Remifentanil requirements for preventing motor response to skin incision in healthy women anesthetized with combinations of propofol and dexmedetomidine titrated to similar Bispectral Index (BIS) values

Wu, Xiang; Hang, Li-Hua; Chen, Y.-F.; Wang, H.; Shao, D.-H.; Chen, Z.

doi:10.1007/s11845-014-1176-2

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…Anesthetic sparing effect of dexmedetomidine was demonstrated in all the articles studying this effect. [678910111213141516171819202122] Our study echoes this finding with a significant reduction in propofol utilization. The difference in patient population (infratentorial intracranial procedures), anesthetic technique (neuromuscular blockade-free anesthesia), and the longer duration of surgery (397.8 ± 99.2 min) in our study did not alter this outcome.…”

Section: Discussionsupporting

confidence: 72%

Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial

Chakrabarti

Sriganesh

Reddy

et al. 2018

J Anaesthesiol Clin Pharmacol

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Background and Aims:The study was conceived to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol (total intravenous anesthesia) on anesthetic dose reduction and anesthesia recovery parameters in cerebello-pontine angle (CPA) surgeries.Material and Methods:This prospective randomized study was conducted on 49 patients (25 with dexmedetomidine, 24 without). After standardized anesthetic induction, anesthesia was maintained using propofol (via target controlled infusion, titrated to maintain BIS between 40 and 60), fentanyl (0.5 μg/kg/hour) and either dexmedetomidine (0.5 μg/kg/hour) or a sham infusion. Neuromuscular blocking agents were excluded to allow cranial nerve EMG monitoring. Adverse hemodynamic events, recovery parameters (time to opening eyes, obeying commands, and extubation) and postoperative sedation score, shivering score, nausea, and vomiting score were recorded.Results:Propofol and fentanyl utilization (as total dose, adjusted for duration of surgery and body weight, and number of extra boluses) was significantly lower in the dexmedetomidine group. There was no difference in any of the recovery parameters between the two groups. Incidence of bradycardia was significantly higher with dexmedetomidine, while no difference was found for hypotension, hypertension, and tachycardia.Conclusion:Dexmedetomidine–fentanyl–propofol anesthesia compares favorably with fentanyl–propofol anesthesia during CPA neurosurgical procedures with regard to anesthesia recovery times, but with lower intraoperative opioid and hypnotic utilization rates.

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Section: Discussionsupporting

confidence: 72%

Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial

Chakrabarti

Sriganesh

Reddy

et al. 2018

J Anaesthesiol Clin Pharmacol

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“… 19 20 Our pilot study also showed that a loading dose of intravenous dexmedetomidine 1 µg/kg, followed by an infusion rate of 0.33 µg/kg/h, does not reduce intraoperative opioid requirements, irrespective of its sedative and sympatholytic properties. 21 Dexmedetomidine is a potent sympatholytic agent, which can inhibit sympathetic activation following surgical stimuli. In the previous and present studies, hemodynamic criteria were used as stress response indicators to guide intraoperative opioid administration upon adjunctive DEX administration in general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia

Hang

Wang

et al. 2016

Yonsei Med J

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PurposeIntranasal dexmedetomidine is an effective sedative for premedication and is regularly used to reduce preoperative tension and anxiety in children. This study aimed to assess the effect of intranasally adjunctive dexmedetomidine on perioperative sedative and analgesic requirements in adults.Materials and MethodsPatients were randomly divided into four groups to receive preoperative administration of saline, intranasal dexmedetomidine 1 µg/kg and 2 µg/kg, and intravenous dexmedetomidine 1 µg/kg, respectively. Propofol and remifentanil were target-controlled infused to maintain intraoperative bispectral index at 45–55 and blood pressure at baseline value±20%. Sufentanil was administered to maintain postoperative visual analogue scale ≤3. Perioperative anesthetics requirements were compared using nonparametric tests.ResultsIntranasal dexmedetomidine significantly attenuated propofol requirements for anesthesia induction and maintenance in a dose-dependent manner. Patients given intranasal dexmedetomidine 2 µg/kg required less remifentanil for anesthesia maintenance. The first postoperative request for sufentanil analgesia was delayed in patients given intranasal dexmedetomidine 2 µg/kg. The anesthetics-sparing effect of intranasal dexmedetomidine was significantly weaker than intravenous dexmedetomidine at the same dose of 1 µg/kg. The incidences of adverse events, including hemodynamic instability and delayed recovery, were comparable with and without intranasal dexmedetomidine.ConclusionIntranasal administration of dexmedetomidine can reduce perioperative anesthetic requirements, and a dose of dexmedetomidine 2 µg/kg produces a better effect in adults. The anesthetics-sparing effect of intranasal dexmedetomidine 1 µg/kg is less than that with the same intravenous dose of dexmedetomidine.

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“…In an earlier study, during BIS-guided closed-loop anesthesia, intraoperative dexmedetomidine could decrease the remifentanil induction dose by 25 %, but not the maintenance remifentanil dose. In addition, Wu et al [20] reported that a bolus administration of dexmedetomidine 0.5 or 1.0 lg/kg could not reduce remifentanil requirement for preventing motorresponse to skin incision in healthy female patients. When dexmedetomidine is used as an adjuvant to general anesthesia, its remifentanil-sparing effect is still controversial Values are expressed as mean ± SD or numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia

Park

Kim

Cho

et al. 2015

J Clin Monit Comput

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The purpose of this study was to evaluate the effects of low-dose dexmedetomidine on hemodynamics and anesthetic requirements during propofol and remifentanil anesthesia for laparoscopic cholecystectomy. Thirty adult patients were randomly allocated to receive dexmedetomidine infusion of 0.3 μg/kg/h (dexmedetomidine group, n = 15) or comparable volumes of saline infusion (control group, n = 15). Target controlled infusion of propofol and remifentanil was used for anesthetic induction and maintenance, and adjusted in order to maintain a bispectral index of 40-55 and hemodynamic stability. We measured hemodynamics and recorded total and mean infused dosages of propofol and remifentanil. For anesthesia induction and maintenance, mean infused doses of propofol (121 ± 27 vs. 144 ± 29 μg/kg/min, P = 0.04) and remifentanil (118 ± 27 vs. 150 ± 36 ng/kg/min, P = 0.01) were lower in the dexmedetomidine group than in the control group, respectively. The dexmedetomidine group required 16 % less propofol and 23 % less remifentanil. During anesthetic induction and maintenance, the dexmedetomidine group required fewer total doses of propofol (9.6 ± 2.3 vs. 12.4 ± 3.3 mg/kg, P = 0.01) and remifentanil (9.6 ± 3.4 vs. 12.7 ± 2.6 μg/kg, P = 0.01). The change in mean arterial pressure over time differed between the groups (P < 0.05). Significantly lower mean arterial pressure was observed in the dexmedetomidine group than in the control group at immediately and 5 min after pneumoperitoneum. The time to extubation after completion of drug administration did not differ between the groups (P = 0.25). This study demonstrated that a low-dose dexmedetomidine infusion of 0.3 μg/kg/h reduced propofol and remifentanil requirements as well as hemodynamic change by pneumoperitoneum without delayed recovery during propofol-remifentanil anesthesia for laparoscopic cholecystectomy.

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Remifentanil requirements for preventing motor response to skin incision in healthy women anesthetized with combinations of propofol and dexmedetomidine titrated to similar Bispectral Index (BIS) values

Abstract: Propofol and its combination with dexmedetomidine have similar opioid requirements for preventing motor response to skin incision when titrated to similar BIS values. These findings indicate that adjunctive dexmedetomidine for general anesthesia has sedative but no opioid sparing effects.

Cited by 8 publications

References 27 publications

Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial

Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial

Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia

The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia

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