Effects of Perioperative Dexmedetomidine Infusion in Patients Undergoing Vascular Surgery

Talke, Pekka; Li, J.; Jain, Uday; Leung, J.; Drasner, Kenneth; Hollenberg, Milton; Mangano, Dennis T.

doi:10.1097/00000542-199503000-00003

Cited by 209 publications

(120 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a study population of elderly patients with vascular disease, Talke and colleagues [24] reported no sudden bradycardias, only a slow decrease in heart rate during and after a 1-h pre-operative infusion of dexmedetomidine. We would recommend that all patients under 40 years of age receiving dexmedetomidine should be pretreated with an anticholinergic drug.…”

Section: Discussionmentioning

confidence: 94%

The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil

Peden

Cloote

Stratford³

et al. 2001

Anaesthesia

119

View full text Add to dashboard Cite

SummaryDexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. We conducted a single-centre, open-label, noncomparative phase II study of the effect of intravenous dexmedetomidine on the dose requirement of propofol to induce loss of consciousness in 49 ASA I and II patients. The initial dexmedetomidine infusion scheme was reduced twice because of adverse events. Forty patients who received the final infusion scheme were randomly allocated to receive one of five stepped propofol infusions; loss of consciousness was assessed after 21 min. The ED 50 for the final infusion rate of propofol to suppress consciousness was 3.45 mg.kg 21 .h 21 (95% CL 2.7±4.2): ED 95 was 6.68 mg.kg 21 .h 21 (95% CL 5.1±19.1), EC 50 was 1.69 m g.ml 21 (95% CL 0.95±2.5) and EC 95 was 5.7 m g.ml 21 (95% CL 3.2 to . 10). Our final dose of dexmedetomidine of 0.63 m g.kg 21 caused a reduction in the overall concentration and dose of propofol required to produce loss of consciousness, but no significant shift in the dose±response curve compared with other studies. Drugs acting as agonists at a 2 -adrenoceptors may enhance anaesthesia by producing dose-related sedation, anxiolysis, decreased upper airway secretions, peri-operative haemodynamic stability and analgesia [1±3]. There is substantial evidence that the a 2 -agonists also exert an anaestheticsparing effect mediated in part through a decrease in central noradrenergic activity, but mainly through a direct effect on central a 2 -adrenoceptors in the locus coeruleus and other sites [4,5]. The a 2 -agonists also have activity at the imidazoline receptors involved in central blood pressure control [2,6,7].Dexmedetomidine, a specific, selective and potent a 2 -adrenoceptor agonist has been shown to have significant anaesthetic, sedative and analgesic-sparing effects in clinical studies [8±12]. Recently, the dose-dependent effects of dexmedetomidine on isoflurane [11] and sevoflurane [12] requirements have been assessed in humans. However, to date, no studies have explored the shift of a dose±response curve for intravenous agents in conjunction with the a 2 -agonists. We aimed to perform a descriptive dose-finding study to determine the effect of an infusion of dexmedetomidine on the dose and blood concentration of propofol required to suppress consciousness and motor activity during total intravenous anaesthesia with propofol and alfentanil.

show abstract

Section: Discussionmentioning

confidence: 94%

The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil

Peden

Cloote

Stratford³

et al. 2001

Anaesthesia

119

View full text Add to dashboard Cite

show abstract

“…We identified 425 studies between 1988 and July 2007, of which 20 studies [13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] fulfilled our inclusion criteria ( Fig. 1).…”

Section: Included Studiesmentioning

confidence: 99%

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Biccard¹,

Goga²,

Beurs³

2007

Anaesthesia

122

View full text Add to dashboard Cite

SummaryWe conducted a systematic review of the effects of dexmedetomidine on cardiac outcomes following non-cardiac surgery. We included prospective, randomised peri-operative studies of dexmedetomidine that reported mortality, cardiac morbidity or adverse drug events. A PubMed Central and EMBASE search was conducted up to July 2007. The reference lists of identified papers were examined for further trials. Of 425 studies identified, 20 were included in the metaanalysis (840 patients). Dexmedetomidine was associated with a trend towards improved cardiac outcomes; all-cause mortality (OR 0.27, 95% CI 0.01-7.13, p = 0.44), non-fatal myocardial infarction (OR 0.26, 95% CI 0.04-1.60, p = 0.14), and myocardial ischaemia (OR 0.65, 95% CI 0.26-1.63, p = 0.36). Peri-operative hypotension (26%, OR 3.80, 95% CI 1.91-7.54, p = 0.0001) and bradycardia (17%, OR 5.45, 95% CI 2.98-9.95, p < 0.00001) were significantly increased. An anticholinergic did not reduce the incidence of bradycardia (p = 0.43). A randomised placebocontrolled trial of dexmedetomidine is warranted. Major peri-operative cardiac events (cardiac death, nonfatal myocardial infarction and non-fatal cardiac arrest) have been reported in 1.4% of unselected patients undergoing elective non-cardiac surgery [1,2] and between 2.6 and 5.8% in selected patients considered to be at risk of cardiac disease [1]. Peri-operative cardiac events are approximately evenly distributed between myocardial oxygen supply demand imbalance and plaque rupture [3,4]. In addition, these cardiac events may be precipitated by a number of potential triggers in the perioperative period, including inflammation, surgical stress, hypercoagulable states and peri-operative hypoxic episodes [1]. It has therefore been estimated that, at best, a single medical therapy could be expected to result in a relative risk reduction of 20-35% for the composite endpoint of cardiac death, non-fatal myocardial infarction and non-fatal cardiac arrest in the peri-operative period [2].There has been considerable interest in the utility of adrenergic antagonists in decreasing peri-operative cardiac events. Beta-adrenergic antagonists decrease peri-operative myocardial ischaemia, although it is controversial whether this results in an improved cardiac outcome [5,6]. In addition, beta-adrenergic antagonists significantly increase the incidence of drug-associated hypotension and bradycardia which require treatment [6]. It is unclear whether these side-effects adversely affect the cardioprotective efficacy of peri-operative beta-blockade.Unfortunately, some patients may not realise the potential cardioprotective benefits of peri-operative beta-blockade, as this may be either contra-indicated or difficult to initiate in the peri-operative period in patients with active bronchospasm, conduction disorders or decompensated cardiac failure. Alpha-2 agonists may be an alternative anti-adrenergic therapy in these patients. Alpha-2 agonists decrease central noradrenergic activity of the locus coeruleus [7] with a decrease in...

show abstract

“…Por este motivo, nos pacientes desta pesquisa clínica, a dose de indução da dexmedetomidina foi infundida em 10 minutos. Em ambos os grupos houve estabilidade hemodinâmica, porém foram observados valores mais baixos para pressões arteriais sistólica e diastó-lica e para freqüência cardíaca nos pacientes de G1 [11][12][13] , mesmo sendo relatados, com o uso do a 2 -agonista, casos de bradicardia ou hipotensão arterial, o que pode ser esperado durante a sua utilização 14 (Figuras 1, 2 e 3). A principal diferença entre os a 2 -agonistas e algumas outras drogas que reduzem a freqüência cardíaca é o mecanismo de ação.…”

Section: Resultsunclassified

“…This is the reason why, in our study, dexmedetomidine induction dose was infused in 10 minutes. Both groups showed hemodynamic stability, but lower systolic and diastolic blood pressure and heart rate values were found in G1 [11][12][13] , even with reports of bradycardia or arterial hypotension with the use of a 2 -agonists, which may be expected during their use 14 ( Figures 1, 2 and 3). The major difference between a 2 -agonists and other heart rate-decreasing drugs is their action mechanism.…”

mentioning

confidence: 99%

Dexmedetomidina e sufentanil como analgésicos per-operatórios: estudo comparativo

Curtis

Castiglia²,

Stolf³

et al. 2002

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

, Paulo do Nascimento Junior, TSA 6 RESUMO Curtis FG, Castiglia YMM, Stolf AA, Ronzella E, Vanni SMD, Nascimento Jr P -Dexmedetomidina e Sufentanil como Analgé-sicos Per-Operatórios. Estudo Comparativo Justificativa e Objetivos -A utilização das drogas agonistas dos a 2 -adrenoceptores para controlar a pressão arterial e f r e q ü ê n c i a c a r d í a c a , p r o p i c i a r m e n o r e s r e s p o s t a s hemodinâmicas à intubação

show abstract

Effects of Perioperative Dexmedetomidine Infusion in Patients Undergoing Vascular Surgery

Abstract: Infusion of dexmedetomidine up to a targeted plasma concentration of 0.45 ng/ml appears to benefit perioperative hemodynamic management of surgical patients undergoing vascular surgery but required greater intraoperative pharmacologic intervention to support blood pressure and heart rate.

Cited by 209 publications

References 30 publications

The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil

The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Dexmedetomidina e sufentanil como analgésicos per-operatórios: estudo comparativo

Contact Info

Product

Resources

About