Attenuation of pressor response and dose sparing of opioids and anesthetic with pre-operative dexmedetomidine

Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India.
Indian journal of anaesthesia 03/2012; 56(2):123-8. DOI: 10.4103/0019-5049.96303
Source: PubMed


Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation.
ONE HUNDRED PATIENTS SCHEDULED FOR ELECTIVE GENERAL SURGERY WERE RANDOMIZED INTO TWO GROUPS: D and F (n=50 in each group). Group D were administered 1 μg/kg each of dexmedetomidine and fentanyl while group F received 2 μg/kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33:66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student's t test and Mann-Whitney U test.
The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P<0.001). The mean dose of fentanyl and isoflurane were also decreased significantly (>50%) by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P=0.014).
Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively.

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Available from: Sukhminder Bajwa, Aug 08, 2015
    • "However, further studies are required to quantify if still lower induction doses of these drugs were sufficient. 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. "
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    ABSTRACT: 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. 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. 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. 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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    • "It should be used judiciously in geriatric patients and in patients with significant biventricular dysfunction. Bajwa et al.[10] and Yildiz et al.[11] described how effectively dexmedetomidine attenuated the pressor response to laryngoscopy, intubation, extubation and how there was a dose sparing of narcotics and anesthetics when given as a loading dose preoperatively and continued perioperatively. "
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    ABSTRACT: morbidity. The advantage of the locoregional technique is that one can monitor neurological status intraoperatively and stressful situations during anesthesia induction, intubation, and extubation can be avoided. GA vs locoregional! The GALA trial by Gough et al. [1] in 2008 was a multicenter, randomized controlled trial which enrolled 3500 patients from 90 centers between 2001 and 2007. They compared general anesthetic versus local anesthesia technique for patients scheduled for CEA. They concluded that there was no major difference in 30 day mortality in either groups and that the choice of anesthetic doesn't affect the perioperative outcome. Rerkasem et al. [2] also concluded from their review published in Cochrane Database Systematic Review that there is insuffi cient evidence of comparing local versus general anesthesia for carotid endarterectomy from the randomized trials. Goals of the anesthetic technique for CEA should be to maintain optimal hemodynamics, avoid precipitous hypotension, reduced perioperative stress, to use short-acting anesthesia drugs agents to facilitate postoperative cerebral function assessment, and to optimize cerebral perfusion. The anesthetic agent should have no or minimal respiratory INTRODUCTION
    Full-text · Article · Apr 2013
    • "Dexmedetomidine, due to its sympatholytic effects, blunts the hyperdynamic response to laryngoscopy and surgery and maintains a stable hemodynamic profile.[3839] [Table 1]. "
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    ABSTRACT: The introduction of newer more selective α(-2) adrenergic agonist, dexmedetomidine has made a revolution in the field of anesthesia owing to its varied application. The aim of the current review is to highlight the various clinical and pharmacological aspects of dexmedetomidine in daily routine practice of anesthesiology and intensive care besides its potential role in other clinical specialties. This review of dexmedetomidine was carried out after searching the medical literature in Pubmed, Science direct, Scopus, Google scholar and various text books and journal articles using keywords anesthesia, dexmedetomidine, neurosurgery, pediatric surgery, regional dexmedetomidine, anesthesia, regional, neurosurgery, and pediatric surgery. Dexmedetomidine has made its application from a novel sedating agent in the intensive care unit to its use as an adjuvant in various regional anesthetic techniques because of its "cooperative sedation" without any respiratory depression. It has a favorable pharmacokinetic profile suitable to be used in the perioperative period to reduce the requirements of opioids and anesthetic drugs. There are few side-effects of dexmedetomidine, which should always be kept in mind before choosing the patients for its use. The various side-effects associated with dexmedetomidine include, but are not limited to hypotension, bradycardia, worsening of heart block, dry mouth, and nausea. However, large scale randomized controlled trials are still needed to establish various effects of dexmedetomidine and to clearly define its safety profile.
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