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Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Sezen G, Demiraran Y, Seker IS, Karagoz I, Iskender A, Ankarali H, Ersoy O, Ozlu O - BMC Anesthesiol (2014)

Bottom Line: Quantitative clinical and demographic characteristics were compared using One Way ANOVA.The values were compared using One-way Analysis of Variance.The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Reanimation, Duzce University Faculty of Medicine, Duzce, Turkey.

ABSTRACT

Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.

Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg(-1), and midazolam was administered at a concentration of 0.025 μg.kg(-1) via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T(beginning), T(preop5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation), T(extubation 5 min)). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.

Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T(preop 5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min) and T(initial surgery). MBP was significantly different in the hypertensive groups at T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation) and T(extubation 5 min). The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.

Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.

Trial registration: Clinicaltrials.gov identifier: NCT02058485.

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Related in: MedlinePlus

Hemodynamic means of groups.
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Fig2: Hemodynamic means of groups.

Mentions: SBP was significantly different between the normotensive and hypertensive groups at the following time points: premedication 5th min (Tpreop 5 min,P < 0.001), premedication 10th min (Tpreop 10 min, P = 0.002), induction (Tinduction, P < 0.001), intubation 1st min (Tintubation, P < 0.001), intubation 5th min (Tintubation5 min, P < 0.001) and initial surgery (Tinitial surgery, P < 0.001). The mean values of SBP at Tpreop 5 min, Tpreop 10 min and Tinduction were significantly reduced in the hypertensive groups. In particular, a marked reduction was noted in Group HM after induction. The mean values of SBP at Tintubation, Tintubation 5 min and Tinitial surgery were significantly increased in the normotensive groups, particularly in Group NM. There were significant differences at 15 min of surgery (Tsurgery 15 min) and 30 min of surgery (Tsurgery 30 min) between the normotensive and hypertensive groups, but no significance between the hypertensive groups. Nevertheless, there were significant differences at 1 min after extubation (Textubation) and 5 min after extubation (Textubation 5 min) between Groups HD and HM. (Textubation,P = 0.018 and Textubation 5 min,P < 0.001). Considering the averages, a minimum increase was observed in Group HD (Figure 2).Figure 2


Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Sezen G, Demiraran Y, Seker IS, Karagoz I, Iskender A, Ankarali H, Ersoy O, Ozlu O - BMC Anesthesiol (2014)

Hemodynamic means of groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279802&req=5

Fig2: Hemodynamic means of groups.
Mentions: SBP was significantly different between the normotensive and hypertensive groups at the following time points: premedication 5th min (Tpreop 5 min,P < 0.001), premedication 10th min (Tpreop 10 min, P = 0.002), induction (Tinduction, P < 0.001), intubation 1st min (Tintubation, P < 0.001), intubation 5th min (Tintubation5 min, P < 0.001) and initial surgery (Tinitial surgery, P < 0.001). The mean values of SBP at Tpreop 5 min, Tpreop 10 min and Tinduction were significantly reduced in the hypertensive groups. In particular, a marked reduction was noted in Group HM after induction. The mean values of SBP at Tintubation, Tintubation 5 min and Tinitial surgery were significantly increased in the normotensive groups, particularly in Group NM. There were significant differences at 15 min of surgery (Tsurgery 15 min) and 30 min of surgery (Tsurgery 30 min) between the normotensive and hypertensive groups, but no significance between the hypertensive groups. Nevertheless, there were significant differences at 1 min after extubation (Textubation) and 5 min after extubation (Textubation 5 min) between Groups HD and HM. (Textubation,P = 0.018 and Textubation 5 min,P < 0.001). Considering the averages, a minimum increase was observed in Group HD (Figure 2).Figure 2

Bottom Line: Quantitative clinical and demographic characteristics were compared using One Way ANOVA.The values were compared using One-way Analysis of Variance.The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Reanimation, Duzce University Faculty of Medicine, Duzce, Turkey.

ABSTRACT

Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.

Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg(-1), and midazolam was administered at a concentration of 0.025 μg.kg(-1) via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T(beginning), T(preop5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation), T(extubation 5 min)). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.

Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T(preop 5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min) and T(initial surgery). MBP was significantly different in the hypertensive groups at T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation) and T(extubation 5 min). The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.

Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.

Trial registration: Clinicaltrials.gov identifier: NCT02058485.

Show MeSH
Related in: MedlinePlus