Title: Dexmeditomodine as Anaesthetic Adjuvant to Relieve Stress Response in Gynecological Laparoscopic Surgeries
Authors: Dr Sherin Sara Roy, Dr Linette J Morris, Dr Baburaj Chakrapani
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.134
Abstract
INTRODUCTION
DEXMEDITOMIDINE is D-enantiomer of 4(5)-1-2-3-dimethyl phenyl imidazole. It is full agonist at alpha 2c and partial at alpha 2a and 2b receptor. DEXMEDITOMIDINE is a highly selective alpha 2 agonist compared to clonidine with property of sedation, hypnosis, analgesia, sympatholytic and anxiolytic properties, making it an ideal anaesthetic adjuvant. Dexmedetomidine can also be used as anti-shivering agent. [1]
Ever since introduction of Dexmedetomidine in clinical practice in 1999, various studies have been conducted to find use of it in various sub-specialties of anaesthesia.
References
1. Aantaa R, Jalonen J: Peri-operative use of alpha2-adrenoceptor agonists and the cardiac patient, European Journal of Anaesthesiology May 2006 23:361-372
2. Richard A Perugini, Mark P Calery : Complication of Laparoscopic surgeries, Surgical treatment: Evidence based and problems oriented 2001 Part 12
3. Bhana Nila, Goa Karen L, McClellan KJ: Dexmedetomidine, Drugs 2000 59:263-268
4. Virtanen Raimo, Savola Juha-Matti, Saano Veigo, Nyman L: Characterization of the selectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist, European journal of Anaesthesiology 1988 150:9-14
5. Pierre Foex: Drugs acting on cardiovascular system. Wiley Churchill-Davidson’s Practise of Anaesthesia Seventh edition 8:145
6. Tobias JD: Dexmedetomidine: applications in paediatric critical care and paediatric anaesthesiology, Paediatric Critical Care Medicine 2007 8:115-131
7. Guo TZ, Jiang JY, Buttermann AE, Maze M: Dexmedetomidine injection into the locus ceruleus produces anti-nociception, Anaesthesiology 1996 84:873-881
8. Dyck JB, Maze M, Haack C, et al: Computer-controlled infusion of intravenous Dexmedetomidine hydrochloride in adult human volunteers, Anaesthesiology, 1993 78:821-828
9. Jaap Vuyk, Elke Sitsen, Marije Reekers: Intravenous Anaesthetic. Miller’s Anaesthesia Eighth Edition, 2015 30:854-859
10. Venn RM, Bradshaw CJ, Spencer R, et al: Preliminary UK experience of Dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit, Anaesthesia54:1136-1142, 1999.
11. Hofer RE, Sprung J, Sarr MG, Wedel DJ: Anaesthesia for a patient with morbid obesity using Dexmedetomidine without narcotics, Canadian Journal Anaesthesia52:176-180, 2005.
12. Aho M, Lehtinen AM, Erkola O, et al: The effect of intravenously administered Dexmedetomidine on perioperative hemodynamic and isoflurane requirements in patients undergoing abdominal hysterectomy, Anaesthesiology74:997-1002, 1991.
13. Aantaa R, Kanto J, Scheinin M, et al: Dexmedetomidine, an alpha2-adrenoceptor agonist, reduces anaesthetic requirements for patients undergoing minor gynaecologic surgery, Anaesthesiology 73:230-235, 1990.
14. Xiang Q, Huang DY, Zhao YL, et al: Caudal Dexmedetomidine combined with bupivacaine inhibit the response to hernia sac traction in children undergoing inguinal hernia repair, British journal of Anaesthesia110:420-424, 2013
15. Drummond JC, Dao AV, Roth DM, et al: Effect of Dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans, Anaesthesiology108:225-232, 2008
16. Marcia L Buck. Dexmedetomidine use in paediatric ICU and procedural sedation. Journal of paediatric pharmacology 2010 15:18
17. Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during Laparo-scopic cholecystectomy. Anaesthesia Analog1993;76: 1067
18. Joris J, Lamy M. Neuroendocrine changes during pneumo-peritoneum for laparoscopic cholecystectomy. British Journal of Anaesthesia1993; 70: A33.
19. Harris HN, Ballytyne GH, Luther MA, Perrino AC. Alteration of Cardiovascular performance during laparoscopic colectomy; a combined hemodynamic and echocardiographic analysis. Anaesthesia Analogue 1996; 83: 482-7.
20. Aantaa R, Kanto J, Scheinin M, et al: Dexmedetomidine, an alpha2-adrenoceptor agonist, reduces anaesthetic requirements for patients undergoing minor gynaecologic surgery, Anaesthesiology 73:230-235, 1990.
21. Timothy Black, Mirjana Corrincevic. Anaesthesia for gynaecologic, urologic and laparoscopic procedure. Wiley Churchill-Davidson. A Practise of Anaesthesia Seventh edition 55:910-911
22. Arcangel, C Dalo, R Gaspai. Dexmedetomidine use in General Anaesthesia. Current Drug Targets 2009.10:687-695
23. Patel CR, Engineer CR, Shah BJ, Madhu S. The effect Dexmedetomidine continuous infusion as an adjuvant to general anaesthesia on sevoflurane requirement: A study based on entropy analysis. Journal of Anaesthesiology Clinic Pharmacology 2013.29 318-322is
24. Tan JA ,Ho KM . Use of Dexmedet-omidine as sedative and analgesic in critically ill adult patients: A Meta-analysis .European journal of Anaesthesiology 2011;28:3-6
25. K. Sudheesh, S S Harzoor. Dexmedeto-midine in anaesthesia practise. A wonder drug? Indian Journal of Anaesthesia.2011 July –August. 55:323-324
26. Ebert T ,Hall J E ,Barney J A, Ulrich T D, Colino M D .The effect of increasing plasma concentration of Dexmedetomidine in human . Anaesthesiology 2000 93:382-394
27. Turen G, Ozgultekin A, Turan C, Dincer E, Vuksel G. Advantageous effect of Dexmedetomidine on hemodynamic and recovery response during extubation for intracranial surgery. European journal of Anaesthesiology 2008: 25 816-820
28. Aksu r, Akin A, Bicer C, Esmaoglu A , Tosun Z, Boyaci A. Comparison of effect of Dexmedetomidine versus fentanyl on airway reflexes and hemodynamic response to tracheal extubation during rhinoplasty. A double blind randomized controlled study. Current Therapeutic Research 2009 70 209- 220
29. Salman N, Uzun S, Coskun F, Salman MA, Salman AE, Aypar U. Dexmedetomidine as a substitute for remifentanyl in ambulatory gynaecologic laparoscopic surgery. Saudi Medicine Journal. 2009. January 30:77-81
30. Turgut N, Turkmen A, Ali A, Altan A. Remifentanyl - Propofol versus Dexmedetomidine – Propofol anaesthesia for supratentorial craniotomy. Middle East Journal Anaesthesiology 2009 20 63
31. Cortinez LI, Hsu YW, Sum-Ping ST et al. Dexmedetomidine pharmacodynamics: Part 2. Cross over comparison of the analgesic effect of Dexmedetomidine and remifentanyl in healthy volunteer. Anaesthesiology 2004 101 1077-1083.
32. Yogesh Chauhan, Heena Parikh. Effect of Dexmedetomidine on Hemodynamics in patients undergoing laparoscopic surgeries under general anaesthesia- A Comparative study. Indian journal of applied research. Volume 4.june 2014 70-72.
33. S Kumar, B B Kushwala , R Prakash et al. Comparative study of effects of Dexmedetomidine and clonidine premedication in peri-operative hemodynamic stability and post-operative analgesia in laparoscopic cholecystectomy. The internet journal of Anaesthesiology. 2014 Volume 33 Number 1
34. Karaman, Semra, günüşen, İlkben; ceylan, Mustafa Arda; karaman, Yücel; çetin, EsraNur; derbent, Abdurrahim; ergenoğlu, Ahmet Mete. Dexmedetomidine infusion prevents post-operative shivering in patients undergoing gynaecologic laparoscopic surgery. Turkish Journal of Medical Sciences .2013; 43:232-237.
35. Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anaesthesia with Dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30: 1537-41.
36. SukhminderJit Singh Bajwa, Sachin Gupta, JasbirKaur, Amarjit Singh, and SS Parmar. Reduction in the incidence of shivering with perioperative Dexmedeto-midine: A randomized prospective study J Anaesthesiology. Clinical Pharmacology. 2012; 28: 86–91.
37. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Current Opinion Anaesthesi-ology journal. 2008;21:457-61.
38. Dhurjoti Prosad Bhattacharjee1, Sushil Kumar Nayek2, Satrajit Dawn3, Gargi Bandopadhyay4, Krishna Gupta5 Effects of Dexmedetomidine on haemodynamics in patients undergoing laparoscopic cholecystectomy- A comparative study. Journal of Anaesthesiology. Clinical Pharmacology 2010;26:45-48.
