Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile

Colin, Pieter; Hannivoort, Laura N.; Eleveld, Douglas J.; Reyntjens, Koen; Absalom, Anthony; Vereecke, Hugo; Struys, Michel

doi:10.1093/bja/aex086

Cited by 56 publications

(49 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this article, we describe and model the sedative effects of dexmedetomidine using our previously published PK model, and using bispectral index (BIS) and the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) as measures of sedative effects. In an accompanying paper, 5 we describe and model the haemodynamic effects of dexmedetomidine.…”

mentioning

confidence: 99%

Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation

Colin

Hannivoort

Eleveld

et al. 2017

British Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation

Colin

Hannivoort

Eleveld

et al. 2017

British Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, suppressing or reversing the increase in hemodynamic effects by the presence of concomitant comorbidity or the use of dexmedetomidine in combination with drugs remains unclear. In studies conducted on healthy volunteers, it has been reported that there is a 21% and 31% decrease in HR after two minutes dexmedetomidine infusion at a dose of 1-2 µg/kg (24). The same study reports an increase in MAP of 7% and 8% at these doses.…”

Section: Discussionmentioning

confidence: 83%

“…The limitation of our study is the absence of a control group in which propofol is used alone. However, we thought that the use of propofol for LMA insertion alone would have to increase the dose (19)(20)(21)(22)(23)(24)(25)(26)(27), which may lead to undesired respiratory and hemodynamic responses.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Lidocaine and Dexmedetomidine Before Propofol Induction During Laryngeal Mask Airway Insertion

Kavakli¹,

Kitapçıoğlu²

2019

eamr

View full text Add to dashboard Cite

Objective: Laryngeal mask (LMA) is an airway device that can be used as an alternative to face mask and tracheal intubation. Different drug combinations can be used to ensure suitable conditions during LMA insertion. Lidocaine and dexmedetomidine are drugs that can be used to reduce hemodynamic response and suppress oropharyngeal reflexes during both intubation and LMA insertion. The aim of this study was to investigate the effects of lidocaine and dexmedetomidine on LMA insertion. Methods: Sixty patients who were scheduled to undergo cystoscopy under general anesthesia with LMA were included in the study. Patients were randomly divided into two groups: Group L (those who received 1.5 mg/kg lidocaine) and Group D (those who received 1 μg/kg dexmedetomidine). Number of attempts of LMA insertion, ease of LMA insertion, mouth opening, laryngospasm, gumming, stomach distention, limb movements and spontaneous breathing and hemodynamic parameters were recorded. Results: There was no statistically significant difference between the two groups in terms of the number of attempts of LMA insertion. In the first attempt, the LMA insertion success rate was 70% for Group L and 73.3% for Group D. There was no statistically significant difference between the two groups in terms of mouth opening, laryngospasm, ease of LMA insertion, gumming, stomach distension, limb movement and spontaneous breathing. Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate were statistically lower in Group D after drug administration. It was determined that the decreases in the other times were statistically significant compared to the baseline values after drug administration in both groups. Conclusion: Based on the results of the present study, 1 μg/kg dexmedetomidine and 1.5 mg/kg lidocaine used before propofol induction provided similar conditions for LMA insertion. Dexmedetomidine has a more hypotensive effect and provides a greater reduction in heart rate than lidocaine. Furthermore, the use of lidocaine before propofol induction provides better hemodynamic control than dexmedetomidine.

show abstract

“…36 Ventilatory adverse events (ventilatory depression, bradypnea, apnea) were mainly observed during the remifentanil step-up, whereas hemodynamic adverse events were mainly observed during the dexmedetomidine step-up. As previously shown by Colin et al, 37 hypertension occurs at high dexmedetomidine plasma levels, whereas low plasma versus dexmedetomidine (DmeD) and remifentanil (remI) concentrations according to the final model. A window of 0 to 10 ng/ ml is shown for both drugs to clarify the view.…”

Section: Perioperative Medicinementioning

confidence: 76%

“…The pharmacokinetic-pharmacodynamic model by Colin et al also shows that because of the slow onset of effects, the slow elimination of dexmedetomidine, and the low EC 50 for the hypotensive effect, significant hypotension (and orthostatic hypotension) is expected during the recovery period. 37 Based on this, subjects were monitored at least 7 h after cessation of infusion in the dexmedetomidine phase and at least 5 h after the interaction phase. Symptomatic orthostatic hypotension was observed in the recovery period of 8 of 30 dexmedetomidine phases and 6 of 30 interaction phases.…”

Section: Interaction Of Remifentanil and Dexmedetomidinementioning

confidence: 99%

Pharmacodynamic Interaction of Remifentanil and Dexmedetomidine on Depth of Sedation and Tolerance of Laryngoscopy

et al. 2019

View full text Add to dashboard Cite

Background: Dexmedetomidine is a sedative with modest analgesic efficacy, whereas remifentanil is an opioid analgesic with modest sedative potency. Synergy is often observed when sedative-hypnotics are combined with opioid analgesics in anesthetic practice. A three-phase crossover trial was conducted to study the pharmacodynamic interaction between remifentanil and dexmedetomidine. Methods: After institutional review board approval, 30 age-and sex-stratified healthy volunteers were studied. The subjects received consecutive stepwise increasing target-controlled infusions of dexmedetomidine, remifentanil, and remifentanil with a fixed dexmedetomidine background concentration. Drug effects were measured using binary (yes or no) endpoints: no response to calling the subject by name, tolerance of shaking the patient while shouting the name ("shake and shout"), tolerance of deep trapezius squeeze, and tolerance of laryngoscopy. The drug effect was measured using the electroencephalogram-derived "Patient State Index." Pharmacokinetic-pharmacodynamic modeling related the administered dexmedetomidine and remifentanil concentration to these observed effects. results: The binary endpoints were correlated with dexmedetomidine concentrations, with increasing concentrations required for increasing stimulus intensity. Estimated model parameters for the dexmedetomidine EC50 were 2.1 [90% CI, 1.6 to 2.8], 9.2 [6.8 to 13], 24 [16 to 35], and 35 [23 to 56] ng/ml, respectively. Age was inversely correlated with dexmedetomidine EC50 for all four stimuli. Adding remifentanil did not increase the probability of tolerance of any of the stimuli. The cerebral drug effect as measured by the Patient State Index was best described by the Hierarchical interaction model with an estimated dexmedetomidine EC 50 of 0.49 [0.20 to 0.99] ng/ml and remifentanil EC 50 of 1.6 [0.87 to 2.7] ng/ml. conclusions: Low dexmedetomidine concentrations (EC 50 of 0.49 ng/ml) are required to induce sedation as measured by the Patient State Index. Sensitivity to dexmedetomidine increases with age. Despite falling asleep, the majority of subjects remained arousable by calling the subject's name, "shake and shout," or a trapezius squeeze, even when reaching supraclinical concentrations. Adding remifentanil does not alter the likelihood of response to graded stimuli.

show abstract

Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile

Abstract: NCT01879865.

Cited by 56 publications

References 16 publications

Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation

Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation

Comparison of the Effects of Lidocaine and Dexmedetomidine Before Propofol Induction During Laryngeal Mask Airway Insertion

Pharmacodynamic Interaction of Remifentanil and Dexmedetomidine on Depth of Sedation and Tolerance of Laryngoscopy

Contact Info

Product

Resources

About