Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial

Kamal, Manoj; Agarwal, Deepa; Singariya, Geeta; Kumari, Kamlesh; Paliwal, Bharat; Ujwal, Shobha

doi:10.4103/joacp.joacp_353_18

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…Based on previous studies (13)(14)(15) and our pilot study, to detect a 45% change in incidence of intubation response, defined as increase in HR or mAP by value of >30% of the baseline value, at a power of 90% and an alpha error of 5%, a total of 23 patients were required in each group. Accounting for a dropout rate of 10%, 26 patients were included in each group.…”

Section: Sample Sizementioning

confidence: 99%

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial

Liu,

Zhang,

Cao

et al. 2023

Front. Cardiovasc. Med.

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IntroductionThe insertion of a double-lumen tracheal tube may cause a transient but more intense sympathetic response. We examined the effects of esketamine vs. dexmedetomidine as an adjuvant to anesthesia induction to blunt double lumen tracheal (DLT) intubation induced cardiovascular stress response.MethodsIn a randomized, double-blind trial, 78 adult patients scheduled for elective thoracotomy under general anesthesia requiring DLT intubation were enrolled. The patients were randomly divided into three groups: each group received one of the following drugs prior to induction of anesthesia: dexmedetomidine 0.8 µg/kg (Group A), esketamine 0.5 mg/kg (Group B), or normal saline (group C). The primary outcome was the incidence of a DLT intubation-related cardiovascular stress response, defined as an increase in mean arterial pressure or heart rate of >30% above the baseline values. The secondary outcomes were changes in hemodynamic and cardiac function.ResultsThe incidence of the response to cardiovascular stress was 23.1%, 30.8%, and 65.4% in groups A, B, and C, respectively. There was a significant decrease in intubation response in groups A and B in comparison with group C (P < 0.01); however, there was no significant difference between group A and group B (P > 0.05). Following the drug infusion and the induction of anesthesia, there was a significant decrease in HR and cardiac output in group A compared with group B. In contrast, no significant differences were observed in the left ventricular ejection fraction or in stroke volume between the three groups during induction of anesthesia.DiscussionEsketamine 0.5 mg/kg and dexmedetomidine 0.8 µg/kg attenuate cardiovascular stress responses related to DLT intubation. As adjuvants to etomidate induction, they do not impair cardiac function (ChiCTR1900028030).

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Section: Sample Sizementioning

confidence: 99%

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial

Liu,

Zhang,

Cao

et al. 2023

Front. Cardiovasc. Med.

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Infusion Versus Bolus Esmolol on Hemodynamic Responses to Intubation in Patients Undergoing Coronary Artery Bypasses Grafting: a Randomized Clinical Trial

Tashakkor¹,

Akbari²,

Mahdian³

et al. 2022

J Adv Med Biomed Res

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Background & Objective: Perioperative myocardial ischemia remains one of the most serious complications of cardiac surgery. This study aimed to evaluate the effect of bolus esmolol versus its infusion on hemodynamic responses after laryngoscopy and intubation in patients undergoing coronary artery bypass grafting (CABG). Materials & Methods:This double-blind randomized clinical trial was conducted on 75 patients that were allocated into three groups. In the infusion group, 10 minutes prior to laryngoscopy 0.5 mg/kg esmolol was injected, and then, 200 µg/kg/minute esmolol was infused. In the bolus group, 2 minutes prior to the laryngoscopy 1.5 mg/kg bolus dose of esmolol was injected intravenously. In the control group, a bolus dose of normal saline was administered. Heart rate (HR), Systolic (SBP) and diastolic (DBP) blood pressures and mean arterial pressure (MAP), were recorded every one minute from 10 minutes prior to laryngoscopy to 10 minutes after intubation. Repeated measure ANOVA was applied as statistical analysis.Results: SBP was at the lowest rate since laryngoscopy was started until 10 minutes after intubation in the esmolol infusion group (P= 0.029). From the initiation of laryngoscopy to 6 minutes after the intubation, DBP was at the lowest rate in the infusion group. There was a significant difference between the groups regarding DBP changes during the measurement. ANOVA model showed that interaction between time and groups on SBP, MAP, and HR (P< 0.05). Conclusion:According to our results, the exact doses of esmolol infusion significantly reduced the level of SBP during intubation, compared with bolus esmolol.

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A Multimodal Analgesic Protocol with Gabapentin-dexmedetomidine for Post-operative Pain Management after Modified Radical Mastectomy Surgery: A Randomized Placebo-Controlled Study

Abdallah

Bakeer²

2022

Open Access Maced J Med Sci

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Background and Aim: Modified radical mastectomy (MRM) is accompanied by severe acute postoperative pain. This study evaluated the safety and efficacy of oral gabapentin plus dexmedetomidine infusion as an analgesic multimodal protocol in patients undergoing MRM. Methods: This prospective randomized, double-blind placebo-controlled study included 30 females scheduled for MRM from June 2021 to December 2021. They were randomly divided into two groups. GD Group (n=15) received oral gabapentin 400 mg and IV infusion of Dexmedetomidine 0.4 µg/kg/h over 10 min after a bolus of 0.5 µg/kg before induction of general anesthesia. Placebo Group (n=15) received a placebo capsule and saline infusion identical to the GD Group. The primary outcome measure was total morphine consumption, and secondary outcomes were pain and sedation scores and intraoperative fentanyl consumption. Results: Pain score was significantly lower in the GD Group than the Placebo group, starting immediately postoperative up to 24 hours except after 18 hours. The total intraoperative fentanyl consumption and postoperative morphine consumption were significantly lower in the GD Group. The sedation score was significantly higher in the GD Group compared to the Placebo group immediately postoperative and after 2 hours. The heart rate and mean arterial pressure were within the clinically accepted ranges intra- and postoperatively in the two groups. Conclusion: Preemptive oral gabapentin plus dexmedetomidine IV infusion is a safe and effective analgesic alternative for patients undergoing MRM.

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Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial

Cited by 4 publications

References 19 publications

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial

Infusion Versus Bolus Esmolol on Hemodynamic Responses to Intubation in Patients Undergoing Coronary Artery Bypasses Grafting: a Randomized Clinical Trial

A Multimodal Analgesic Protocol with Gabapentin-dexmedetomidine for Post-operative Pain Management after Modified Radical Mastectomy Surgery: A Randomized Placebo-Controlled Study

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