scholarly journals Effects of Dexmedetomidine Infusions on Hemodynamic Stability in Patients undergoing Laparoscopic Cholecystectomy

2018 ◽  
Vol 04 (01) ◽  
pp. 010-014
Author(s):  
Himanshu Dodeja ◽  
Vinaya Udaybhaskar ◽  
Amol Singam
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Cardiovascular System ◽  
Normal Saline ◽  
Pressor Response ◽  
Hemodynamic Instability ◽  
System Stability ◽  
Plasma Catecholamine ◽  
Hemodynamic Stability ◽  
Inhalation Agent

Abstract Objectives: In laparoscopic cholecystectomy, there has been emphasis on maintaining hemodynamic stability by avoiding hypertension, hypotension, or tachycardia. The hemodynamic instability is persistent during the duration of pneumoperitoneum (PNP), namely, CO2 insufflations. This study helps us to find out the efficacy of dexmedetomidine on cardiovascular system stability in patients undergoing laparoscopic cholecystectomy. Materials and methods: Thirty patients were randomized into two groups of 15 members each: group P (placebo group) and group D (dexmedetomidine group). In the former, patients received 0.9% 20 mL normal saline, while in the latter, patients received 0.4 μg/kg/hr of injection dexmedetomidine in 0.9% normal saline. In all patients, age, weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded. Results: Dexmedetomidine being a highly selective and potent and specific alpha 2 agonist attenuates the hemodynamic response to tracheal intubation, decreases plasma catecholamine concentration during anesthesia, and decreases perioperative requirements of inhaled anesthetics. We found that dexmedetomidine helped in blunting the pressor response during the intubation, kept the HR and mean arterial pressure stable intraoperatively, and there was faster recovery as the requirement of inhalation agent was decreased intraoperatively. Conclusion: The drug dexmedetomidine maintained cardiovascular stability during laparoscopic cholecystectomy. The inhalational agent (isoflurane) requirement was found to be considerably lower. Also, the mean recovery time as indicated by the ability to vocalize following extubation was found to be significantly less. Hence, it can be recommended in laparoscopic cholecystectomy for maintaining cardiovascular system stability.

Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Jonathan M. Chen ◽  
Suzanne Cullinane ◽  
Talia B. Spanier ◽  
John H. Artrip ◽  
Ranjit John ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetes Insipidus ◽  
Low Dose ◽  
Clinical Evidence ◽  
Pressor Response ◽  
Hemodynamic Instability ◽  
Solid Organ ◽  
Organ Donors ◽  
Plasma Vasopressin ◽  
Before And After

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P <0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

scholarly journals Dexmedetomidine and magnesium sulphate as the anaesthetic adjuncts for intraoperative management for resection of pheochromocytoma - a case report

2016 ◽  
Vol 3 (2) ◽  
pp. 87-89
Author(s):  
Gentle Sunder Shrestha ◽  
Sachit Sharma Rupakhetee ◽  
Sunil Pathak ◽  
Pragya Acharya ◽  
Bashu Dev Parajuli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Magnesium Sulphate ◽  
Antihypertensive Agents ◽  
Hemodynamic Instability ◽  
Tumour Resection ◽  
Tumour Site ◽  
Hemodynamic Stability ◽  
Intraoperative Management ◽  
History Of ◽  
Acute Changes

Pheochromocytoma, a tumour arising from adrenal medulla or other ganglia of sympathetic nervous system is notorious for secreting catecholamines. This form of the tumour is a major challenge to anaesthesia team as acute changes in blood pressure and heart rate usually occurs due to the release of catecholamines from the tumour site before tumour resection and cessation of the same after resection leading to hemodynamic instability intraoperatively. Better hemodynamic stability is desired during this form of tumour resection as acute fluctuations in blood pressure may lead to severe intracranial or cardiovascular events. Dexmedetomidine and magnesium sulphate were used as anaesthetic adjuncts to achieve good hemodynamic stability in a 35 years old female who presented with the history of headaches, palpitation and sweating on and off since last 2 years. The use of these agents allowed us to obtain an acceptable level of hemodynamic stability along with the help of other agents such as inotropes, vasopressors, vasodilators and antihypertensive agents. Dexmedetomidine and magnesium sulphate were used before resection of the tumour in our case and stopped thereafter. These agents may be an excellent option as anaesthetic adjuncts to obtain greater hemodynamic stability during resection of pheochromocytoma.

scholarly journals Intravenous dexmedetomidine 1µg/kg as premedication to attenuate hemodynamic response to laryngoscopy and endotracheal intubation in surgeries under general anesthesia

2017 ◽  
Vol 4 (6) ◽  
pp. 1884
Author(s):  
Dixitkumar B. Modh ◽  
Pratiti Gohil ◽  
Manthan Parmar
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Normal Saline ◽  
Induction Agent ◽  
Hemodynamic Parameters ◽  
Hemodynamic Changes ◽  
Dose Requirement ◽  
Hemodynamic Stability ◽  
Induction Dose

Background: Choice of premedication and hemodynamic stability are always remain important concerns during laryngoscopy and endotracheal intubation for Anesthesiologists. Dexmedetomidine offers anxiolytic, sedation, hypnosis, analgesia, antisialagogue action as well as sympatholysis which make most suitable drug as premedication. Our aims for this study to evaluate efficacy of Injection Dexmedetomidine 1µg/kg intravenously as premedication on attenuation of hemodynamic changes to laryngoscopy and intubation as well as requirement of injection Propofol as an induction agent.Methods: In Present study, 60 patients of ASA I, II of age 18 to 45 years were randomly divided in to two groups of 30 each. In group NS, 10 ml normal saline and in group D1 injection Dexmedetomidine 1µg/kg diluted in 10 ml of normal saline was used. In both groups study solutions administered over 10 minutes. Both the groups were administered standard general anaesthesia and requirement of Propofol was noted as an induction agent. Heart rate, blood pressure (systolic, diastolic and mean arterial pressure) were compared at baseline, 2 min, 5 min, 10 minutes (SD2, SD5, SD10) after study drugs administration, before induction (BI), after induction (AI), 1 minute (T1), 2 minutes (T2), 5 minutes (T5) and 10 minutes (T10) after laryngoscopy and intubation in both groups.Results: HR, SBP, DBP and MAP highly significantly reduced at 2 min, 5 min and 10 minutes after infusion of Dexmedetomidine in group D1 as compared to group NS. (P<0.01). After induction values are highly significant in group D1 than group NS from baseline (P<0.01). Highly significant mean rise in hemodynamic parameters (HR, SBP, DBP and MAP) from baseline were observed in group NS compared to group D1 after laryngoscopy and intubation (P<0.01). Induction dose requirement of inj. Propofol significantly reduced in group D1 compared to other group (P<0.01).Conclusions: Injection Dexmedetomidine 1µg/kg provides effective and complete attenuation of pressure response to laryngoscopy and endotracheal intubation as premedication with decreased requirement of inj. Propofol for induction without any side effects.

scholarly journals Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy- A Randomised Controlled Trial

2021 ◽  
Author(s):  
Anish Kumar Singh ◽  
Sanjay Johar ◽  
Sudesh Kumar ◽  
Mamta Jain ◽  
Kiranpreet Kaur ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Pulse Rate ◽  
Normal Saline ◽  
Double Blind Study ◽  
Rescue Analgesia ◽  
Extubation Time ◽  
Sedation Scores ◽  
Stage 1 ◽  
Group D

Introduction: Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more so in case of laparoscopic surgeries and alpha-2 agonists premedication may be useful in such patients. Aim: To assess perioperative haemodynamic fluctuations in untreated stage 1 hypertension (HTN) patients and the role of Dexmedetomidine (Dexmed) in it. Materials and Methods: This prospective, randomised, double blind study was conducted at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from March 2019 to September 2020. Sixty-five patients with stage 1 HTN not on any anti-hypertensive drugs undergoing laparoscopic cholecystectomy were enrolled and randomly divided into group D (dexmedetomidine) and group NS (Normal Saline). Group D received Dexmed 1 μg/kg over 10 minutes before induction, followed by continuous infusion of Dexmed at 0.2 μg/ kg/h and Group NS received similar volume of normal saline. Serial recording of pulse rate, Mean Arterial Pressure (MAP) and oxygen saturation was done. Postoperative sedation scores, extubation time and time to first rescue analgesia were also assessed. For analysis, quantitative variables were expressed as mean±SD and compared using unpaired and paired t-test. Mann-Whitney test was used for quantitative data that did not follow a normal distribution. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 60 patients (30 in group NS, mean age 38.40±10.32 years and 30 in group D, mean age 42.5±11.72 years) were analysed in the present study. In NS group, haemodynamic variations were seen at induction, Laryngoscopy and Intubation (L&I), creation and release of Pneumoperitoneum (PNP) and extubation but actual changes were within 10-12% of baseline value, whereas in group D, pulse rate and MAP remained stable and moderately lower than baseline throughout the perioperative period. An increase in extubation time was observed in group D (15.57±3.16 vs.9.15±1.60 min). Group D also had significantly higher sedation scores postextubation. Group NS patients demanded rescue analgesia early (18.33±7.46 min vs.43.53±8.57 min) (p=0.001). Conclusion: It was concluded that the administration of i.v. Dexmed 1 μg/kg over 10 minutes followed by infusion at 0.2 μg/Kg/h results in haemodynamic stability during surgical stress, slightly delayed but smooth extubation, delayed demand of postoperative rescue analgesia and mild sedation of short duration. Dexmed induced effects help in improving the recovery profile of the patient and keeping the patient more comfortable in the postoperative period.

COMPARISION OF ORAL PREGABALIN VERSUS BOLUS DOSE OF INTRAVENOUS DEXMEDETOMIDINE IN ATTENUATING THE HEMODYNAMIC RESPONSES DURING LARYNGOSCOPY, INTUBATION AND PNEUMOPERITONIZATION IN LAPROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED STUDY

2021 ◽  
pp. 74-77
Author(s):  
Jyoti Rani ◽  
Meenaxi Sharma ◽  
Deepak Kumar ◽  
Anumeha Jain
Keyword(s):  
Blood Pressure ◽  
Normal Saline ◽  
Bolus Dose ◽  
Pressor Response ◽  
Randomized Study ◽  
Intravenous Bolus ◽  
Hemodynamic Parameters ◽  
Randomised Study ◽  
Placebo Tablet ◽  
Group D

Background: Laryngoscopy, intubation and pneumoperitoneum during general anaesthesia are severe noxiousstimuli that can produce many adverse effects. Aim of the study was to compare the efcacy of oral pregabalin versus intravenous bolus dose of dexmedetomidine as premedication for attenuating the haemodynamic pressor response during intubation, pneumoperitonization and extubation as well as perioperative stability and requirement of postoperative analgesics. Methods: A Randomised study was conducted in 100 patients undergoing Laparoscopic Cholecystectomy. Participants were divided into two groups in which group P (n=50) received oral pregabalin 150mg with sips of water 1 hour prior to surgery and intravenous normal saline (0.9%) 10ml, 10 mins prior to induction over 10 minutes and those in group D (n=50) received oral placebo tablet with sips of water 1 hour prior to surgery and intravenous dexmedetomidine at 1mcg/kg diluted with normal saline (total volume 10ml), 10 minutes prior to induction over 10 minutes. Hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SPO2) and ETCO2 were noted before premedication and induction (baseline), at the end of induction and at laryngoscopy and intubation (I0) and then at 1,3,5,10 minutes after intubation as well as atstart of pneumoperitoneum and then after every 10 minutesinterval till the deation of CO2 and also at the time of extubation and 10 minutes thereafte

Increased blood pressure and water intake in transgenic mice expressing rat tonin in the brain

2010 ◽  
Vol 391 (4) ◽  
Author(s):  
Cibele C. Cardoso ◽  
Natalia Alenina ◽  
Anderson J. Ferreira ◽  
Fatimunnisa Qadri ◽  
Mércia P. Lima ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Angiotensin Ii ◽  
Transgenic Mice ◽  
Cardiovascular System ◽  
Water Intake ◽  
Pressor Response ◽  
Alternative Pathway ◽  
Serine Proteinase ◽  
Nervous Control ◽  
The Brain

Abstract Tonin is a serine proteinase of the kallikrein family that can produce angiotensin II directly from angiotensinogen. To clarify the importance of this enzyme for central nervous control of the cardiovascular system, we generated transgenic mice, TGM(rTon), that express rat tonin in astrocytes. These mice present high levels of tonin mRNA and activity specifically in the brain. As a consequence, TGM(rTon) develop increased blood pressure and water intake. Lisinopril, an ACE inhibitor, is less hypotensive for transgenic mice than for control animals. The AT1 receptor antagonist candesartan equally lowers blood pressure in transgenic and in control mice. Plasma angiotensin II, but not angiotensin I, is increased in TGM(rTon) compared to the wild type, suggesting release of the peptide from the brain into the circulation. However, AT1 receptors are desensitized in this transgenic model, as demonstrated by a blunted pressor response to intravenous application of angiotensin II. In conclusion, tonin in the brain may represent an alternative pathway for angiotensin II generation with effects on the cardiovascular system.

scholarly journals Effects of Dexmedetomidine on Intraoperative Hemodynamics, Recovery Profile and Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Qin Ye ◽  
Fangjun Wang ◽  
Hongchun Xu ◽  
Le Wu ◽  
Xiaopei Gao
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Systolic Blood Pressure ◽  
Analogue Scale ◽  
Hemodynamic Stability ◽  
Scale Scores ◽  
Respiratory Recovery

Abstract Background: To investigate the optimal dose of dexmedetomidine to maintain hemodynamic stability, prevent of cough and minimize postoperative pain for patients undergoing laparoscopic cholecystectomy.Methods: 120 patients were randomly divided into D1, D2, D3 and NS groups, and dexmedetomidine 0.4, 0.6, 0.8ug/kg and normal saline were administrated respectively. Patients' heart rate, systolic blood pressure and diastolic blood pressure were measured at T1-T7. The incidence of cough was recorded. Other parameters were noted, the time of spontaneous respiratory recovery and extubation, visual analogue scale scores and dosage of tramadol.Results: The heart rate, systolic blood pressure and diastolic blood pressure of D2 and D3 groups has smaller fluctuations at T2-3 and T7 compared with NS and D1 groups (P < 0.05). The incidence of cough was lower in D2 and D3 groups than NS group (P < 0.05). The visual analogue scale scores and tramadol dosage of D2 and D3 groups were lower than NS group (P < 0.05). The time of spontaneous respiratory recovery and extubation in D3 group was longer than that in D1 and D2 groups (P < 0.05). Conclusions: Intravenous infusion of 0.6ug/kg dexmedetomidine before induction can maintain hemodynamic stability, decrease cough during emergence, relieve postoperative pain of patients undergoing laparoscopic cholecystectomy.Trial registration: ChiCTR1900024801, registered at the Chinese Clinical Trial Registry, principal investigator: Qin Ye, date of registration: July 28, 2019.

scholarly journals “EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMICS IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY”

2021 ◽  
pp. 1-2
Author(s):  
D.V.Rama Siva Naik ◽  
J.Sudheer Kumar
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Normal Saline ◽  
Surgical Stress ◽  
Saline Group ◽  
Normal Saline Group ◽  
Sympathetic Response ◽  
Adrenoceptor Agonist ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group D

The physiological response to surgical stress and anaesthesia is well documented. Laparoscopic surgery which involves insufflation with carbon dioxideproduces undesirable responses like hypertension, tachycardia and dysrhythmias. Introduction of Dexmedetomidine which is highly specific and selectiveα2 adrenoceptor agonist has been tried in various studies to modify the stress response to surgery and to have a pleasant anaesthetic outcome with minimal cardiovascular changes. In our present study we have taken the pharmacological advantage of Dexmedetomidine to study the various cardiovascular parameters at different periods during the laparoscopic procedure. The aim is to studythe effectiveness of Dexmedetomidineinattenuating the sympathetic response tolaryngoscopy and endotracheal intubation and in maintaining the hemodynamic stability in laparoscopic cholecystectomy. Materials & Methods: 30 ASA I and II patients of either sex, scheduled for elective Laparoscopic Cholecystectomy under General anaesthesia were randomly allocated to receive either 1mcg/kg of Dexmedetomidine in 100ml of 0.9% normal saline (Group D,n=30) or 100ml of 0.9% normal saline(Group S, n=30) 30min beforeinduction. Results: In patients who received Dexmedetomidine there was a statistically significant differencein heartrate, systolic blood pressure, diastolic blood pressure and meanarterial pressures during Laparoscopy and Intubation. Conclusion: Dexmedetomidine when given as a premedication before Laparoscopic Cholecystectomy attenuates the sympathetic response to laryngoscopy and intubation and provides stable intra operative hemodynamics.

scholarly journals Comparison of hemodynamic responses of intravenous dexmedetomidine and esmolol infusion during laparoscopic cholecystectomy

2018 ◽  
Vol 6 (4) ◽  
pp. 1429
Author(s):  
Azka Zuberi ◽  
Vaibhav Tiwary ◽  
Bhawana Rastogi ◽  
Kumkum Gupta ◽  
Abhishake Kumar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Normal Saline ◽  
Study Drug ◽  
Systemic Blood Pressure ◽  
Skin Incision ◽  
Control Group ◽  
Hemodynamic Stability ◽  
Set Up ◽  
Group B

Background: Laparoscopic cholecystectomy is one of the commonest surgery performed under general anesthesia in this set up but maintaining the hemodynamic stability is challenging in these patients. The present study was conducted to comparatively analyse the hemodynamic variations using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years, of ASA grade I or II of both gender, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized into three groups of 30 patients each. Patients of Group A received esmolol infusion (loading: 1mg/kg and maintenance: 5-15µg/kg/min), patients of Group B received dexmedetomedine infusion (loading: 0.7µg/kg and maintenance: 0.4µg/kg/hr) and Group C (control group) received normal saline infusion. Patients were monitored for changes in heart rate, ECG, systemic blood pressure and EtCO2, at baseline, at 5 min and 10 min after giving study drug bolus, after induction, intubation, skin incision and CO2 insufflation. Thereafter, these changes were recorded at 15 min intervals till the end of surgery.Results: It was observed that perioperative use of dexmedetomidine and esmolol infusions maintained better hemodynamic stability as compared to the normal saline in control group. Though the patients in esmolol group showed less fluctuations in BP and HR (as compared to control group), but, stability was better in the patients of dexmedetomidine group at all-time intervals.Conclusions: Dexmedetomidine infusion was a better option for maintaining hemodynamic stability in comparison to emolol infusion during laparoscopic surgeries.

Pressor responses and adrenomedullary catecholamine release during brain stimulation in the rat

1981 ◽  
Vol 59 (5) ◽  
pp. 485-492 ◽  
Author(s):  
Pierre Gauthier
Keyword(s):  
Blood Pressure ◽  
Electrical Stimulation ◽  
Brain Stimulation ◽  
Active Sites ◽  
Pressor Response ◽  
Secondary Phase ◽  
Plasma Catecholamine ◽  
Central Gray Matter ◽  
Central Gray ◽  
Stimulation Of

Electrical stimulation of the diencephalon and rostral mesencephalon produced a biphasic pressor response consisting of an initial sharp rise followed by a more prolonged elevation in blood pressure. Active sites from which comparable responses could be evoked were found in the ventral medial and lateral hypothalamus, in the region of the parafascicularis nucleus, and in the central gray matter and the tegmentum of the mesencephalon. Together with the biphasic pressor response brain stimulation also increased plasma catecholamine (CA) concentrations 10-fold. Either bilateral adrenalectomy or demedullation selectively abolished the secondary phase of the pressor response and greatly reduced the plasma CA response to stimulation. After chemical destruction of the terminals of the sympathetic neurones by intravenous administration of 6-hydroxydopamine (6-OHDA), the primary pressor phase was eliminated whereas the secondary phase as well as plasma CA concentration reached higher levels than in normal rats. 6-OHDA treatment combined with adrenalectomy completely abolished both pressor and CA responses. The results demonstrate that adrenomedullary mechanisms capable of increasing blood pressure significantly can be activiated by electrical stimulation of different sites in the diencephalon and mesencephalon.

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