Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Sezen, Gülbin; Demiraran, Yavuz; Şeker, İlknur Suidiye; Karagöz, İbrahim; Iskender, Abdülkadir; Ankaralı, Handan; Ersoy, Özlem; Özlü, Onur

doi:10.1186/1471-2253-14-113

Cited by 12 publications

(15 citation statements)

References 35 publications

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“…For hypertensive patients in long‐term standard treatment (e.g. β ‐blockers), premeditation with dexmedetomidine could provide them with stable perioperative haemodynamics, which is especially important for hypertensive patients . Our study also observed that patients who received dexmedetomidine‐remifentanil at a dose of 0.2 μ g/kg/hour and patients who received midazolam‐remifentanil all exhibited stable haemodynamics during HIFU therapy.…”

Section: Discussionsupporting

confidence: 56%

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Huang

Chen

et al. 2017

BJOG

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Objective To compare the effects of dexmedetomidineremifentanil with the traditional analgesia and sedation regimen midazolam-remifentanil during HIFU treatment of uterine fibroids.Design A randomised controlled trial.Setting Department of Anesthesia in a single hospital. Population Patients with uterine fibroids.Methods A total of 80 patients diagnosed with uterine fibroids and scheduled for selective HIFU treatment were randomly divided into the dexmedetomidine group (the D group) and midazolam group (the M group). At 20 minutes before the HIFU procedure, patients in the D group received a loading dose of 0.8 lg/kg dexmedetomidine, followed by a continuous intravenous infusion of 0.2 lg/kg/hour until the end of the operation. Patients in the M group were given a corresponding amount of 0.9% saline. Patients in the M group received a slow intravenous infusion of 0.03 mg/kg midazolam before the procedure, an intravenous injection of 0.02 mg/kg 30 minutes later, another 0.02 mg/kg 60 minutes later, followed by 0.02 mg/kg at 40-minutes intervals. Patients in the D group were given a corresponding amount of 0.9% saline. During the HIFU procedure, patients in both groups were administered remifentanil at an effect site concentration of 1.0 ng/ml. Sedation and analgesia were rated using the Ramsay Sedation Scale (RSS) and Visual Analogue Scale (VAS) before drug administration (T1), after drug administration but before HIFU (T2), at the beginning of HIFU (T3), 15 minutes later (T4), 45 minutes later (T5), 75 minutes later (T6), and at the end of HIFU (T7). Patient satisfaction score and Steward recovery score survey were conducted 30 minutes after surgery.Main outcome measures Different effects of the traditional midazolam-remifentanil regimen and dexmedetomidineremifentanil.Results All patients in both groups underwent a successful HIFU procedure without developing serious complications during the postoperative period. However, the D group reported significantly fewer cases of respiratory depression than the M group during HIFU treatment (P < 0.05). The pause during HIFU ablation in the D group was significantly shorter than that in the M group. HIFU ablation intensity, the number of patients with an RSS of 3 or 4 measured at different time points, and the number of patients with an RSS of 3 or 4 measured at arousal were significantly greater in the D than the M group (P < 0.05). Likewise, the D group scored significantly higher in the evaluation of patient satisfaction, recovery score, and surgeon satisfaction (P < 0.05).Conclusions Both dexmedetomidine-remifentanil and midazolamremifentanil met the requirements and ensured the safety of HIFU treatment of uterine fibroids. However, compared with the traditional midazolam-remifentanil regimen, dexmedetomidineremifentanil was associated with more stable sedation in patients, more efficient HIFU treatment and higher degree of patient comfort.Keywords Dexmedetomidine, high-intensity focused ultrasound, remifentanil, uterine fibroids.Tweetable abstract Dexmedetomidine-re...

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Section: Discussionsupporting

confidence: 56%

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Huang

Chen

et al. 2017

BJOG

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“…Dexmedetomidine is a highly selective α 2 -adrenoreceptor agonist that induces sedation providing improved hemodynamic stability without eliciting respiratory depression (10)(11)(12)(13). Previous studies have reported that dexmedetomidine is rapidly and efficiently absorbed after intranasal administration, and is better tolerated compared with intravenous administration (14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Intranasal dexmedetomidine combined with local anesthesia for conscious sedation during breast lumpectomy: A prospective randomized trial

et al. 2020

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Breast lumpectomy is usually performed under general or local anesthesia. To the best of our knowledge, whether conscious sedation with intranasal dexmedetomidine and local anesthesia is an effective anesthetic technique has not been studied. Thus, the present study aimed to investigate the effectiveness of conscious sedation with intranasal dexmedetomidine combined with local anesthesia in breast lumpectomy, and to identify its optimal dose. A prospective randomized, double-blinded, placebo-controlled, single-center study was designed, and patients undergoing breast lumpectomies were recruited based on the inclusion and exclusion criteria. All patients were randomly allocated to four groups: i) Local anesthesia with 0.9% intranasal saline (placebo); local anesthesia with ii) 1 µg.kg-1 ; iii) 1.5 µg.kg-1 ; or iv) 2 µg.kg-1 intranasal dexmedetomidine. The sedation status, pain relief, vital signs, adverse events, and satisfaction of patient and surgeon were recorded. Patients in the three dexmedetomidine groups were significantly more sedated and experienced less pain compared with the placebo group 45 min after intranasal dexmedetomidine administration and during 30 min in the post-anesthesia care unit. Patients in the 1.5 µg.kg-1 group were more sedated compared with the 1 µg.kg-1 group (without reaching statistical significance), whereas the 1.5 µg.kg-1 group exhibited a similar level of sedation 45 min after intranasal dexmedetomidine administration compared with the 2 µg.kg-1 group. In addition, patients in the 1 and 1.5 µg.kg-1 group experienced no adverse hemodynamic effects. Patient and surgeon satisfaction were greater in the 1.5 µg.kg-1 group compared with the 1 and 2 µg.kg-1 groups. Taken together, the results of the present study suggested that conscious sedation with intranasal dexmedetomidine and local anesthesia may be an effective anesthetic for breast lumpectomy surgery, and that the optimal dose for intranasal dexmedetomidine administration may be 1.5 µg.kg-1 , as it resulted in good sedation and patient satisfaction without adverse effects.

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“…[7,8] Earlier reports demonstrated that patients benefit a lot from perioperative application of Dex, such as reduced stress response during incubation and operation, and hemodynamic stability. [9,10] However, the effects of Dex on gastrointestinal function remain controversial. Some researchers demonstrated that Dex could protect intestine from injury caused by intestinal I/R and endotoxemia, [11,12] whereas others found that Dex would prolong the gastric emptying and gastrointestinal transit in the rat.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer

et al. 2016

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Background:To investigate the effects of intraoperative application of dexmedetomidine (Dex) on early gastrointestinal motility after laparoscopic resection of colorectal cancer.Methods:In this prospective, randomized double-blind investigation, 60 patients who underwent laparoscopic resection of colorectal cancer were randomly allocated to receive Dex (DEX group, n = 30) or saline (CON group, n = 30). In the DEX group, Dex was loaded (1 μg/kg) before anesthesia induction and was infused (0.3 μg/kg/h) during surgery. Time to postoperative first flatus (FFL) and first feces (FFE), and time to regular diet were recorded. Serum diamine oxidase (DAO) activity and intestinal fatty acid-binding protein (I-FABP) were detected.Results:Both the time to the FFL (44.41 ± 4.51 hours vs 61.03 ± 5.16 hours, P = 0.02) and the time to the FFE (60.67 ± 4.94 hours vs 82.50 ± 6.88 hours, P = 0.014) were significantly shorter in the DEX group than the CON group. Furthermore, the time to regular diet of the DEX group was shorter than that of the CON group (76.15 ± 4.11 hours vs 91.50 ± 5.70 hours, P = 0.037). Both DAO and I-FABP increased significantly from beginning of surgery to postoperative day 1 in the CON group (2.49 ± 0.41 ng/mL vs 4.48 ± 0.94 ng/mL for DAO, P = 0.028, 1.32 ± 0.09 ng/mL vs 2.17 ± 0.12 ng/mL for I-FABP, P = 0.045, respectively), whereas no significant change was observed in the DEX group. Furthermore, patients in the DEX group had stable hemodynamics and shorter hospital stay than those in the CON group.Conclusion:Dex administration intraoperatively benefits recovery of gastrointestinal motility function after laparoscopic resection of colorectal cancer with stable hemodynamics during surgery though further studies are needed to explore the mechanisms of Dex on gastrointestinal motility.

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Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Cited by 12 publications

References 35 publications

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Intranasal dexmedetomidine combined with local anesthesia for conscious sedation during breast lumpectomy: A prospective randomized trial

Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer

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