Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study

Abstract

SUMMARY OBJECTIVES.To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. METHODS. Randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at Hospital São Lucas (PUCRS) between May 2004 and February 2005. Patients were assigned to two groups: (a) Dexmedetomidine group (n=13): infusion of 1μg/kg over 10 minutes and maintenance dose of 0.5μg/kg/ h) as an adjuvant to inhaled isoflurane anesthesia; (b) Control group (n=13): normal saline infusion at a similar rate and volume of the dexmedetomidine infusion. During the different surgical and anesthetic periods, groups were compared regarding heart rate, systolic and diastolic arterial blood pressures as well as need of supplemental fentanyl infusion. Student's t test, ANOVA, and Finner's procedure were used for statistical analysis. RESULTS. During the strongest nociceptive stimuli (airway access and abdominal catheter placement), the heart rate and systolic blood pressure increased significantly (p<0.001) in the control group compared to the dexmedetomidine group. Compared to baseline levels, the hemodynamic responses to nociceptive stimuli were more stable when dexmedetomidine was used in combination with inhaled isoflurane anesthesia. The need for supplemental doses of fentanyl and the hemodynamic parameters were similar for both groups. CONCLUSION. Dexmedetomidine combined with inhaled isoflurane for anesthesia of children submitted to videolaparoscopic appendectomy, efficiently blocks the hemodynamic responses to nociceptive stimuli. When compared to placebo, the use of dexmedetomidine did not change the need for supplemental doses of fentanyl for maintenance of hemodynamic parameters during the intraoperative period.

A Comparative Study of Infusion Dexmedetomidine and Infusion Magnesium Sulphate on Attenuation of Blood Pressure Surge in Laparoscopic Surgery Under General Anaesthesia

“…10 Smania et al found that dexmedetomidine efficiently blocks the hemodynamic responses to nociceptive stimuli when combined with inhaled isoflurane for anaesthesia of children submitted to laparoscopic video appendectomy. 11 The effect of dexmedetomidine on haemodynamics is due to decrease of sympathetic outflow from the locus ceruleus. Its sympatholytic effect leads to decrease of mean arterial blood pressure (MAP) and heart rate (HR) by reducing norepinephrine release.…”

Continuous Infusion of Dexmedetomidine to Attenuate the Hemodynamic Response During Laparoscopic Surgery in Children

“…Dexmedetomidine causes sympatholytic action combined with increase in the vagal activation and causes lower increase of blood pressure level and the heart rate when compared to placebo. 1 Dexmedetomidine reduces the norepinephrine/ catecholamine level by 50% & they remain low even in the presence of nociceptive stimuli also. 6 Dexmedetomidine is highly specific, potent and selective α2 agonist, has relatively high ratio of α2/α1 activity (1620;1 as compared to 220;1 for clonidine) and therefore, it is considered as full agonist.…”

“…15,16,17 Systolic blood pressure unlike the heart rate remains stable in control group during intubation and umbilical port may be due to hypotensive effect of thiopentone used for induction. 1 Difference in response was due to sensitivity of the patient to the drug.…”

“…It reduces sympathetic responses to nociceptive stimuli reduces the usage of other anaesthetics and improves the intra-op hemodynamic stability. 1 Dexmedetomidine produces sedative state in number of ways and is dose dependent. At low doses it produces only sedation but arousable and cooperative.…”

Impacto das publicações científicas brasileiras nos recentes avanços científicos na cardiologia

“…Another important population study, carried out in Rio de Janeiro, confirmed the importance of smoking as a public health problem, increasing the number of cases of disability, chronic obstructive pulmonary disease, cerebrovascular disease and cardiovascular disease 5 . Another aspect that has been broadly discussed was the cardiovascular risk in non-cardiac surgeries, as well as methods of intraoperative monitoring and the importance of the cardiologic assessment in the context of this interdisciplinary evaluation [6][7][8] .…”