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

Year 2006, Volume: 23 Issue: 1, 9 - 16, 30.12.2009

C. Kaya E. Kelsaka B. Sarıhasan Y. Aliyazıcıoğlu S. Kocamanoğlu S. Karacalar H. Şahinoğlu

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

References

• Aho M, Erkola O, Kallio A, et al. Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole. J Clin Anesth 1993; 5: 194–203.
• Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382–394.
• Jaakola ML, Salonen M, Lehtinen R, Scheinin H. The analgesic action of dexmedetomidine a novel alpha 2 - a d r e n o c e p t o r agonist in healthy volunteers. Pain 1991; 46: 281–285.
• Aantaa R, Kanto J, Scheinin M. Intramuscular dexmedetomidine, a novel alpha 2-adrenoceptor agonist, as premedication for minor gynecological surgery. Acta Anaesthesiol Scand 1991; 35: 283–288.
• Aantaa RE, Kanto JH, Scheinin M, et al. Dexmedetomidine premedication for minor gynecologic surgery. Anesth Analg 1990; 70: 407–413.
• Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136–1142.
• Jones JG, Taylor PM. Receptor-specific reversible sedation: dangers of vascular effects. Anesthesiology 1999; 90: 1489–1490.
• Scheinin B, Lindgren L, Randell T, et al. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth 1992; 68: 126–131.
• Belleville JP, Ward DS, Bloor BC, et al. Effects of intravenous dexmedetomidine in humans. I. Sedation,
• Anesthesiology 1992; 77: 1125–1133. and metabolic
• rate. 10. Metz SA, Halter JB, Robertson RP. Induction of d e f e c t i ve insulin secretion and impaired glucose t o l e r a n ce by clonidine. Selective stimulation of metabolic alpha-adrenergic pathways. Diabetes 1978; 27: 554–562.
• Nguyen D, Abdul-Rasool I, Ward D, et al. Ventilatory effects of dexmedetomidine, atipamezole, and isoflurane in dogs. Anesthesiology 1992; 76: 573–579.
• Maze M, Virtanen R, Daunt D, et al. Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: in vivo and in vitro studies. Anesth Analg 1991; 73: 204–208.
• Bloor BC, Ward DS, Belleville JP, et al. Effects of dexmedetomidine
• Hemodynamic changes. Anesthesiology 1992; 77: 1134–1142. in
• humans. 17. Aho MS, Erkola OA, Scheinin H, et al. Effect of i n t r a v e n o u s l y administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg 1991; 73: 112–118.
• Nagla Abdalla, Amera H. Soliman. The effects of dexmedetomidine premedication on cortisol and interleukin-6 in patients undergoing major abdominal surgery. EG. J. Anaesth. 2003; 19: 283–290.
• Dutta S, Lal R, Karol MD, et al. Influence of cardiac output on dexmedetomidine pharmacokinetics. J Pharm Sci 2000; 89: 519–527.
• Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136–1142.
• Vainio O, Palmu L. Cardiovascular and respiratory effects of medetomidine in dogs and influence of a n t icholinergics. Acta Vet Scand 1989; 30: 401–408.