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

S S Harsoor, Devika D Rani, S Lathashree, S S Nethra, K Sudheesh, S S Harsoor, Devika D Rani, S Lathashree, S S Nethra, K Sudheesh

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.

Keywords: Adrenergic alpha-2 receptor agonists; Dexmedetomidine; Sevoflurane; blood glucose; entropy; metabolic stress response.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Graph showing comparison of heart rate between the groups. Heart rate was significantly low in group D
Figure 2
Figure 2
Graph showing comparison of end tidal concentration of Sevoflurane between groups

References

    1. Jorden VS, Avery T. Dexmedetomidine: Clinical update seminars in anesthesia. Perioperotive Med Pain. 2002;21:265–74.
    1. Lee JH, Kim H, Kim HT, Kim MH, Cho K, Lim SH, et al. Comparison of Dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation. Korean J Anesthesiol. 2012;63:124–9.
    1. Günes Y, Gündüz M, Özcengiz D, Özbek H, Isik G. Dexmedetomidine–remifentanil or Propofol-remifentanil anesthesia in patients undergoing intracranial surgery. Neurosurg. 2005;15:122–6.
    1. Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, et al. Dexmedetomidine pharmacodynamics: Part I: Crossover comparison of the respiratory effects of Dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101:1066–76.
    1. O’Riain SC, Buggy DJ, Kerin MJ, Watson RW, Moriarty DC. Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg. 2005;100:244–9.
    1. Singh M. Stress response and anesthesia altering the peri and post-operative management. Indian J Anaesth. 2003;47:427–34.
    1. Loke J, Shearer WA. Cost of anaesthesia. Can J Anaesth. 1993;40:472–4.
    1. Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011;27:297–302.
    1. Yu SB. Dexmedetomidine sedation in ICU. Korean J Anesthesiol. 2012;62:405–11.
    1. Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY, et al. Monitored anesthesia care with Dexmedetomidine: A prospective, randomized, double-blind, multicenter trial. Anesth Analg. 2010;110:47–56.
    1. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–17.
    1. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010;24:84–9.
    1. Marana E, Russo A, Colicci S, Polidori L, Bevilacqua F, Viviani D, et al. Desflurane versus Sevoflurane: A comparison on stress response. Minerva Anestesiol. 2013;79:7–14.
    1. Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative Fentanyl. Br J Anaesth. 1992;68:126–31.
    1. Feng C, Qi SH, Zou YM, Ma XS, Gao DP, Han BQ. [Effects of Dexmedetomidine combined with Fentanyl in patients undergoing anesthesia induction by Sevoflurane.] [Article in Chinese. ]Zhonghua Yi Xue Za Zhi. 2012;92:1889–91.
    1. Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of Dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis. Indian J Anaesth. 2012;56:542–6.
    1. Liu Z, Lu H, He G, Ma H, Wang J. Non-steroidal anti-inflammatory drugs reduce the stress response during Sevoflurane anesthesia. Acta Anaesthesiol Scand. 2012;56:890–5.
    1. Yacout AG, Osman HA, Abdel-Daem MH, Hammouda SA, Elsawy MM. Effect of intravenous Dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery. Alexandria J Med. 2012;48:3–8.
    1. Aho AJ, Lyytikäinen LP, Yli-Hankala A, Kamata K, Jäntti V. Explaining entropy responses after a noxious stimulus, with or without neuromuscular blocking agents, by means of the raw electroencephalographic and electromyographic characteristics. Br J Anaesth. 2011;106:69–76.
    1. Kawaguchi M, Takamatsu I, Kazama T. Rocuronium dose-dependently suppresses the spectral entropy response to tracheal intubation during Propofol anaesthesia. Br J Anaesth. 2009;102:667–72.
    1. Raid W, Schreiber M, Saeed AB. Monitoring with EEG entropy decreases Propofol requirement and maintains cardiovascular stability during induction of anaesthesia in elderly patients. Eur J Anaesthesiol. 2007;24:684–8.
    1. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology. 1997;87:842–8.
    1. Magalhães E, Govêia CS, Ladeira LC, Espíndola BV. Relationship between Dexmedetomidine continuous infusion and end-tidal Sevoflurane concentration, monitored by bispectral analysis. [Article in Portuguese. ] Rev Bras Anestesiol. 2004;54:303–10.
    1. Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55:352–7.
    1. Uyar AS, Yagmurdur H, Fidan Y, Topkaya C, Basar H. Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy. J Neurosurg Anesthesiol. 2008;20:174–9.
    1. Dilek O, Yasemin G, Atci M. Preliminary experience with Dexmedetomidine in neonatal anesthesia. J Anaesthesiol Clin Pharmacol. 2011;27:17–22.
    1. Fragen RJ, Fitzgerald PC. Effect of Dexmedetomidine on the minimum alveolar concentration (MAC) of Sevoflurane in adults age 55 to 70 years. J Clin Anesth. 1999;11:466–70.
    1. Orhon ZN, Devrim S, Celik M, Dogan Y, Yildirim A, Basok EK. Comparison of recovery profiles of Propofol and Sevoflurane anesthesia with bispectral index monitoring in percutaneous nephrolithotomy. Korean J Anesthesiol. 2013;64:223–8.
    1. Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of Dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur J Anaesthesiol. 2008;25:816–20.
    1. Aksu R, Akin A, Biçer C, Esmaoğlu A, Tosun Z, Boyaci A. Comparison of the effects of Dexmedetomidine versus Fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A double-blind, randomized, controlled study. Curr Ther Res. 2009;70:209–20.

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