Study to Compare the Effect of Bolus versus Intravenous Infusion of Dexmedetomidine on Intraoperative Haemodynamics in ENT Surgeries Under General Anaesthesia
Creators
- 1. Assistant Professor, Department of Anaesthesia, National Capital Region Institute of Medical Sciences, Meerut, U.P.
- 2. Assistant Professor, Department of ENT, Head & Neck Surgery, National Capital Region Institute of Medical Sciences, Meerut, U.P.
Description
Background: Modern anaesthesia demands optimal intraoperative conditions for surgical success and patient safety. Dexmedetomidine, a selective α2-adrenergic agonist, offers potential due to its sedative, analgesic, and sympatholytic properties. Administered via bolus injection or infusion, its impact on intraoperative haemodynamics in otolaryngological surgeries is a relevant exploration. Comparing these methods’ effects can refine anaesthetic practices and enhance outcomes in ENT surgeries. Methods: A prospective, randomized controlled trial included patients aged 18-60 undergoing elective ENT surgeries under general anesthesia. Randomized into bolus or infusion groups, blinding was ensured. Anaesthesia protocol included induction with propofol and sevoflurane maintenance. Hemodynamic parameters were recorded pre-, intra-, and post-surgery. Bolus group received Dexmedetomidine (loading dose: 1 μg/kg), infusion group received Dexmedetomidine (0.2 μg/kg/h) starting 20 minutes before induction. Statistical analysis included T test and Chi-square test, with p-value < 0.05 indicating significance. Results: A total of 70 patients were analysed (Group I: 33 and Group B: 37) in the present study. Baseline characteristics such as age, gender, body mass index (BMI), ASA grade was comparable between the two groups. In terms of systolic blood pressure (SBP) and mean arterial blood pressure (MABP), the patterns were similarly dynamic over time intervals, highlighting significant differences between the two groups at distinct points. Recovery time showed similar values in both groups, with 10.23 ± 3.54 minutes in Group B and 9.67 ± 2.94 minutes in Group I (p = 0.477). Occurrence of adverse events differed between the two groups, with bradycardia showing a statistically significant higher incidence in Group I (21.2%) as compared to (2.7%). Conclusion: This study highlights dexmedetomidine’s benefits for surgical conditions, haemodynamic stability, and bleeding reduction. Its use as premedication induces hypotension and enhances field visibility. Dexmedetomidine’s consistent efficacy and safety, along with versatile applications, make it valuable in modern anaesthesia.
Abstract (English)
Background: Modern anaesthesia demands optimal intraoperative conditions for surgical success and patient safety. Dexmedetomidine, a selective α2-adrenergic agonist, offers potential due to its sedative, analgesic, and sympatholytic properties. Administered via bolus injection or infusion, its impact on intraoperative haemodynamics in otolaryngological surgeries is a relevant exploration. Comparing these methods’ effects can refine anaesthetic practices and enhance outcomes in ENT surgeries. Methods: A prospective, randomized controlled trial included patients aged 18-60 undergoing elective ENT surgeries under general anesthesia. Randomized into bolus or infusion groups, blinding was ensured. Anaesthesia protocol included induction with propofol and sevoflurane maintenance. Hemodynamic parameters were recorded pre-, intra-, and post-surgery. Bolus group received Dexmedetomidine (loading dose: 1 μg/kg), infusion group received Dexmedetomidine (0.2 μg/kg/h) starting 20 minutes before induction. Statistical analysis included T test and Chi-square test, with p-value < 0.05 indicating significance. Results: A total of 70 patients were analysed (Group I: 33 and Group B: 37) in the present study. Baseline characteristics such as age, gender, body mass index (BMI), ASA grade was comparable between the two groups. In terms of systolic blood pressure (SBP) and mean arterial blood pressure (MABP), the patterns were similarly dynamic over time intervals, highlighting significant differences between the two groups at distinct points. Recovery time showed similar values in both groups, with 10.23 ± 3.54 minutes in Group B and 9.67 ± 2.94 minutes in Group I (p = 0.477). Occurrence of adverse events differed between the two groups, with bradycardia showing a statistically significant higher incidence in Group I (21.2%) as compared to (2.7%). Conclusion: This study highlights dexmedetomidine’s benefits for surgical conditions, haemodynamic stability, and bleeding reduction. Its use as premedication induces hypotension and enhances field visibility. Dexmedetomidine’s consistent efficacy and safety, along with versatile applications, make it valuable in modern anaesthesia.
Files
IJPCR,Vol15,Issue10,Article63.pdf
Files
(342.3 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:d690a8bd2e9b474cca4069e8d8cfa8dc
|
342.3 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-09-30
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue10,Article63.pdf
- Development Status
- Active
References
- 1. Taghipour Anvari Z, Afshar-Fereydouniyan N, Imani F, Sakhaei M, Alijani B, Mohseni M. Effect of clonidine premedication on blood loss in spine surgery. Anesth Pain Med. 2012; 1(4):252–6 2. Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H, et al. Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil. Eur Arch Otorhinolaryngol. 2017;274(1):239–45. 3. Marzban S, Haddadi S, Mahmoudi Nia H, Heidarzadeh A, Nemati S, Naderi Nabi B. Comparison of surgical conditions during propofol or isoflurane anesthesia for endoscopic sinus surgery. Anesth Pain Med. 2013; 3(2):234–8. 4. Kim H, Min KT, Lee JR, Ha SH, Lee WK, Seo JH. Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy. Yonsei Med J. 2016;57(4):980–6. 5. Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. 2011;120(9):586–92. 6. Das A, Mukherje A, Chhaule S, Chattopadhyay S, Halder PS, Mitra T, et al. Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study. Saudi J Anaesth. 2016;10(1):74–80. 7. Lee DC, Kwak HJ, Kim HS, Choi SH, Lee JY. The preventative effect of ramosetron on postoperative nausea and vomiting after total thyroidectomy. Korean J Anesthesiol. 2011;61(2):154–8. 8. Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia: A PRISMA-compliant metaanalysis of randomized controlled trials. Medicine (Baltimore). 2017;96(1):e5770. 9. Gupta K, Rastogi B, Gupta PK, Singh I, Singh VP, Jain M. Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gel(R): a randomized control study. Korean J Anesthesiol. 2016;69(6):573–8. 10. Su S, Ren C, Zhang H, Liu Z, Zhang Z. The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study. Front Pharmacol. 2016;7:407. 11. Valitalo PA, Ahtola-Satila T, Wighton A, Sarapohja T, Pohjanjousi P, Garratt C. Population pharmacokinetics of dexmedetomidine in critically ill patients. Clin Drug Investig. 2013;33(8):579–87. 12. Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur J Anaesthesiol. 2008; 25(10):816–20. 13. Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. AnesthAnalg. 2000;90(4):834–9. 14. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth. 2001;87(5):684–90. 15. Kallio A, Scheinin M, Koulu M. Effects of dexmedetomidine, a selective alpha 2- adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989;46(1):33–42. 16. Kim SH, Oh YJ, Park BW, Sim J, Choi YS. Effects of single-dose dexmedetomidine on the quality of recovery after modified radical mastectomy: a randomised controlled trial. Minerva Anestesiol. 2013;79(11):1248–58. 17. Mariappan R, Ashokkumar H, Kuppuswamy B. Comparing the effects of oral clonidine premedication with intraoperative dexmedetomidine infusion on anesthetic requirement and recovery from anesthesia in patients undergoing major spine surgery. J Neurosurg Anesthesiol. 2014;26(3):192-7. 18. Lee JS, Choi SH, Kang YR, Kim Y, Shim YH. Efficacy of a single dose of dexmedetomidine for cough suppression during anestheticemergence: a randomized controlled trial. Can J Anaesth. 2015;62(4):392–8. 19. Karaaslan K, Yilmaz F, Gulcu N, Colak C, Sereflican M, Kocoglu H. Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study. Curr Ther Res Clin Exp. 2007;68:69–81. 20. Sadhasivam S, Boat A, Mahmoud M. Comparison of patient-controlled analgesia with and without dexmedetomidine following spine surgery in children. J Clin Anesth. 2009;21(7):493–501. 21. Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30(12):1537–41. 22. Harsoor S, Rani DD, Yalamuru B, Sudheesh K, Nethra S. Effect of supplementation of lowdose intravenous dexmedetomidine on characteristics of spinal anesthesia with hyperbaric bupivacaine. Indian J Anaesth. 2013;57:265–9. 23. Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, et al. The effect of intraoperative infusion of dexmedetomidine on quality of recovery after major spinal surgery. J Neurosurg Anesthesiol. 2013;25(1):16. 24. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anaesth. 2010;57:39–45. 25. Al-Mustafa MM, Badran IZ, Abu-Ali HM, AlBarazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anaesthesiol. 2009;20:225–31. 26. Dinesh CN, Sai Tej NA, Yatish B, Pujari VS, Mohan Kumar RM, Mohan CV. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study. Saudi J Anaesth. 2014; 8:202–8. 27. Kol IO, Kaygusuz K, Yildirim A, Dogan M, Gursoy S, Yucel E, et al. Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: A double-blind, randomized, controlled trial. Curr Ther Res Clin Exp. 2009; 70:197-208. 28. Ibraheim OA, Abdulmonem A, Baaj J, Zahrani TA, Arlet V. Esmolol versus dexmedetomidine in scoliosis surgery: Study on intraoperative blood loss and hemodynamic changes. Middle East J Anesthesiol. 2013; 22:27-33. 29. Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek A. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anesthesia. Eur J Anaesthesiol. 2008;25(1):22-8. 30. Lee MH, Ko JH, Kim EM, Cheung MH, Choi YR, Choi EM. The effects of intravenous dexmedetomidine on spinal anesthesia: Comparison of different doses of dexmedetomidine. Korean J Anesthesiol. 2014; 67:252–7.