Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy.

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Abstract

Dexmedetomidine is a α2 agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful adjuvant in anaesthesia as stress response buster, sedative and analgesic. We aimed primarily to evaluate the effects of low dose dexmedetomidine infusion on haemodynamic response to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecystectomy. The secondary aims were to observe the effects on extubation time, sedation levels, post-operative analgesia requirements and occurrence of adverse effects.

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Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions.

Robert Barney, Timothy J. Hall, T Uhrich … (2000)

This research determined the safety and efficacy of two small-dose infusions of dexmedetomidine by evaluating sedation, analgesia, cognition, and cardiorespiratory function. Seven healthy young volunteers provided informed consent and participated on three occasions with random assignment to drug or placebo. Heart rate, blood pressure, respiratory rate, ETCO(2), O(2) saturation, and processed electroencephalogram (bispectral analysis) were monitored. Baseline hemodynamic measurements were acquired, and psychometric tests were performed (visual analog scale for sedation; observer's assessment of alertness/sedation scale; digit symbol substitution test; and memory). The pain from a 1-min cold pressor test was quantified with a visual analog scale. After a 10-min initial dose of saline or 6 microg. kg(-1). h(-1) dexmedetomidine, volunteers received 50-min IV infusions of saline, or 0.2 or 0.6 microg. kg(-1). h(-1) dexmedetomidine. Measurements were repeated at the end of infusion and during recovery. The two dexmedetomidine infusions resulted in similar and significant sedation (30%-60%), impairment of memory (approximately 50%), and psychomotor performance (28%-41%). Hemodynamics, oxygen saturation, ETCO(2), and respiratory rate were well preserved throughout the infusion and recovery periods. Pain to the cold pressor test was reduced by 30% during dexmedetomidine infusion. Small-dose dexmedetomidine provided sedation, analgesia, and memory and cognitive impairment. These properties might prove useful in a postoperative or intensive care unit setting. IMPLICATIPNS: The alpha(2) agonist, dexmedetomidine, has sedation and analgesic properties. This study quantified these effects, as well as cardiorespiratory, memory and psychomotor effects, in healthy volunteers. Dexmedetomidine infusions resulted in reversible sedation, mild analgesia, and memory impairment without cardiorespiratory compromise.

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Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes.

Jordan D. Ward, B C Bloor, J A Belleville … (1992)

Dexmedetomidine (DMED) is a novel clonidine-like compound known to have sedative, analgesic, and cardiovascular stabilizing qualities. DMED is a more highly selective alpha 2-adrenergic agonist than clonidine. This investigation examined the hemodynamic effects of four selected iv doses in consenting healthy male volunteers. In a randomized, double-blind, placebo-controlled trial subjects received 0 (n = 9), 0.25 (n = 6) 0.5 (n = 6), 1.0 (n = 6), or 2.0 (n = 10) micrograms/kg of DMED by infusion (2 min). ECG, heart rate (HR), arterial blood pressure (MABP), bioimpedance cardiac output (CO), and plasma catecholamines concentrations (CA) were monitored from 90 min before to 360 min after infusion. Plasma DMED concentrations were measured. DMED produced a maximum decrease in MABP at 60 min of 14%, 16%, 23%, and 27% for the 0.25, 0.5, 1.0, and 2.0 micrograms/kg groups, respectively (P < .05). At 330 min MABP remained below baseline by 8% and 17% at the two largest doses (P < .05). Both HR and CO decreased maximally by both 17% at 105 min. The two largest doses produced a transient (peak at 3 min lasting < 11 min) increased in MABP (16 +/- 2.5 and 24 +/- 10 mmHg, respectively; P < .05) with a concomitantly reduced CO (41%, 2 micrograms/kg; P < .05) and HR (22%, 2 micrograms/kg; P < .05), whereas systemic vascular resistance doubled. Even the lowest dose decreased CA immediately to values close to 20 pg/ml for 5 h. A 2-min iv infusion of DMED produced a transient increase in MABP and a longer lasting decrease in MABP and CA. These DMED doses were well tolerated in the healthy volunteers.

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Dexmedetomidine: a review of clinical applications.

Bobby Nossaman, D Carollo, Usha Ramadhyani (2008)

The present review serves as an overview update in the diverse uses of the sedative dexmedetomidine. Dexmedetomidine is a selective alpha2 adrenoreceptor agonist that has been described as a useful, safe adjunct in many clinical applications. This paper reviews current clinical uses, mechanism of action, and side effects of dexmedetomidine. The current uses reviewed include sedation in the ICU (adult and pediatric), neurosurgery, pediatric procedural sedation, awake fiber-optic intubation, cardiac surgery, and bariatric surgery. Dexmedetomidine is a useful medication with many clinical applications. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, propofol, and other sedative medications. Short-term sedation has been shown to be safe in studies, although hypotension and bradycardia are the most significant side effects. Dexmedetomidine has been used effectively for sedation during pediatric procedures and in the ICU. In order to reduce sympathetic tone during cardiac surgery, a low-dose dexmedetomidine infusion has been utilized. The bariatric surgery population has also been studied with dexmedetomidine because of its adequate sedation and less prevalent respiratory depression when compared with opioid administration. Dexmedetomidine is emerging as an effective therapeutic agent in the management of a wide range of clinical conditions with an efficacious, safe profile.

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Author and article information

Journal

Journal ID (iso-abbrev): Indian J Anaesth

Title: Indian journal of anaesthesia

Publisher: Medknow

ISSN: 0019-5049

ISSN (Print): 0019-5049

Publication date (Electronic): January 28 2015

Volume: 58

Issue: 6

Affiliations

[1 ] Department of Anaesthesiology, Medical College, Vadodara, Gujarat, India.

Article

Publisher Item ID: IJA-58-726

DOI: 10.4103/0019-5049.147164

PMC ID: 4296358

PubMed ID: 25624537

SO-VID: ef801abf-b619-4e8e-9263-f54917359ab1

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Keywords: Dexmedetomidine,haemodynamic stress response,laparoscopic cholecystectomy

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Keywords: Dexmedetomidine, haemodynamic stress response, laparoscopic cholecystectomy

Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy.

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Most cited references 16

Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions.

Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes.

Dexmedetomidine: a review of clinical applications.

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