Dexmedetomidine decreases the requirement of ketamine and propofol during burns debridement and dressings

Abstract

Background and Aims:Dexmedetomidine (Dex), a highly selective α2-adrenoreceptor agonist, is used for sedation management in various clinical settings and shows anaesthetic-sparing effect. Our aim was to study the effects of Dex on requirements of propofol, ketamine, and intraoperative haemodynamic variations during burns debridement and dressing changes, and compare its effectiveness and safety with combination of ketamine and propofol.Methods:Sixty adult patients posted for elective debridement and dressing were included in the study. Thirty patients received Dex (intramuscular)(IM) 1 μg/kg, 1 h before shifting to the operation theatre while the other thirty did not. Anaesthesia was induced with propofol and ketamine followed by adjusted infusion to achieve a Ramsay Sedation Scale score (RSS) of six in all patients. Intraoperatively haemodynamic parameters were recorded at regular intervals of 5, 15, 30, 45, and 60 min. The mean data between the groups were compared by unpaired t test and medians by Mann-Whitney U test. Within group analysis was performed by using repeated measures ANOVA. P < 0.05 was considered significant.Results:The dose requirement of ketamine and propofol in Dex group was significantly lower when compared to control group (100.5 ± 17.58 mg vs. 231.5 ± 60.39 mg (P < 0.0001) and 127.7 ± 15.47 mg vs. 254 ± 59.22 mg (P < 0.0001) respectively). Additionally, recovery time was lower in the Dex group as compared to the control group, 9.57 ± 1.50 min vs. 11.53 ± 2.56 min (P = 0.0006). Haemodynamic variations were also significantly lower in the Dex group as compared to the control group.Conclusion:Dexmedetomidine (1 μg/kg IM) reduced the requirement of propofol and ketamine, with more stable intraoperative haemodynamics.

Effects of medetomidine and its active enantiomer dexmedetomidine on N‐demethylation of ketamine in canines determined in vitro using enantioselective capillary electrophoresis

“…The affinity of the S ‐enantiomer to the NMDA receptor is two times higher than that of racemic ketamine and four times higher than that of the R ‐enantiomer . Medetomidine is an α 2 ‐adrenergic receptor agonist used for sedation and anesthetic premedication and, because of its anesthetic‐sparing effect, it is applied as anesthetic adjuvant . Low analgesic and myorelaxation effects have also been observed .…”

Dexmedetomidine Premedication With Ketamine and Propofol During Burns Debridement and Dressings

“…There was sta s cally significant difference between the groups as per Student t-test (p<0.05). Ravipa P et al [13] observed Time to recovery was 9.57 ± 1.50 min in the Dex group which was significantly lower than in the control group 11.53 ± 2.56 min (P = 0.0006). (Figure no.6) It was observed that dose requirement of Ketamine (228.8±21.9) and Propofol (263.2 ± 22.5) was significantly more in Group A as compared to Group B (101.1±20.3 and 120.8±22.4 respec vely).…”

“…(Figure no.1) The gender distribu on in the two groups as per Fisher's test were comparable and sta s cally not significant (p>0.05). 40 % and 39% pa ents were females in Group A and B respec vely (Figure no.2)Ravipa P et al [13] observed there was no sta s cally significant difference in the demographic and clinical characteriscs among the two groups. It was observed that intraopera vely the heart rate, systolic and diastolic Blood pressure was significantly higher in Group A as compared to Group B.…”

“…Sta s cally significant difference was found by applying Student ttest (p<0.05). (Figure no.7) Ravipa P et al [13] observed mean dose of Ketamine used in Dex group was significantly less (100.5 ± 17.58 mg) whereas it was 231.5 ± 60.39 mg in the control group (P < 0.0001). Similarly, mean dose of Propofol in Dex and control groups were 127.7 ± 15.47 mg and 254 ± 59.22 mg respec vely (P < 0.0001).…”

Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development

“…The few published investigations of procedural sedation in adults are encouraging [47,48] but the place of these combinations in the sedation of obese adult ICU patients requires more investigation before conclusions may be reached and recommendations issued. Matters in need of consideration include determination of the optimal dose ratios and structured appraisal of adverse reactions [49].…”