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Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia.

Harsoor SS, Rani DD, Lathashree S, Nethra SS, Sudheesh K - J Anaesthesiol Clin Pharmacol (2014)

Bottom Line: In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo.Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P.IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.

ABSTRACT

Background: Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for abdominal surgeries on blood glucose levels and on Sevoflurane requirements during anesthesia.

Materials and methods: Forty patients scheduled for abdominal surgery under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 20 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable.

Results: During the first postoperative hour, Dexmedetomidine group showed blood glucose levels of 118.2 ± 16.24 mg/dL, compared to placebo group which was 136.95 ± 19.76 mg/dL and it was statistically significant (P < 0.01). Mean hourly Sevoflurane requirement in Group D was 11.10 ± 2.17 mL, compared to 15.45 ± 3.97 mL in placebo group. In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P.

Conclusion: IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.

No MeSH data available.


Related in: MedlinePlus

Graph showing comparison of end tidal concentration of Sevoflurane between groups
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Figure 2: Graph showing comparison of end tidal concentration of Sevoflurane between groups

Mentions: End-tidal Sevoflurane concentration was significantly reduced in both the groups during entropy guided anesthesia. It was 1.78 ± 0.90 at induction and 1.13 ± 0.37 at 60th min (P = 0.005) indicating 36% reduction, but in group D it was 1.68 ± 0.54 and 0.74 ± 0.42, respectively (P < 0.001), suggesting a 56% decrease in Et Sevoflurane concentration [Figure 2]. There was statistically significant 28% reduction in the Sevoflurane requirement in the 1st h of anesthesia, as suggested by 11.10 ± 2.17 mL in group D compared to 15.45 ± 3.97 mL in group P (P < 0.001). While it was 10.58 ± 3.4 mL in 2nd h and 7.00 ± 2.33 mL in 3rd h in group P compared to 8.13 ± 2.75 mL and 8.14 ± 1.35 mL group D (P = 0.02 for 2nd h, P = 0.06 for 3rd h), respectively [Table 4]. The time from turning off of Sevoflurane to tracheal extubation was considered as time for extubation and it was 5.4 ± 1.35 min. in group P, compared to 5.5 ± 1.82 min in group D. Ramsay sedation score was significantly higher at 2.6 ± 0.75 in patients treated with Dexmedetomidine, while it was 1.25 ± 0.44 in placebo group (P < 0.001) indicating arousable sedation. Pain assessed by visual analog scale at first hour of postoperative period was 2.05 ± 0.69 in group D, which was significantly lower against 3.65 ± 0.49 in group P (P < 0.001) [Table 5]. In group P, 13 patients and 1 patient in group D required epidural analgesia at end of 1 h postoperatively. Remaining 7 patients in group P and 19 patients in group D received epidural analgesia by the end of 2 h.


Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia.

Harsoor SS, Rani DD, Lathashree S, Nethra SS, Sudheesh K - J Anaesthesiol Clin Pharmacol (2014)

Graph showing comparison of end tidal concentration of Sevoflurane between groups
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927287&req=5

Figure 2: Graph showing comparison of end tidal concentration of Sevoflurane between groups
Mentions: End-tidal Sevoflurane concentration was significantly reduced in both the groups during entropy guided anesthesia. It was 1.78 ± 0.90 at induction and 1.13 ± 0.37 at 60th min (P = 0.005) indicating 36% reduction, but in group D it was 1.68 ± 0.54 and 0.74 ± 0.42, respectively (P < 0.001), suggesting a 56% decrease in Et Sevoflurane concentration [Figure 2]. There was statistically significant 28% reduction in the Sevoflurane requirement in the 1st h of anesthesia, as suggested by 11.10 ± 2.17 mL in group D compared to 15.45 ± 3.97 mL in group P (P < 0.001). While it was 10.58 ± 3.4 mL in 2nd h and 7.00 ± 2.33 mL in 3rd h in group P compared to 8.13 ± 2.75 mL and 8.14 ± 1.35 mL group D (P = 0.02 for 2nd h, P = 0.06 for 3rd h), respectively [Table 4]. The time from turning off of Sevoflurane to tracheal extubation was considered as time for extubation and it was 5.4 ± 1.35 min. in group P, compared to 5.5 ± 1.82 min in group D. Ramsay sedation score was significantly higher at 2.6 ± 0.75 in patients treated with Dexmedetomidine, while it was 1.25 ± 0.44 in placebo group (P < 0.001) indicating arousable sedation. Pain assessed by visual analog scale at first hour of postoperative period was 2.05 ± 0.69 in group D, which was significantly lower against 3.65 ± 0.49 in group P (P < 0.001) [Table 5]. In group P, 13 patients and 1 patient in group D required epidural analgesia at end of 1 h postoperatively. Remaining 7 patients in group P and 19 patients in group D received epidural analgesia by the end of 2 h.

Bottom Line: In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo.Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P.IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.

ABSTRACT

Background: Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for abdominal surgeries on blood glucose levels and on Sevoflurane requirements during anesthesia.

Materials and methods: Forty patients scheduled for abdominal surgery under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 20 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable.

Results: During the first postoperative hour, Dexmedetomidine group showed blood glucose levels of 118.2 ± 16.24 mg/dL, compared to placebo group which was 136.95 ± 19.76 mg/dL and it was statistically significant (P < 0.01). Mean hourly Sevoflurane requirement in Group D was 11.10 ± 2.17 mL, compared to 15.45 ± 3.97 mL in placebo group. In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P.

Conclusion: IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.

No MeSH data available.


Related in: MedlinePlus