Dexmedetomidine premedication in relevance to ketamine anesthesia: A prospective study

Gupta, Kumkum; Gupta, Amit; Gupta, Prashant; Rastogi, Bhawna; Agarwal, Salony; Lakhanpal, Mahima

doi:10.4103/0259-1162.84193

Cited by 22 publications

(15 citation statements)

References 14 publications

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“…Similar effects were observed with study done by Gupta K et al . [ 6 ] who compared the effect of dexmedetomidine with midazolam in ketamine anesthesia. Our study results on hemodynamic parameters were similar to yet another study done by Kolhe et al .…”

Section: Discussionmentioning

confidence: 99%

“…Patients were premedicated with intravenous metoclopramide (10 mg), glycopyrrolate (0.2 mg) followed by intravenous midazolam at a dose of 0.02 mg/kg[ 6 ] which was given slowly over a period of 10 min. After preoxygenation with 100% oxygen, anesthesia was induced with intravenous ketamine (1% solution) at a dose of 1 mg/kg slowly over 30 s.[ 7 ] Anesthetic and surgical techniques were standardized for all the patients.…”

Section: Methodsmentioning

confidence: 99%

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Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study

et al. 2015

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Objective:Ketamine administration is known to induce hemodynamic pressor response and psychomimetic effects which could be attenuated by appropriate premedication. The present study was designed to evaluate the effect of midazolam on hemodynamic stability and postoperative emergence phenomenon following ketamine anesthesia.Methods:This was a prospective observational study including 30 adult patients with American Society of Anesthesiologists physical grades I and II scheduled for elective short surgeries under ketamine anesthesia. Patients were premedicated with midazolam (0.02 mg/kg intravenously) before the ketamine induction (1 mg/kg intravenously). Demographic data and hemodynamic variables were observed during the perioperative period. Pain score by visual analog scale score and psychomimetic effects were recorded postoperatively.Findings:The mean ± standard deviation of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were decreased postoperatively (85.3 ± 11.4, 120.7 ± 8.2, 79.2 ± 5.5, 13.5 ± 1.8, respectively) compared to intraoperative period (88.53 ± 14.1, 123.83 ± 13.8, 83 ± 9.1, 14.13 ± 2.0, respectively). There was statistically significant decrease in systolic (P = 0.03) and diastolic (P = 0.002) blood pressure, but not with heart rate and respiratory rate. Eighty percent of patients had no pain at ½ hour and 1 hour, while this increased to 90% at 2 hours postoperatively. Mild emergence delirium was noted in 13.3% and 16.7% at ½ hour and 1 hour, respectively, which decreased to 13.3% at 2 hours. Dreams were noticed in 20%, 27% and 10% of patients at ½ hour, 1 and 2 hours after surgery, respectively.Conclusion:Midazolam premedication in ketamine anesthesia effectively attenuated the hemodynamic pressor response and postoperative emergence phenomenon. Hence, the combination of midazolam with ketamine can be safely used for short surgical painful procedures in adults.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study

et al. 2015

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“…Several studies in the past have also demonstrated that pretreatment with dexmedetomidine significantly attenuated the cardiovascular and catecholamine responses to tracheal intubation. [7][8][9][10][11][12] However; attenuation was significantly It is a well-known fact that dexmedetomidine reduces the inducing dose of propofol and thiopentone, but in this study we tried to find out that how much beneficial it is when compared to clonidine. 13,14 It was found that the requirement of propofol was reduced after pretreatment with dexmedetomidine as compared to clonidine.…”

Section: Discussionmentioning

confidence: 98%

A comparative study of effect of dexmedetomidine in dose of 0.7 and micro;g/kg and clonidine in doses of 2 and micro;g/kg as premedication before general anaesthesia

Singh

Nazir

2016

Int J Res Med Sci

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Alpha-2 adrenoceptor agonists have widely been used in anaesthesia and critical care as analgesics and sedatives. Both clonidine and dexmedetomidine, a more selective and specific α-2 agonist have been shown to decrease induction doses of i.v. anaesthetics and intraoperative opioid and volatile anaesthetic requirements for maintenance of anaesthesia resulting in more rapid recovery from anaesthesia and also a reduced need for pain medication in post-operative period, thereby reducing the length of stay. We have compared the preoperative as well as the perioperative effects of clonidine and dexmedetomidine to determine whether dexmedetomidine being a more selective α 2 agonist (α 2: α 1 ratio: 8:1), has any advantage over clonidine. 1 Various routes of administration of alpha-2 agonists like intrathecal, epidural, nerve blocks and intravenous have been tried. 2,3 Both the drugs have been ABSTRACT Background: Alpha-2 adrenoceptor agonists have widely been used in anaesthesia and critical care as analgesics and sedatives. Both clonidine and dexmedetomidine, a more selective and specific α-2 agonist have been shown to decrease induction doses of i.v. anaesthetics and intraoperative opioid and volatile anaesthetic requirements for maintenance of anaesthesia resulting in more rapid recovery from anaesthesia and also a reduced need for pain medication in post-operative period, thereby reducing the length of stay. The current prospective randomised double blind study was undertaken to compare the effects of dexmedetomidine and clonidine, as i.v. premedication, on perioperative hemodynamics , reduction in dose of inducing agent and post-operative analgesia duration. Methods: A total of 60 ASA class I and II patients undergoing elective surgeries under general anesthesia were randomised into two groups. Group D-dexmedetomidine 0.7µg/kg, and group C-clonidine 2µg/kg. Drugs were given 15 minutes before induction. The cases were conducted under General anesthesia with endotracheal intubation using Propofol, Vecuronium, N 2 O and O 2. Heart rate, blood pressure, dose of inducing agent and time of rescue analgesia were recorded. Results: The rise in mean arterial pressure and heart rate during intubation and extubation was lesser with group D as compared to group C. (p<0.05). Lesser amounts of inducing agent was required with group D as compared to group C (p<0.0001). Post-operative analgesia duration was more with group D as compared to group C (p<0.001). Conclusions: Study concluded that Dexmedetomidine had better control over hemodynamics as compared to clonidine when given as premedication, the drug dose used for induction was lesser and also the post-operative analgesia duration was longer with dexmedetomidine.

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“…Handa F,Tanaka M, Nishikawa T, Toyooka H [17] conducted a study to determine the effects of oral clonidine premedication on haemodynamic changes during the entire course of ketamine anaesthesia and concluded that oral clonidine 2.5 microgram/kg and 5 microgram/kg attenuate cardiostimulatory effects associated with ketamine induction. Levanen J, Makela ML, Scheinin H [18] studied the effects of dexmedetomidine premedication on ketamine induced cardiostimulatory effects and [19] studied dexmedetomidine premedication in relevance to ketamine anaesthesia. They concluded that the dexmedetomidine premedication effectively attenuated the ketamine induced haemodynamic pressor response and postanaesthetic delirium effects.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study Of Intravenous Clonidine And Intravenous Dexmedetomidine Premedication On Cardiovascular Response To Ketamine Anesthesia In Patients Undergoing Dilatation & Curettage.

Shahani

2015

ijmsci

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Background-Ketamine induced hemodynamic pressor response should be attenuated by appropriate premedication. The present study was designed to evaluate and compare the efficacy of dexmedetomidine and clonidine premedication to counter the effects of ketamine.Method-A total of 68 normotensive adult female patients of ASA grade I and II, aged 20-50 years, weighing between 40-65 kgs and undergoing dilatation and curettage under ketamine anaesthesia were randomized for this double blind, interventional, hospital based study.These patients were divided into two treatment groups of 34 patients each. Group A (n=34) received Clonidine 1mcg/kg as continuous i.v. infusion over 30 minutes before induction. Group B (n=34) received Dexmedetomidine 1mcg/kg as continuous i.v. infusion over 10 minutes before induction Observations regarding the demographic profile, preoperative and intraoperative heart rate, mean arterial pressure were recorded. Analysis of data was done using unpaired student "t" test and chisquare tests.A "p" value <0.05 was considered significant.Result: No statistically significant difference was found in age, weight & ASA grade of both groups (p>0.05). Mean heart rate in Group A was 81.91± 6.84 and in Group B 80.94±7.09 (P value = 0.56 no statistical significance); after induction with ketamine,HR in Group A was 102.35± 12.55 and in Group B 78.02± 9.91 (P value = 0.000 high statistical significance). Mean arterial pressure in Group A was 90.85± 5.86 and in Group B 93.43± 8.14 (P value = 0.13 no statistical significance); after induction with ketamine, MAP in Group A was 103.76±7.74 and in Group B 99.05± 11 (P value = 0.04 statistical significance). Conclusion: Dexmedetomidine attenuates ketamine induced hemodynamic pressor response more effectively than clonidine. It maintains stable hemodynamic parameters during dilatation & curettage under ketamine anaesthesia.

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Dexmedetomidine premedication in relevance to ketamine anesthesia: A prospective study

Cited by 22 publications

References 14 publications

Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study

Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study

A comparative study of effect of dexmedetomidine in dose of 0.7 and micro;g/kg and clonidine in doses of 2 and micro;g/kg as premedication before general anaesthesia

A Comparative Study Of Intravenous Clonidine And Intravenous Dexmedetomidine Premedication On Cardiovascular Response To Ketamine Anesthesia In Patients Undergoing Dilatation & Curettage.

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