Juárez-Pichardo JS, Ávila-López A, Serrano-Herrera MA

Language: Spanish
References: 24
Page: 81-88
PDF size: 70.54 Kb.

ABSTRACT

Objective: It was assessed the analgesic effectiveness and the hemodynamic stability of dexmetomidine, an alfa-2 agonist, and lidocaine, a local anesthetic, at continuous infusion. Both drugs present clinical usefulness as adjuvant in anesthetic practice, in patients subjected to laparoscopic cholecystectomy. Material and methods: Forty-five patients presenting ASA I physical condition were evaluated before accepting an informed consent. The patients were practiced a laparoscopic cholecystectomy; they were distributed in three groups: Group one or lidocaine group received an initial dose of 1 intravenous microgram / kilogram of lidocaine followed by 25 micrograms/kilogram/minute; Group two or dexmetomidine group received an initial dose of 1 microgram/kilogram of dexmetomidine during 15 minutes, followed by 0.5 micrograms/kilogram/hour; and Group three or control group (or witness group) that received a pre-medication based upon a placebo. The three groups stayed under trans-anesthetic maintenance based upon sevofluorane (ultane) plus fentanyl. Hemodynamic parameters at the post-opera tive period were determined, as well as post-operative sedation and analgesia by means of the visual analog scale (VAS). Results: It was observed remarkable changes in the cardiac frequency and the systolic arterial blood pressure (p ‹ 0.001) of the patients managed through dexmetomidine. The same did not happen with the values of diastolic arterial blood pressure, which stayed stable and constant in the three studied groups. Equally, this treatment extended the effect of analgesia at the post-operative period (p ‹ 0.05). Conclusions: Dexmedetomidine in continuous infusion keeps showed security because of its hemodynamic stability and extended immediate post-operative analgesia for a longer time.

REFERENCES

1. Lundy J. Balanced anesthesia. Minn Med 1925;8:399-403.

2. Ramsay MAE, Luterman DL. Dexmedetomidine as total intravenous anesthetic agent. Anesthesiology 2004;101:787-790.

3. Triltsch AE, Welte M, Von Homeyer P, Grobe J, Genahr A, Moshirzadeh M, Sidiropoulos A, Konertz WJ, Kox W, Spies CD. Bispectral index-guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo-controlled phase II study. Critical Care Medicine 2002:30:1007-1014.

4. Pereira CT, Alves GJM, Carvalho PFE, Calvante SL, Tigre de Arruda Leitao IM, Sousa MH, Escalante RD. Avaliaçao hemodinámica e metabólica da infusao continua de dexmedetomidina e remifentanyl em colecistectomía videolaparoscopica. Estudio comparativo. Revista Brasileira de Anestesiologia 2003;53:419-430.

5. Ho AMH, Chen S, Karmakar MK. Central apnea after balanced general anaesthesia that included dexmedetomidina. Case report. British Journal of Anaesthesia 2005;95:773-775.

6. Dawson C, Daqing Ma, Chow A, Maze M. Dexmedetomidine enhances analgesic action of nitrous oxide. Anesthesiology 2004;100:894-904.

7. Hall JE, Uhrich TD, Barney JA, Shahbaz R, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions. Anestesia-Analgesia. 2000;90:699-705.

8. Cortinez LI, Yung-Wei H, Sum-Ping ST, Young C, Keifer JC, MacLeod D, Kerri MR, Wright DR, Moretti EW, Somma J. Dexmedetomidine pharmacodynamics: Part II. Crossover comparison of the analgesic effect of dexmedetomidine and remifentanyl in healthy volunteers. Anesthesiology 2004;101:1077-1083.

9. McCutcheon CA, Orme RM, Scott DA, Davies MJ, McGlade DP. Comparison of dexmedetomidine versus conventional therapy for sedation and hemodinamic control during carotid endarterectomy performed under regional anesthesia. Anesthesia-Analgesia 2006;102:668-675.

10. Ibacache ME, Muñoz HR, Brandes V, Morales A. Single dose dexmedetomidine reduces de agitation after sevoflurane anaesthesia in children. Anestesia-Analgesia 2004;98:60-63.

11. Curtis FG, Machado CYM, Albres SA, Ronzella E, Vanni SMD, Do Nascimento JP. Dexmedetomidine e sufentanyl como analgésicos per-operatorios. Estudo comparativo. Revista Brasileira de Anestesiología 2002;52:525-534.

12. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesthesia-Analgesia 2004;98:153-158.

13. Venn RM, Karol MD, Grounds RM. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care unit. British Journal of Anaesthesia 2002;88:669-675.

14. Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, Heard S, Cheung A, Son SL, Kallio A. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesthesia-Analgesia 2000;90:834-839.

15. Ebert TJ, Hall. JE, Barney JA, Uhrich TD, Colinco M. The effects of increasing plasma concentrations of dexmedetomidina in humans. Anesthesiology 2000;93:382-394.

16. Scheinin H, Aanta R, Anttila M, Hakola P, Helminen A, Karhuvaara S. Reversal of the sedative and sympatholitic effects of dexmedetomidine with a specific alfa 2 adrenoreceptor antagonist atipazole: A pharmacodynamic and kinetic study in healthy volunteers. Anesthesiology 1998;89:574-584.

17. Aanta R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology 1997;86:1055-1060.

18. Shahbaz RA, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesthesia-Analgesia. 2002;95:461-466.

19. Nociti JR, Serzedo PSM, Zuccolotto EB, Sebben F, Gonzales RF. Dexmedetomidina asociada a propofol em sedaçao durante anestesia local para cirugía plastica. Revista Brasileira de Anestesiología 2003;53:198-208.

20. Venn RM, Bryant A, Hall GM. Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. British Journal of Anaesthesia 2001;86:650-656.

21. Acevedo RPE, Revilla PF, Cendon OMM. Influencia de lidocaína y clonidina sobre los requerimientos de sevoflurano, desflurano y fentanyl durante anestesia general balanceada. Anales Médicos Hospital ABC. 2003;48:38-41.

22. Campos KD, Guimaraes AC, Carvalho MG, de Carvalho EM. Papel da lidocaina por via venosa no tratamento da dor na esclerodermia. Relato de caso. Revista Brasileira de Anestesiologia 2003;53:797-801.

23. Hodgson PS, Liu SS, Gras TW. Does epidural anesthesia have general anesthetic effects? Anesthesiology 1999;91:1687-1692.

24. Aguilar RMT, Cuenca DJF. Anestesia general endovenosa balanceada con lidocaína, citrato de fentanyl y bromuro de pancuronio. Revista Mexicana de Anestesiología 1981;4:121-123.