Title: Effects of Premedication with Dexmedetomidine on Perioperative Hemodynamics and Anesthetic Requirements during Elective General Abdominal Surgeries

Authors: Nuzhat Ul Islam, Rukhsana Najeeb, Masarat Ara, M Ahsan Wani, M Ommid

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.57

Abstract

Background and Aims: Effective use of sedative-hypnotic and analgesic agents is an integral part of providing patient comfort and safety for patients during general anaesthesia. The present study was carried out to evaluate the effects of premedication with dexmedetomidine on perioperative haemodynamic and dose requirement of propofol and fentanyl during laryngoscopy and tracheal intubation.

Methods: 100 patients belonging to ASA class I and ASA class II of either sex, in the age group of 20-55years were divided into two groups, Group 1 and Group 2 with 50 patients in each group. Group 1 received 100ml of Normal saline over a period of 10 minutes and 1µg/kg of fentanyl 3 minutes before induction of general anaesthesia. Group 2 received 1µg/kg of dexmedetomidine in 100 ml of normal saline over a period of 10 minutes and 1µg/kg of fentanyl 3 minutes before induction of general anaesthesia.

Results: 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 propofol were also decreased significantly by the administration of dexmedetomidine. The total dose requirement of fentanyl and propofol was decreased by 33.58% and 43.01%  in Group 2 as compared to Group 1 and the difference was statistically significant.

Conclusions: Dexmedetomidine is an effective drug when used as an adjunct to general anaesthesia for attenuation of pressor response. It not only decreased the magnitude of stress response to intubation, surgery and extubation but also decreased the dose of propofol and opioids in achieving adequate anaesthesia and analgesia respectively.

Keywords: Dexmedetomidine, fentanyl, heart rate, propofol, mean arterial pressure, entropy, pressor response.

References

  1. Iannuzzi E, Iannuzi M, Cirillo V, et al. Peri-intubation cardiovascular response during low dose remifentanyl or sufentanyl administration in association with propofol TCI. A double blind comparison. Minerva Anestesiol; 2004 Mar, 70(30); 109-15.
  2. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987; 59:295–9
  3. Seyed Mojtaba Marashi et. al. Attenuation of hemodynamic responses following laryngoscopy and tracheal intubation: Comparative assessment of Clonidine and Gabapentin premedication. M.E.J. Anesth 2009; 20(2).
  4. Bucx MJ, Snijders CJ, van Geel RT, et al. Forces acting on the maxillary incisor teeth during laryngoscopy using the Macintosh laryngoscope. Anaesthesia 1994; 49: 1064–70.
  5. Bedford RF and Lt Marshal K. Cardiovascular responses to endotracheal intubation during four anaesthetic techniques. Acta Anaesthesiologica Scandinavia. 1984; 28: 563-566.
  6. Chandrashekara PM and King R. Attenuation of cardiovascular responses to endotracheal intubation. Indian Journal of Anaesthesia. 1984; 32(5): 358-367.
  7. Kay B, Nolan D, Mayall R, Healy TEJ. The effects of sufentanil on the cardiovascular response to tracheal intubation. Anaesthesia. 1987; 42: 382-386.
  8. Mounir-Abou-Madi, Hugo Keszler and Odile Yacoub. A method for prevention of cardiovascular responses to laryngoscopy and intubation. Canadian Anaesthetic Society Journal. 1975; 22(3): 316-329.
  9. Kimura A et al .Use of fiberoptic stylet scope reduces the hemodynamic response to intubation in normotensive and hypertensive patients. Can J Anaes 2001; 48: 919-23.
  10. Yoshitaka Fujii MD, Yuhji Saitoh MD, Shinji Takahashi MD, Hidenori Toyooka MD. Diltiazem-lidocaine combination for the attenuation of cardiovascular responses to tracheal intubation in hypertensive patients. Canadian Journal of Anaesthesia. 1998; 45: 935-937.
  11. Hayashi Y, Maze M. Alpha, adrenoceptor agonists and anaesthesia. Br J Anaesth 1993; 71: 108-18
  12. Segal IS, Vickery RG, Walton JK, Doze VA, Maze M. Dexmedetomidine diminishes halothane anesthetic requirements in rats through a postsynaptic alpha2 – adrenergic receptor. Anesthesiology 1988; 69: 818-23.
  13. Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991; 74: 997-1002.
  14. Aantaa R, Kanto J, Scheinin M et al. Dexmedetomidine, an α2 adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology 1990; 73: 230-235.
  15. Patel A, Davidson M, Tran MC, Quraishi H. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg 2010; 111: 1004-10.
  16. Vivan M, Micheal G, Theresa W, Man K, Libby H. A double-blind, cross over assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg 2007; 105: 374-80.
  17. Hall JE, Uhrich TD, Barney JA, Arain SA, Ebert TJ. Sedative, amnestic and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699-705.
  18. Stoelting RK. Circulating responses to laryngoscopy and intubation with or without prior oropharngeal viscous lignocaine. Anaesthesia Analgesia. 1977; 56: 618-21.93
  19. Suvadeep Sen, Jananti Chakraborti, Sankari Santra et al. The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anaesthesia during elective spine surgery. Indian Journal of Anesthesia Aug. 2013; Vol. 57, Issue 4.
  20. SJS Bajwa, Jasbir Kaur, Amarjit Singh, SS Parmer, Gurpreet Singh, Ashish Kulsheshtha, Sachin Gupta, Veenita Sharma, Aparajita Panda. Attenuation of pressure response and dose spearing of Opiodes and anesthetics with preoperative dexmetomedine. Indian J Anaesth. 2012 Mar-Apr; 56(2): 123–128.
  21. Siddareddigari velayudha Reddy, Donthu Balaji, Shaikh Nawaz Ahmad. Dexmedetomidine versus esmolol to attenuate the hemodynamic response to laryngoscopy and tracheal intubation: A randomized double- blind clinical study. International Journal of Applied and Basic Medical Reseach, Jul-Dec 2014; Vol.4, Issue 2.
  22. Yildiz Munise, Tavlan Aybars, Tuncer Sema, Reisli Ruhiye et al. Effects of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs in R&D 2006; 7(1): 43-52.
  23. Guler G, Akin Z, Tosun E, Eskitascoglu, Mizrak A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005; 49: 1088-91.

Corresponding Author

Dr Nuzhat Ul Islam

Resident, Department of Anesthesiology & Critical Care,

Govt. Medical College, Srinagar, India

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