Effects of Intraoperative Dexmedetomidine Infusion on Hemodynamic Stability during Brain Tumor Resection

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

“…[8][9][10][11][12] Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers and vasodilators etc. [13][14][15][16][17] Although the corresponding increases in blood pressure and heart rate are transitory and variable, they are more pronounced and unpredictable in patients with 19 % maximum increase in the heart rate after one minute of intubation and it was further decreased by 1.24% from the baseline.While patients of group B showed a 12% initial rise in pulse rate(at the first minof intubation) which did not return to the baseline even after ten minutes The maximum percentage increase in the SBP in Group B was 4%, while patients of Group A showed maximum percentage increase of only 0.29%.Dexmedetomidine group of patients also showed later a percentage decrease which was maximum at the third and fourth minutes (-0.61 %) raised intracranial tension, cardiovascular disease like hypertension following laryngoscopy.…”

“…8,[23][24][25] Sedation, analgesic, sympatholytic, anxiolytic and blunting of haemodynamic responses by administering dexmedetomidine are exclusively mediated by activation of alpha-2 receptors located in the post-synaptic terminals in the central nervous system (CNS), leading to reduced neuronal activity &augmentation of vagal activity. [26][27][28][29] Dexmedetomidine is generally initiated with a loading infusion dose of 1 μg/kg over 10-20 minutes, (optional) followed by a maintenance infusion dose of 0.2-0.7 μg/kg/hr.…”

Attenuation of pressor response and dose sparing effect on opioids with the use of dexmedetomidine in spine surgeries

“…To date numerous efforts have been made to make the procedure safe, full proof and devoid of any complications.Attenuation and blunting of pressor response during laryngoscopy and intubation has been one of the most researched topics in anaesthesia, but with only a few positive established outcome [1][2][3][4][5]. Numerous drugs and their combinations have been tried in the past and studies have highlighted the use of these drugs in varying doses for suppression of stress response but not without the significant incidence of quite a few side-effects, especially with higher doses of opioids [5][6][7][8][9][10].Cardiovascular responses viz.…”

“…Sympatho-adrenal stimulation with sudden rise in heart rate and blood pressure can also lead to left ventricular failure, myocardial ischaemia, cerebral haemorrhage, pulmonary edema, increase in intracranial pressure and its complications; for example, convulsions in pre-eclamptic patients.The analgesic, sedatives, anxiolytic, sympatholytic and blunting of exaggerated haemodynamic responses by administration of dexmedetomidine are being extensively studied and are mainly mediated by the activation of alpha-2 receptors located in the postsynaptic terminals in the central nervous system (CNS), which causes decreased neuronal activity and augmentation of the vagal activity [4,[19][20][21]. The role of alpha-2 agonists in regulating the autonomic and cardiovascular responses is well understood, whereby they inhibit release of catecholamines (norepinephrine) from the sympathetic nerve terminals by augmentation of a vasoconstrictive effect [1,[22][23].In the present study, we have tried to evaluate the efficacy of intravenous dexmedetomidine in attenuation of pressor response to laryngoscopy and intubation and also minimising the requirement of induction agent and opioids in patients undergoing spine surgeries [24].The mean age, weight, height and sex distribution in both groups was comparable ('P' > 0.05).The method of administration of study drugs over 20 minutes in our study, is similar to the studies conducted by Mowafi et al [25]. Basar et al [26] and Kunisawa et al [34].…”

“…The pressor response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamines concentrations in patients undergoing surgery under general anaesthesia [1][2][3][4][5].Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, ______________________________ *Correspondence Dr. Amarjeet Dnyandeo Patil Assistant Professor, MGM Medical College and Hospital, MGMUHS, Navi Mumbai,India E Mail: amarjeetpatil999@yahoo.co.in benzodiazepines, beta blockers, calcium channel blockers, vasodilators, etc [6][7][8][9][10]. The dose of opioids required for effective attenuation of stress response is fairly high and numerous drugs have been used as adjuncts in decreasing the dose of opioids with a varied level of success, but are not absolutely free from sideeffects [10][11][12].Alpha-2 agonists like clonidine has been used extensively in the past for attenuation of sympathoadrenal stimulation caused by tracheal intubation and surgery [4,13].…”