EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA
DOI:
https://doi.org/10.22159/ajpcr.2018.v11i6.25198Keywords:
Dexmedetomidine, Thiopentone, Propofol, Bispectral index, Dose reductionAbstract
Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.
Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists' physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.
Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).
Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone.
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Kayhan Z, Aldemir D, Mutlu H, Ogus E. Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin? Eur J Anaesthesiol 2005;22:780-5.
Morin AM, Geldner G, Schwarz U, Kahl M, Adams HA, Wulf H, et al. Factors influencing preoperative stress response in coronary artery bypass graft patients. BMC Anesthesiol 2004;4:1-6.
Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996;8:63-79.
Savola J, Ruskoaho H, Puurunen J, Salonen J, Karki N. Evidence for medetomidine as a selective and potent agonist at α2 adrenoreceptors. J Auton Pharm 1986;5:275-84.
Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an α2-adrenoceptor agonist. Eur J Pharmacol 1988;150:9-14.
Bansal T, Hooda S. Newer drugs in anaesthesia. Int J Pharm Pharm Sci 2012;4:668-70.
Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. Anesthesiology 1992;77:1134-42.
Hall JE, Uhrich TD, Barney J, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.
Iirola T, Aantaa R, Laitio R, Kentala E, Lahtinen M, Wighton A, et al. Pharmacokinetics of prolonged infusion of high-dose dexmedetomidine in critically ill patients. Crit Care 2011;15:R257. Available from: http://ccforum.com/content/15/5/R257.
Kamibayashi T, Maze M. Clinical uses of α2 adrenergic agonists. Anesthesiology 2000;93:1345-9.
Wong ES, Man RY, Vanhoutte PM, Ng KF. Dexmedetomidine induces both relaxations and contractions, via different {alpha}2-adrenoceptor subtypes, in the isolated mesenteric artery and aorta of the rat. J Pharmacol Exp Ther 2010;335:659-64.
Fairbanks CA, Kitto KF, Nguyen HO, Stone LS, Wilcox GL. Clonidine and dexmedetomidine produce antinociceptive synergy in mouse spinal cord. Anesthesiology 2009;110:638-47.
Jaakola ML, Ali-Mellkkli T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation response and anesthetic requirement in patients undergoing opthalmic surgery. BJA Br J Anaesth 1992;68:570-5. Available from: http://www.bja.oxfordjournals.org/content/68/6/570.short.
Aho M, Lehtinen A, Erkola O, Kallio 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.
Mowafi HA, Aldossary N, Ismail SA, Alqahtani J. Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. Br J Anaesth 2008;100:485-9.
Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A, Otelcioglu S. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: Perioperative haemodynamics and anaesthetic requirements. Drugs R D 2006;7:43-52.
Basar H, Akpinar S, Doganci N, Buyukkocak U, Kaymak Ç̧, Sert O, et al. The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters. J Clin Anesth 2008;20:431-6.
Kunisawa T, Nagata O, Nagashima M, Mitamura S, Ueno M, Suzuki A, et al. Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation. J Clin Anesth 2009;21:194-9.
Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011;55:352-7.
Chen Z, Shao DH, Hang LH. Effects of dexmedetomidine on performance of bispectral index as an indicator of loss of consciousness during propofol administration. Swiss Med Wkly 2013;143:w13762.
Menda F, Koner O, Sayin M, Ture H, Imer P, Aykac B. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth 2010;13:16. Available from: http://www.annals.in/text.asp?2010/13/1/16/58829.
Sebastian B, Talikoti AT, Krishnamurthy D. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: A comparison between two doses. Indian J Anaesth 2017;61:48-54.
Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992;68:126-31.
Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine, an α2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology 1990;73:230-5.
Turgut N, Turkmen A, Ali A, Altan A. Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy. Middle East J Anesthesiol 2009;20:63-70.
Kang WS, Kim SY, Son JC, Kim JD, Bin MH, Kim SH, et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol 2012;62:113-8.
Ghodki P, Sardesai S, Thombre S, Harnagle K. Dexmedetomidine as an anesthetic adjuvant in laparoscopic surgery: An observational study using entropy monitoring. J Anaesthesiol Clin Pharmacol 2012;28:334. Available from: http://www.joacp.org/text.asp?2012/28/3/334/98329.
Laha A, Ghosh S, Sarkar S. Attenuation of sympathoadrenal responses and anesthetic requirement by dexmedetomidine. Anesth Essays Res 2013;7:65. Available from: http://www.aeronline.org/text.asp?2013/7/1/65/113996.
Sulaiman S, Karthekeyan R, Ravullapalli H, Gandham R, Vakamudi M, Sundar A. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth 2012;15:39. Available from: http://www.annals.in/text.asp?2012/15/1/39/91480.
Kataria BC, Mehta DS, Chhaiya SB. Approval of new nervous system drugs in india compared with the us and eu. Int J Pharm Pharm Sci 2012;4:705-9.
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