Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia

Abstract

Background:Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for abdominal surgeries on blood glucose levels and on Sevoflurane requirements during anesthesia.Materials and Methods:Forty patients scheduled for abdominal surgery under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 20 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable.Results:During the first postoperative hour, Dexmedetomidine group showed blood glucose levels of 118.2 ± 16.24 mg/dL, compared to placebo group which was 136.95 ± 19.76 mg/dL and it was statistically significant (P < 0.01). Mean hourly Sevoflurane requirement in Group D was 11.10 ± 2.17 mL, compared to 15.45 ± 3.97 mL in placebo group. In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P.Conclusion:IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.

Effect of perioperative dexmedetomidine infusion on blood glucose levels in non-diabetic morbid obese patients undergoing laparoscopic bariatric surgery

“…Also, in a previous investigation done by Sarpkaya and his fellows [22], they showed no remarkable difference in blood glucose levels and insulin levels. However, one study showed significant difference in blood glucose levels only during first postoperative hour while there was no noteworthy difference during 1st 30 min after intubation and 6 h postoperatively [23].…”

Assessment of Blood Glucose Levels and Sevoflurane Requirement in Patients on Dexmedetomidine Infusion for Intra-Peritoneal Surgeries

“…However, one study showed significant difference in blood glucose levels during postoperatively in 1h while there was no significant difference during 30 min postintubation and 6 h postoperatively. [15] The hypnotic and supraspinal analgesic effects of Dexmedetomidine are mediated by suppression of neuronal firing in the locus coeruleus, resulting in inhibition of norepinephrine release and activity in the descending medullo-spinal noradrenergic pathway. [16][17] This suppression of inhibitory control leads to decreased histamine secretion, resulting in hypnosis similar to natural sleep, without ventilatory depression.…”

Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial

“…2 The other previous study had used intravenous dexmedetomidine to assess its effect on inhalational anesthetics requirement. 3 As the mechanism of drug action and the magnitude of effect produced vary with the route of administration, we used data of those with a similar route of administration for sample size calculation. Although our study failed to demonstrate the primary objective of 50% reduction in isoflurane concentration, we were fortunate enough to find a statistically significant decrease in isoflurane requirements with the use of paravertebral dexmedetomidine.…”

“…Trimarchi et al note an incidence of aortic valve replacement of 23.1%. 3 In our busy cardiac surgery practice, in which we see approximately 50 to 60 type A dissections each year, it has been our experience that type III AR (as described in the article-in which the intimal flap prolapses through the aortic valve during diastole to restrict cusp mobility) is the most common. Overall, in…”