Haemodynamic and anaesthetic advantages of dexmedetomidine

Abstract

Objectives: The aim of this study was to describe the effect of dexmedetomidine on haemodynamic stability in the intraoperative period, as well as on the pressor response to intubation and extubation and the requirement of inhalation anaesthetics and recovery. Design: A simple descriptive study. Settings and subjects: The study was conducted in a tertiary hospital in India from June 2010-June 2011. The 81 American Society of Anesthesiologists classification I and II patients who were enrolled in the study were given a loading dose of dexmedetomidine 1 μg/kg, followed by a continuous infusion of 0.5 μg/kg/hour. Supplementation with end-tidal sevoflurane 1-2% was considered when heart rate (HR) and mean arterial pressure exceeded 20% of baseline values. On completion of surgery, the time taken to discontinue dexmedetomidine infusion and the extubation time were recorded. Outcome measures: Changes in haemodynamic variables from baseline and a comparison of means were analysed by paired t-test for each time interval. Results: There was significant reduction in HR and systolic blood pressure following the loading dose of dexmedetomidine (12.31% and 8.82% respectively), in the intraoperative period (17.71% and 16.5% respectively), and during intubation and extubation (p-value < 0.001). None of the patients required supplementary doses of analgesics in the intraoperative period. Only 13 patients required end-tidal sevoflurane of 1% during the study. Seventy per cent of patients could be extubated within five minutes of discontinuing the infusion. Conclusion: Dexmedetomidine provided a stable haemodynamic profile in the perioperative period and a blunted pressor response to intubation and extubation. With its use, there was a minimal requirement for analgesics and inhalational agents. It had an acceptable recovery profile.