The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting

Sulaiman, Sajith; Karthekeyan, Ranjith Baskar; Vakamudi, Mahesh; Sundar, Ayya Syama; Ravullapalli, Harish; Gandham, Ravikumar

doi:10.4103/0971-9784.91480

Cited by 89 publications

(53 citation statements)

References 9 publications

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“…These include hypertension, bradycardia, and hypotension owing to pre- and postsynaptic α 2 -receptor activation, which causes vasoconstriction, vasodilatation, and reflex bradycardia [8, 9]. Moreover, dexmedetomidine has been shown to attenuate stress responses, thereby creating a more stable hemodynamic profile during stressful events such as surgery or anesthetic induction [10–12]. The aim of this article is to critically review and summarize published data on the clinical pharmacokinetics and pharmacodynamics of dexmedetomidine in healthy volunteers, the targeted patient populations, and several special patient populations.…”

Section: Introductionmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

et al. 2017

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Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α2-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.

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Section: Introductionmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

et al. 2017

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“…During surgery and anesthesia, many patients undergo hemodynamic depression and this is more often seen in patients with hypertension or myocardial insufficiency (3). Many of the available clinical approaches for addressing this are not completely safe and dexmedetomidine has been shown to have many positive effects on cardiovascular stability in patients undergoing cardiac surgery (4,5). Dexmedetomidine, a highly selective and potent α2-adrenoreceptor agonist, with analgesic as well as anaesthetic effects also has other beneficial effects including reduction in the release of catecholamine (6), incidence of postoperative delirium (7,8), and also need for anesthetics (9,10).…”

Section: Introductionmentioning

confidence: 99%

Myocardial protective effects of dexmedetomidine in patients undergoing cardiac surgery: A meta-analysis and systematic review

Gong

Zhong

et al. 2017

Experimental and Therapeutic Medicine

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Arrhythmias are the common complications following cardiac surgery and contribute to hemodynamic instability, cognitive impairment, thromboembolic events, and congestive heart failure. Prevention of atrial fibrillation following cardiac surgery reduces morbidity and among the many available preventive approaches dexmedetomidine shows many positive effects on cardiovascular stability. Even though many studies indicated the beneficial effects of dexmedetomidine, the power of the analysis and conclusion of these studies is rather weak due to relatively smaller number of patients in these studies. In the present meta-analysis, we included a large number of patients, both children and adults, undergoing cardiac surgery, to address the efficacy of dexmedetomidine. Several databases were searched to identify clinical studies comparing the efficacy of dexmedetomidine in myocardial protection in patients undergoing cardiac surgery. Cardiac function related parameters including heart rate, blood pressure, tachycardia, arrhthmias, and bradycardia were measured. In accordance with the selection criteria, a total of 18 studies published between 2003 and 2016, with a total of 19,225 patients were included in the present meta-analysis. Dosage of dexmedetomidine was in the range of 0.5–1 µg/kg body weight loading followed by continuous infusion at a rate of 0.2–0.7 µg/kg/h. Dexmedetomidine treatment was found to lower heart rate, systolic blood pressure, incidence of tachycardia and arrhythmias in both adult and pediatric patients, but elevated the risk of bradycardia. In conclusion, results of this meta-analysis indicate that dexmedetomidine is an efficacious cardioprotective drug in adults and children undergoing cardiac surgery.

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“…Dexmedetomidine has been shown to attenuate the hemodynamic responses to laryngoscopy and endotracheal intubation when used as an adjunct to opioids. [18] In the present study, dexmedetomidine (0.5 μg/kg) was administered without any opioids which may not be sufficient to abolish the sympathetically mediated HR response associated with laryngoscopy and tracheal intubation.…”

Section: Discussionmentioning

confidence: 99%