Dexmedetomidine in premedication before laparoscopic cholecystectomy: Prospective randomised study
Authors:
Málek Jiří 1; Mareček František 1; Hess Ladislav 2; Votava Martin 3; Kurzová Alice 1; Očadlík Martin 4
Authors‘ workplace:
Klinika anesteziologie a resuscitace 3. LF UK a FNKV, Praha, 2Pracoviště experimentální medicíny IKEM, Praha, 3Ústav farmakologie 3. LF UK, Praha, 4Chirurgická klinika 3. LF UK a FNKV, Praha
1
Published in:
Anest. intenziv. Med., 21, 2010, č. 4, s. 179-184
Category:
Original Article
Overview
Objective:
Alpha-2 sympatho-mimetic drugs are used to prevent adverse peri-operative reactions. The aim of this study was to compare premedication with dexmedetomidine against other currently used agents.
Design:
Prospective, randomised, double-blinded clinical study.
Setting:
University Hospital.
Materials and methods:
After ethic committee approval and patients’ consent, premedication with atropine 0.5 mg and one of the following agents was administered in a randomised and blind fashion to the deltoid muscle 15 min before induction to anaesthesia: dexmedetomidine 1.0 µg . kg-1 + ketamine 0.5 mg . kg-1 + fentanyl 1.0 µg . kg-1 (group DexKeFNT), pethidine 1.5 mg . kg-1 (group Dolsin), dexmedetomidine 1.0 µg . kg-1 + morphine 0.05 mg . kg-1 (group DexMor) and morphine 0.05 mg . kg1 (group Morfin). Induction and maintenance of anaesthesia were standardised. Parameters of the vital functions, side-effects and time to request for the first dose of analgesics after surgery were examined and processed by Kruskal-Wallis, chi-squared and Fisher tests.
Results:
Total 61 patients scheduled for laparoscopic cholecystectomy were enrolled in the trial. Capnoperitoneum-induced hypertension and peri-operative fentanyl consumption were the most frequent in Dolsin group (68.7 %, p < 0.001 vs. all others; and 165 ± 111 μg vs. 13 ± 15 μg in DexMor, 25 ± 42 μg in Morfin and 31.5 ± 53.8 μg in DexKeFNT group, respectively). Amnesia was present in 92.9 % in DexKeFNT (p < 0.001 vs. all others) and longer postoperative analgesia was found in both the dexmedetomidine groups, p < 0.01 (DexMor 3.7 ± 1.0 h, Morfin 0.7 ± 1.1 h, Dolsin 0.9 ± 1.1 h, DexKeFNT 2.3 ± 1.0 h).
Conclusion:
The combination of dexmedetomidine, ketamine, fentanyl and atropine suppresses the adverse haemodynamic effects of the capnoperitoneum, decreases fentanyl consumption and prolongs postoperative analgesia without side-effects.
Keywords:
premedication – surgery – circulation – adrenergic drugs – dexmedetomidine – anaesthetics – ketamine – analgesics – opioids
Sources
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