The Effects Of Intramuscular Dexmedetomidine Premedication On Hemodynamics, Plasma Norepinephrine, Cortisol And Glucose Consentrations

Abstract

The aim of our study was to investigate the effect of dexmedetomidine premedication on hemodynamic parameters, plasma Cortisol, norepinephrine, glucose levels and requirements of opioid for induction and postoperative period. This study was randomized controlled trial and population consisted of 57 patients (ASA I- II, aged 20-55 years) undergoing elective abdominal surgery. General anesthesia was induced with thiopental and cis-atracurium. Patients subsequently received desflurane 3-5% with 66% in Electrocardiogram, pulse oxymeter and noninvasive blood pressure were monitored. Patients were divided into two groups: Group D patients received 1 ug kg-1 dexmedetomidine in saline (total volume 3 ml) in the deltoid muscle. Dexmedetomidine premed icatio n was not given to the control group. Plasma cortisol and norepinephrine levels were recorded 1 hour before induction, 1 and 30 min. after skin incision, 1 min after skin closure. In control group, heart rate (HR) and mean arterial pressure (MAP) increased after intubation and extubation when compared to baseline values. In dexmedetomidine group, HR and MAP were similar to baseline values. Plasma norepinephrine level increased in control group during surgery. However, plasma norepinephrine levels 1 and 30 min after skin incision decreased when compared to baseline values.We found that 1 ug kg-1 of intramuscular dexmedetomidine premedication reduced opioid requirement at induction and postoperative period without any changes in hemodynamic parameters, cortisol and glucose levels. We concluded that intramuscular dexmedetomidine premedication should be alternative to other premedicant agents. İntramusküler Deksmedetomidin Premedikasyonunun Hemodinami, Plazma Kortizol, Norepinefrin ve Glukoz Konsantrasyonuna Etkisi Bu çalışmanın amacı; deksmedetomidin premedikasyonunun hemodinamik parametreler, plazma kortizol, norepinefrin, glukoz düzeyi ile indüksiyon ve postoperatif dönemdeki opioid ihtiyacına etkisini araştırmaktır. Elektif abdominal cerrahi operasyonu geçirecek yaşları 20-55 olan, ASA I-II grubu toplam 57 hasta çalışmaya alındı. Genel anestezi indüksiyonunda tiyopental ve sisatrakuryum kullanıldı. Anestezi idamesi N2O+O2+ %3-5 desfluran ile sağlandı. EKG, noninvaziv kan basıncı, pulsoksimetre monitörize edildi. Hastalar iki gruba ayrıldı. Grup D'deki hastalara 1 ug kg-1 deksmedetomidin, toplam 3 ml salin içinde deltoid kas içine yapıldı. Kontrol grubuna deksmedetomidin premedikasyonu verilmedi. Plazma kortizol ve norepinefrin (NE) düzeyleri indüksiyondan 1 saat önce, cilt insizyonundan 1 ve 30 dakika sonra ve cilt kapandıktan 1 dak. sonra ölçüldü. Kontrol grubunda; kalp atım hızı ve ortalama kan basıncı preoperatif değerlere göre entü-basyon ve ekstübasyondan sonra yükseldi. Deksmedetomidin grubunda ise preoperatif değerlere benzerdi. Plazma norepinefrin düzeyi cerrahi süresince kontrol grubunda yüksekti. Fakat, plazma NE düzeyi insizyondan 1 ve 30 dak. sonra preoperatif değerlere göre düşüktü. İntramusküler deksmedetomidin premedikasyonunun hemodinamik parametreler, kortizol ve glukoz düzeylerinde değişiklik yapmadan indüksiyon ve postoperatif dönemdeki opioid ihtiyacını azalttığını gösterdik. İntramusküler deksmedetomidin premedikasyonunun diğer premedikasyon ajanlarına alternatif olabileceği kanısına vardık.

Keywords

• Premedication
• dexmedetomidine
• surgery stress response

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