Hülya BAŞAR, Çetin KAYMAK, Alpaslan APAN, Özgür SERT, Nur DOĞANCI

The effects of perioperative low- moderate doses of dexmedetomidine infusion on hemodynamic and neuroendocrine parameters

Amaç: Bu çalışmanın amacı elektif transuretral cerrahi yapılan hastalarda, orta ve düşük doz dexmedetomidin infüzyonunun, hemodinamik ve nöroendokrin parametrelere olan etkisinin incelenmesidir. Yöntem ve Gereç: Randomize olarak 50 hasta, anestezi indüksiyonundan 10 dakika önce 0.45 (Grup 1) veya 0.6 ug/kg/saat (Grup 2) dexmedetomidin infüzyonu aldılar. Kalp hızı, kan basıncı, end-tidal CO2, oksijen satürasyonu, ve noninvaziv kardiyak output parametreleri monitorize edildi. Ölçümler, bazal (I), dexmedetomidin infüzyonu sonrası (II), tiyopental sonrası (III), entübasyon sonrası (IV) ve desfluran anestezi uygulaması boyunca her 10 dakikada bir gerçekleştirildi. Anestezi idamesi (2L dak"1, % 50 N20+02), BİS değeri 40-60 olacak şekilde, % 4-6 desfluran kullanılarak sağlandı. Plazma adrenalin ve noradrenalin seviyelerinin belirlenmesi için venöz kan örnekleri, entübasyondan önce (I), intraoperatif dönemin 30. dakikasında (II) ve ekstübasyondan sonra (III) alındı. İstatistiksel analizde Chi- Square, Student-t test ve tekrarlı ölçümlerde varyans analizi kullanıldı. Bulgular: Her iki dexmedetomidin infüzyonu benzer hemodinamik değişiklikler oluşturdu. Kardiyovasküler ve nöroendokrin değereler ise, Grup 2'de; Grup l'den daha fazla baskılandı. Sonuç: Bu bulgularla, intraoperatif 0.45 ve 0.6 ug kg"1 saat"1 doz dexmedetomidin benzer hemodinamik yanıt oluşturmuştur. Kardiyovasküler ve nöroendokrin parametreler, orta doz dexmedetomidin ile daha fazla hastalanmaktadır.

Perioperatif düşük ve orta doz dexmedetomidin infüzyonunun hemodinamik ve nöroendokrin parametreler üzerine etkileri

Aim: The aim of this study was to determine the effects of low and moderate doses of dexmedetomidine infusions by evaluating hemodynamic and neuroendocrine responses in patients undergoing elective transurethral surgery. Materials and Methods: Fifty patients were randomly allocated to receive 0.45 (Group 1) or 0.6 (Group 2) ug kg"1 hr"1 dexmedetomidine infusion 10 minutes before induction of anesthesia. Heart rate, blood pressures, ETC02 and peripheral oxygen saturation values and parameters of non-invasive cardiac output were monitored. Measurement times were baseline (I), after dexmedetomidine infusion (II), after thiopental induction (III), after intubation (IV) and at 10-minute intervals during desflurane anesthesia. Anesthesia (2L min"1 50% N20+02) was maintained with 4-6% desflurane corresponding to a bispectral index (BIS) value of 40-60. Venous blood samples were collected prior to intubation (1), at the 30th min intraoperatively (II) and after extubation (III) to determine plasma adrenaline and noradrenaline levels. Chi-square, Student's t-test and repeated measures of variance were used for statistical analysis. Results: Two different doses of dexmedetomidine infusion produced similar hemodynamic effects. The cardiovascular and neuroendocrine parameters were suppressed more in Group 2 than in Group 1. Conclusions: These findings suggest that intraoperative 0.45 and 0.6 ug kg"1 hr"1 doses of dexmedetomidine result in similar intubation, recovery and hemodynamic responses. Cardiovascular and neuroendocrine parameters were suppressed more by the moderate dose of dexmedetomidine.

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1. Bhana N, Goa KL, McClean KJM. Dexmedetomidine. Drugs 2000; 59: 263-8.
2. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. 1 Sedation, ventilation and metabolic rate. Anesthesiology 1992; 77: 1125-33.
3. Wheeler AP. Sedation and paralysis in the intensive care unit. Chest 1993; 104: 566-77.
4. Taittonen MT, Kirvelâ OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesthesia 1997; 78: 400-6.
5. Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg 1997; 85: 1136-42.
6. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II Hemodynamic changes. Anesthesiology 1992; 77: 1134-42.
7. Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttilâ J, Salmenperâ M. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 1997; 86: 331-45.
8. Hofer RE, Sprung J, Sarr MG, Wedel DJ. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anesth 2005; 52: 176-80.
9. Appel PL, Kram HB, Mackabee J, Fleming AW, Shoemaker WC. Comparison of measurements of cardiac output by bioimpedance and thermo dilution in severely ill surgical patients. Crit Care Medicine 1986; 14: 933-5.
10. Thangathurai D, Charbonnet C, Roessler P, Wo CC, Mikhail M, Yoahida R et al. Continuous intraoperative noninvasive cardiac output monitoring using a new thoracic bioimpedance device. J Cardio Vase 1997; 11:440-4.
11. Moore FA, Haenel JB, Moore EE. Alternatives to Swan-Ganz cardiac output monitoring. Surg Clin North Am 1991; 71: 699-721.
12. Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology 2000; 93: 1345-9.
13. McSPI-EUROPE Research Group: Perioperative sympatholysis. Beneficial effects of the alpha 2 adrenoreceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. Anesthesiology 1997; 86: 346-63.
14. Qintin L, Bonnet F, Macquin I.Skezely B, Becquemin P, Ghignone M. Aortic surgery: effect of clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesth Scand 1990; 34: 132-7.
15. Aho M, Lehtinen AM, Erkola O, Kallio A, Kortilla K. The effect of intravenously administrated dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesth Analg 1991; 74: 997-1002.
16. Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H. Effects of dexmedetomidine, a selective alpha 2-adrenoreceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol 1989; 46: 33-42.
17. Güler G, Akın A, Tosun E, Eskitaşoğlu E, Mızrak A, Boyacı A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesth Scand 2005; 49: 1088-91.
18. Jaakola ML, Melkkila-Ali T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation responses and anesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth 1992; 68: 570-5.
19. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and perioperative haemodynamic stability. Anaesthesia 1997; 52: 736-44.
20. Hall JE, Uhrich TD, Barley JA, Arain SR, Ebert TJ. Sedative, amnesic and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699-705.
21. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382-94.
22. Dorman BH, Zucker JR, Verrier ED, Gartman DM, Slachman FN. Clonidine improves perioperative myocardial ischemia, reduces anesthetic requirement, and alters hemodynamic parameters in patients undergoing coronary artery bypass surgery. J Cardiothorac Vase Anesth 1993; 7: 386-95.
23. Stühmeijer KD, Mainzer B, Cierpka J, Sandmann W. Small oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85: 706-12.