Dexmedetomidine Controls the Hemodynamic Manifestations of Tourniquet Pain

Abstract

Dexmedetomidine is an α2-adrenergic agonist that is Food and Drug Administration-approved for the provision of short-term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiological effects, including sedation and anxiolysis, various applications have been reported in the perioperative period. We report the use of dexmedetomidine to control the hemodynamic consequences of tourniquet pain in three patients having either orthopedic or plastic surgical procedures requiring the use of tourniquets. In all cases, dexmedetomidine controlled the hemodynamic responses to tourniquet pain, including tachycardia and hypertension. The use of dexmedetomidine in this scenario is discussed, and its potential advantages over other agents, including opioids, are reviewed.

Tourniquet application during anesthesia: “What we need to know?”

“…These changes persist until tourniquet deflation and poorly respond to analgesic drugs or increasing the depth of anesthesia. Many interventions have been reported to reduce cardiovascular stress:[242526272829303132] Ketamine, dexmedetomidine, magnesium sulfate, clonidine, and remifentanil infusion.…”

“…Many techniques[27] like application of EMLA cream, infiltration with local anesthetics, use of wider cuff with lower inflation pressure, addition of opioids, clonidine, epinephrine along with local anesthetics in spinal block have been tried in order to decrease the incidence or severity of this pain but none has attained complete success in pain relief. Intravenous drugs,[242527282930313247] ketamine, dexmedetomidine, magnesium sulfate, clonidine remifentanil infusions have also been studied, and the only thing that works reliably is tourniquet deflation.…”

Role of Low Dose Preoperative Dexmedetomidine in Preventing Tourniquet Induced Hypertension in Paediatric Orthopaedic upper Limb Surgeries during General Anaesthesia

“…The painful stimuli of tourniquet inflation leads to activation of sympathetic nervous system. So, the intravenous Dexmedetomidine, is suggested to have a role in attenuating the sympathetic surge as well as the perioperative requirement of sedation and analgesia due to its intrinsic property [21][22][23] . It was Tetzlaff et al [22] who demonstrated the correlation between TIH and sympathetic system activation.…”