The Mechanism of [alpha]2-Adrenergic Inhibition of Sympathetic Ganglionic Transmission

McCallum, J. Bruce; Boban, Nataša; Hogan, Quinn H.; Schmeling, William T.; Kampine, John P.; Bošnjak, Željko J.

doi:10.1097/00000539-199809000-00001

Cited by 16 publications

(13 citation statements)

References 37 publications

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“…[20] At lower doses, the dominant action of α2 agonist is sympatholysis. [21] Basar et al .,[22] investigated the effect of single dose of dexmedetomidine 0.5 μg/kg administration 10 min before induction of anesthesia and reported significant reduction in MAP and HR. The efficacy of dexmedetomidine in providing better surgical and less blood loss during controlled hypotension was previously reported during tympanoplasty, septoplasty and maxilofascial surgery.…”

Section: Discussionmentioning

confidence: 99%

Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

et al. 2013

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Objective:A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS).Methods:Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 μg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 μg/Kg/h infusion during maintenance (DEX group), or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance (E group) to maintain mean arterial blood pressure (MAP) between (55-65 mmHg). General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR); arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia (Aldrete score ≥9) were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded.Result:Both DEX group and E group reached the desired MAP (55-65 mmHg) with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP (55-65 mmHg) were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score ≥9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group.Conclusion:Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect.

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Section: Discussionmentioning

confidence: 99%

Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

et al. 2013

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“…In the CNS, activation of ␣ 2 -receptors leads to a reduction in sympathetic outflow and an increase in vagal activity. In addition, DEX may have some action as a peripheral ganglionic blocker, further enhancing the sympatholytic effect (60). The net effect of ␣ 2 -adrenoreceptor action is a significant reduction in circulating catecholamines, modest reduction in blood pressure, and modest reduction in heart rate (80,82).…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

Dexmedetomidine for Neurological Surgery

Bekker¹,

Sturaitis²

2005

Operative Neurosurgery

172

171

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Dexmedetomidine is a new intravenous drug gaining popularity in neuroanesthesia and neurocritical care practice. This alpha2-adrenergic receptor agonist offers a unique "cooperative sedation," anxiolysis, and analgesia with no respiratory depression. Cerebral effects are generally consistent with a desirable neurophysiological profile, including neuroprotective characteristics. In addition, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments of neurosurgical stimulation. This review will address the neuropharmacology and neurophysiology of alpha2-adrenergic agonists and will specifically consider the rapidly evolving applicability of dexmedetomidine as an adjuvant to neurosurgical case management.

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“…In the CNS, activation of α2-receptors leads to a reduction in sympathetic outflow and an increase in vagal activity. In addition, dexmedetomidine may have some action as a peripheral ganglionic blocker, further enhancing the sympatholytic effect13). The net effect of α2-adrenoreceptor action is a significant reduction in circulating catecholamines, modest reduction in blood pressure, and modest reduction in heart rate10,18).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Dexmedetomidine during Intracerebral Aneurysm Coiling

Lee

Jung

Choi

et al. 2014

J Korean Neurosurg Soc

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ObjectiveGeneral anesthesia is often preferred for endovascular coiling of intracranial aneurysm at most centers. But in the authors' hospital, it is performed under monitored anesthesia care (MAC) using dexmedetomidine. To determine the feasibility and safety of this approach, the authors reviewed our initial experience.MethodsRetrospective data was analyzed from July 2012 to November 2012. We performed coil embolization in 28 cases using this method. Among them, for statistical significance, we analyzed 12 cases in which the procedure time exceeded an hour. Vital signs were analyzed every 10 minutes. Depth of sedation was measured according to the Ramsay sedation scale and frequency of the repeated roadmap image(s) caused by movement of the patient's head during the procedure.ResultsAll procedures were completed without occurrence of procedure related complications. Under MAC using dexmedetomidine, vital signs of the patients were stable, no statistical significance regarding hemodynamic and respiratory parameters was observed between time points (p>0.05). Adequate sedation was achieved. Mean Ramsay sedation scale was 3.67±1.61 (2 to 6). Repeated roadmap image(s) due to patient's factor occurred in only one case. The mean dosage of drug for adequate sedation for the procedure was 0.65±0.12 mcg/kg/hr without loading doses.ConclusionTo the best of my knowledge, this is the first report published in English using the method of monitored anesthesia with dexmedetomidine for intracranial aneurysm coiling. Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia.

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The Mechanism of [alpha]2-Adrenergic Inhibition of Sympathetic Ganglionic Transmission

Cited by 16 publications

References 37 publications

Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

Dexmedetomidine for Neurological Surgery

Usefulness of Dexmedetomidine during Intracerebral Aneurysm Coiling

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