Anesth Pain Med.  2018 Apr;13(2):158-164. 10.17085/apm.2018.13.2.158.

Blunting effect of dexmedetomidine on transient cardiovascular changes induced by inhalation of desflurane: a randomized controlled trial

• Jang MS
• Han JH
• Park SJ
• Oh ID
• Ahn SE
• Choi JH

• KMID: 2437422
• DOI: http://doi.org/10.17085/apm.2018.13.2.158

Abstract

BACKGROUND
A rapid increase in desflurane concentration has been demonstrated to induce transient sympathetic hyperactivity and lead to increases in blood pressure and heart rate (HR). Additionally, the use of dexmedetomidine as an anesthetic adjunct has been reported to attenuate intraoperative sympathetic responses. We examined the hemodynamic effects of dexmedetomidine infusion before anesthetic induction on desflurane-induced cardiovascular changes.
METHODS
Patients were randomly divided into three groups. They received either normal saline (NS) (group 1, only NS) or dexmedetomidine solution diluted in 50 ml NS (group 2, 0.5 µg/kg; group 3, 1.0 µg/kg) for 10 minutes with a syringe pump before anesthetic induction. Desflurane was administered at a vaporizer dial setting of 8% for 5 minutes by manual ventilation.
RESULTS
In group 1, the HR significantly increased above the baseline during the entire 5 minutes after desflurane inhalation and the mean blood pressure (MBP) significantly increased above the baseline at 1, 2, and 3 minutes after desflurane inhalation. However, in groups 2 and 3, the increases in HR and MBP induced by desflurane inhalation were significantly suppressed. The HR and MBP in group 2 remained closer to the baseline than in group 3.
CONCLUSIONS
A loading infusion of dexmedetomidine for 10 minutes before induction of general anesthesia effectively attenuates the transient cardiovascular stimulation induced by desflurane inhalation, without significant hemodynamic side effects. The HR and MBP remained closer to the baseline after administration of 0.5 µg/kg dexmedetomidine than after administration of a dose of 1.0 µg/kg.

Keyword

Desflurane; Dexmedetomidine; Hemodynamics

MeSH Terms

Anesthesia, General
Blood Pressure
Dexmedetomidine*
Heart Rate
Hemodynamics
Humans
Inhalation*
Nebulizers and Vaporizers
Syringes
Ventilation
Dexmedetomidine

Figure

• 

  Fig. 1 CONSORT flow chart presenting the study protocol. CONSORT: consolidated standards of reporting trials, ASA PS: American Society of Anesthesiologists physical status, Hct: hematocrit, SBP: systolic blood pressure, HR: heart rate, DM: diabetes mellitus, IV: intravenous.

• 

  Fig. 2 (A) Changes in MBP observed in the three groups during the study period. (B) Changes in HR observed in the three groups during the study period. Group 1: IV normal saline loading for 10 minutes prior to induction. Group 2: 0.5 hhhhhhhhg/kg IV dexmedetomidine loading for 10 minutes prior to induction. Group 3: 1.0 nnnnnnnng/kg IV dexmedetomidine loading for 10 minutes prior to induction. 5 min: 5 minutes after initiating drug infusion. 10 min: 10 minutes after initiating drug infusion. Des 1–5 min: 1–5 minutes after desflurane inhalation. MBP: mean blood pressure, HR: heart rate, IV: intravenous. *P < 0.05, significant difference between groups 1 and 3. †P < 0.05, significant difference between groups 1 and 2.

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