne-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg−1, and midazolam was administered at a concentration of 0.025 μg.kg−1 via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (Tbeginning, Tpreop5 min, Tpreop 10 min, Tinduction, Tintubation, Tintubation5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation, Textubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.ResultsSBP was significantly different between normotensive and hypertensive groups at the following time points: Tpreop 5 min, Tpreop 10 min, Tinduction, Tintubation, Tintubation 5 min and Tinitial surgery. MBP was significantly different in the hypertensive groups at Tinduction, Tintubation, Tintubation 5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation and Textubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.ConclusionIn the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.Trial registrationTrial registration: Clinicaltrials.gov identifier: NCT02058485.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, a limited number of studies have evaluated the usage of dexmedetomidine [7, 8]. Dexmedetomidine is 1600 times more selective to α-2 receptors than to α-1 receptors (clonidine, 200:1), and this high selectivity contributes to increases in hypnotic and analgesic efficacies and decreases in cardiovascular side effects [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

et al. 2014

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“…In their study, they measured catecholamine concentration and found that the concentration of noradrenaline in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction. Ferdi Menda et al .,[17] concluded that dexmedetomidine effectively blunts the hemodynamic response to endotracheal intubation in patients undergoing myocardial re-vascularization and can be safely used at induction of general anesthesia in combination with fentanyl even among patients receiving beta blockers.…”

Section: Discussionmentioning

confidence: 99%

Attenuation of sympathoadrenal responses and anesthetic requirement by dexmedetomidine

2013

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Context:During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. Dexmedetomidine attenuates the hemodynamic response to endotracheal intubation and reduces anesthetic requirement.Aims:The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 μg/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation and need for anesthetic agent.Materials and Methods:Fifty patients scheduled for elective major surgery were randomized into two groups each having twenty five patients-dexmedetomidine group (Group 1) and control group (Group 2). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and Ramsay sedation score were recorded at 1, 2 and 5 min after completion of administration of study drug. Fentanyl 2 μg/kg was administered to all patients and propofol was given until loss of verbal contact. Intubation was facilitated with vecuronium 0.1 mg/kg i.v. Anesthesia was maintained with oxygen (O2) and nitrous oxide (N2O) 33%: 67% and isoflurane. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) was noted at 1 min, 2 min and 5 min after intubation.Statistical Analysis Used:For statistical analysis of the clinical data obtained, the analysis of variances (ANOVA) with paired t-test was used.Results:Pretreatment with dexmedetomidine 1 ug/kg attenuated, but did not totally abolish the cardiovascular and catecholamine responses to tracheal intubation after induction of anesthesia. In our present study, HR, SBP, DBP all increased after intubation at 1, 2, 3 and 5 min in both the groups, but the rise was significantly less in the dexmedetomidine group. Requirement of propofol was significantly less in the dexmedetomidine group.Conclusions:Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses during laryngoscopy, and reduced anesthetic requirements.

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“…The effects of α-2 agonists in decreasing the MAC for volatile anesthetics and opioids have been previously reported[17] and possibly is mediated through both pre- and post-synaptic α-receptor activation in the central nervous system. [1819] Reports available in the literature have reported use of dexmedetomidine as an adjunct to general anesthesia. When administered as a premedication at a dose range of 0.33-0.67 μg/kg given 15 min before surgery, it appears to be efficacious while minimizing the cardiovascular side-effects of hypotension and bradycardia.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine decreases requirement of thiopentone sodium and pentazocine followed with improved recovery in patients undergoing laparoscopic cholecystectomy

Khanduja

Ohri

Panwar

2014

J Anaesthesiol Clin Pharmacol

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Background:Pain relief remains the most fundamental and consequential aspect of surgery for patients throughout perioperative period. Dexmedetomidine has created an interest in α2-adrenoceptor agonists in the management of pain and hence the aim of this study was to evaluate the effectiveness of the drug in hilly population of North India.Materials and Methods:Patients, irrespective of gender, were randomly allocated to two groups, control and test, each having 30 patients. Test group received an infusion of dexmedetomidine at a rate of 0.5 μg/kg/h 30 min before induction and 0.6 μg/kg/h after inducing anesthesia. Control patients received a volume-matched infusion of normal saline as placebo. Approximately 2 min before induction, analgesia was provided in the form of pentazocine, 0.5 mg/kg in control and 0.3 mg/kg in the test group. Induction was performed by 2 mg/kg thiopentone sodium supplemented with intravenous boluses of 25 mg thiopentone sodium every 15 s until loss of eyelid reflex (determined every 15 s). Induction dose of thiopentone sodium and total pentazocine dose were recorded. Recovery was assessed on the clinical recovery score (CRS) scale.Results:Infusion of dexmedetomidine decreased the induction dose of thiopentone approximately by 33% and of pentazocine dose by approximately 39% in patients undergoing laparoscopic cholecystectomy. Moreover, incidence of pain was also decreased significantly. Improved CRS from 4.33 to 6.87 was noticed immediately post-operatively in dexmedetomidine group of patients.Conclusion:Infusion of dexmedetomidine during the laparoscopic cholecystectomy decreases the requirement of thiopentone sodium and pentazocine and leads to early recovery of patients.

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Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

Cited by 105 publications

References 26 publications

Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Attenuation of sympathoadrenal responses and anesthetic requirement by dexmedetomidine

Dexmedetomidine decreases requirement of thiopentone sodium and pentazocine followed with improved recovery in patients undergoing laparoscopic cholecystectomy

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