Farklı dozlarda deksmedetomidinin laringoskopi ve endotrakeal entübasyona karşı oluşan hemodinamik yanıta, peroperatuvar anestezik gereksinimine ve derlenmeye etkilerinin karşılaştırılması

Amaç: Anestezi indüksiyonundan önce farklı doz ve sürelerde uygulanan deksmedetomidinin laringoskopi ve entübasyona verilen hemodinamik yanıta, peroperatuvar anestezik gereksinimine ve derlenmeye etkilerini karşılaştırmaktır. Yöntem: Çalışmaya alınan 45 hasta üç eşit gruba ayrıldı. Deksmedetomidin I. grupta 0.6 $mu$ $kg^{-1}$ 10 dak'da, II. grupta 1 $mu$ $kg^{-1}$ 5 dak'da ve III. grupta 2 $mu$ $kg^{-1}$ 10 dak'da intravenöz (İV) olarak uygulandı. Tüm hastalarda tiyopental ve rokuronyumla sağlanan anestezi indüksiyonundan sonra, hava-oksijen içinde desfluran ve deksmedetomidin infüzyonuyla anestezi idame ettirildi. Hastaların kalp atım hızı (KAH), ortalama arter basıncı (OAB) ve periferik oksijen satürasyonu (SpO2) deksmedetomidin uygulanmadan önce (bazal), peroperatif ve postoperatif dönemlerde; desfluranın inspiratuvarI minimum alveoler konsantrasyonları (FilMAK) ile end tidal karbondioksit (ETCO2) değerleriyse entübasyondan sonra kaydedildi. Tiyopental miktarı, Aldrete derlenme ve sedasyon skorları, postoperatif derlenme kriterleri ve yan etkiler kaydedildi. Bulgular: Grup II ve IH'te indüksiy on öncesi KAH ile grup IH'te entübasyondan 4 dak sonraki O AB bazal değere göre; grup IH'te indüksiy on öncesi, laringoskopi ve cilt insizyonu sırasındaki KAH ile entübasyondan 4 dak sonraki O AB grup Ve göre azaldı. Gruplar tiyopental miktarı, desfluran FilMAK, SpO2, ETCO2, Aldrete derlenme ve sedasyon skorları, derlenme kriterleri ve yan etkiler açısından benzerdi. Sonuç: Laringoskopi ve entübasyona hemodinamik yanıt 2 $mu$ $kg^{-1}$ deksmedetomidinle 0.6 $mu$ $kg^{-1}$ a göre baskılanırken, desfluran gereksinimi ve derlenme kriterleri benzer bulundu.

Anahtar Kelimeler:

Anesteziden uyanma dönemi, Laringoskopi, Deksmedetodimin, Entübasyon, intratrakeal

A comparison of the effects of different doses of dexmedetomidine on the hemodynamic response to laryngoscopy and endotracheal intubation, peroperative anesthetic requirement and recovery

Background: Forty-five patients were divided in three groups to compare the effects of different dexmedetomidine doses on the hemodynamic response to laryngoscopy and intubation, peroperative anesthetic requirement, and recovery. Method: Dexmedetomidine 0.6 $mu$ $kg^{-1}$ in 1 min (group I), 1 $mu$ $kg^{-1}$ in 5 min (group II) and 2 $mu$ $kg^{-1}$ in 10 min (group HI) were administered intravenously (IV) before induction of anesthesia. In all three groups, anesthesia was induced with thiopentone and rocuronium, and then maintained with desfluran in air-oxygen and dexmedetomidine infusion. Heart rate (HR), mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2) were recorded before dexmedetomidine (control), per- and postoperatively; inspiratory I minimum alveolar concentration (FilMAC) of desflurane and end tidal carbon dioxide (ETC02) were recorded after intubation. The amount of thiopentone used, Aldrete and sedation scores, recovery criteria and side effects were recorded. Results: In groups II and III, HR before induction, and MAP 4 minutes after intubation significantly decreased compared to the control group. In group III, HR before induction, during laryngoscopy and skin incision, and MAP 4 minutes after intubation signficantly decreased compared to group I. The amount of thiopentone used, desflurane FilMAC, ETCO2, SpO2, Aldrete and sedation scores, recovery criteria and side effects of all groups were comparable. Conclusion: Hemodynamic response to laryngoscopy and intubation was blunted with 2 $mu$ $kg^{-1}$ dexmedetomidine with respect to 0.6 $mu$ $kg^{-1}$, while the desfluran requirement and recovery were comparable.

Keywords:

Anesthesia Recovery Period, Laryngoscopy, Dexmedetomidine, Intubation, Intratracheal,

PDF

___

1. Scheinin B, Lingren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympatoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anesth 1992; 68: 126-31.
2. Aho M, Lehtinen AM, Erkola O, Kaili A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991; 74: 997-1002
3. Jaakola ML, Ali-Melkkila T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophtalmic surgery. Br J Anaesth 1992; 68: 570-5.
4. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia 1997; 52: 736-44.
5. Arain S, Ebert Tl. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intra-operative sedation. Anesth Analg 2002; 95: 461-6.
6. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992; 77:1125-33.
7. Khan ZP, Munday IT, Jones RM, Thornton C, Mont TG, Amin D. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. l:Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999; 83: 372-80.
8. Dundee JW, Hassard TH, McGowan WA, Henshaw J. The induction dose of thiopentone. A method of study and preliminary illustrative results. Anaesthesia 1982; 37:1176-84.
9. Aho M, Erkola O, Kallio A, Scheinin H, Korttila K. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg 1992; 75: 940.
10. Heavner JE, Kaye AD, Lin BK, King T. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anaesth 2003; 91: 502-6.
11. Bloor CB, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77: 1134-42.
12. Unlugenç H, Gunduz M, Güler T, Yağmur O, Işık G. The effects of pre-anesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient controlled morphine. Eur J Anaesthesiol 2005; 22: 386-91.
13. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98: 153-8.
14. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effect of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382-94.
15. Aho M, Erkola O, Kallio A, Scheinin H, Kortilla K. Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole. J Clin Anesth 1993; 5: 194-200.
16. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699-705.
17. Aantaa RE, Kanto JH, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine a2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology 1990; 73: 230-5.
18. Buhrer M, Mappes A, Lauber R, Stanski DR, Maitre PO. Dexmedetomidine decreases thiopental dose requirement and alters distribution pharmacokinetics. Anesthesiology 1994; 80: 1216-27.
19. Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1. Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999;83: 372-80.
20. Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years. J Clin Anesth 1999; 11: 466-70