Comparison of a loading dose of dexmedetomidine combined with propofol or sevoflurane for hemodynamic changes during anesthesia maintenance: a prospective, randomized, double-blind, controlled clinical trial

Abstract

BackgroundThere may be great individual variability in the hemodynamic effects of this dexmedetomidine. For this reason, the dose must be carefully adjusted to achieve the desired clinical effect. Whether a loading dose of dexmedetomidine produces hemodynamic side effects during the anesthesia maintenance is unknown. The aim of this study was to compare the effects of a loading dose of dexmedetomidine combined with propofol or sevoflurane on hemodynamics during anesthesia maintenance.MethodsEighty-four patients who were scheduled for general surgery under balanced general anesthesia were randomly allocated into 4 groups (n = 21): the propofol and dexmedetomidine group, the sevoflurane and dexmedetomidine group, the propofol and normal saline group, or the sevoflurane and normal saline group. The hemodynamic indexes at the time of just before, 5 min after and the end of study drug infusion (dexmedetomidine or normal saline) were recorded. The incidence rates of increasing blood pressure at the end of study drug infusion (greater than 20% compared to baseline or before study drug infusion) were evaluated.ResultsMean arterial pressure increased significantly (P < 0.01) only in the propofol and dexmedetomidine group after intravenous dexmedetomidine compared administration. 80% of cases with propofol and dexmedetomidine had increased mean arterial blood pressure compared to only 5% of cases in the sevoflurane and dexmedetomidine group (P < 0.05). Heart rates in the propofol and dexmedetomidine and the sevoflurane and dexmedetomidine groups decreased significantly after dexmedetomidine infusion (P < 0.01).ConclusionsIntraoperative administration of a loading dose of dexmedetomidine combined with propofol in anesthesia maintenance proceeded a significant increase in blood pressure. In contrast, it combines with sevoflurane didn’t produce increased blood pressure. Meanwhile it is not unexpected that dexmedetomidine combined with propofol or sevofurance decreased heart rate, due to the known side effects of DEX. Therefore, dexmedetomidine should be used cautiously during the entire intravenous anesthesia maintenance period, especially during maintenance with propofol.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-17010423, registered on 13 January 2017.

Anesthetic effect of propofol combined with remifentanil or sevoflurane anesthesia on patients undergoing radical gastrectomy

“…Therefore, gastric cancer, which poses a serious threat to human health and social and economic development, is the major public health problem in China and the world (19,20). Because multiple tissues and organs are involved in radical gastrectomy, severe stress response will occur to cancer patients during operation, bringing some difficulties to anesthesia and postoperative management (21). At present, propofol combined with opiates or propofol combined with inhaled anesthetics are commonly used in patients undergoing radical gastrectomy.…”

“…It was found that patients' sedation score in group A was lower than that in group B, and the incidence of pain in group A was higher than that in group B, indicating that patients had a high acceptance of propofol combined with sevoflurane anesthesia and a low incidence of adverse reactions. Cancer patients were prone to restlessness and other adverse reactions in general anesthesia due to pain, so sedation and analgesia effect were the main indicators to evaluate the anesthetic effect (21,26). In addition to produce general anesthesia, sevoflurane also had vasodilator and analgesic effects, so it is more suitable for elderly patients and patients with cardiovascular insufficiency (27).…”

Imrecoxib Inhibits Paraquat-Induced Pulmonary Fibrosis through the NF-κB/Snail Signaling Pathway

“…Clinically, pirfenidone can be used to treat mild or moderate idiopathic pulmonary fibrosis, but it has many side effects, such as skin photosensitivity, liver injury, vomiting, and gastrointestinal reaction. Using glucocorticoids, such as dexamethasone, to treat pulmonary fibrosis through anti-inflammation is a classic treatment, but it can cause serious side effects such as the liver and kidney dysfunction and osteoporosis [ 6 – 10 ]. Therefore, it is urgent to find a drug that can not only effectively treat pulmonary fibrosis but also produce fewer side effects on patients.…”

Parthenolide attenuated bleomycin-induced pulmonary fibrosis via the NF-κB/Snail signaling pathway

“…Recent research demonstrated that dexamethasone (DEX) attenuated bleomycin (BLM)-induced lung fibrosis [ 5 ]. However, DEX treatment produces many side effects, such as growth retardation, hyperglycemia, hypertension, myocardial hypertrophy, gastrointestinal perforation, and neurological impairment [ 6 – 8 ]. Therefore, new drugs with improved treatment efficacy and fewer side effects are urgently needed.…”