Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care

R M Venn, J Hell, R M Grounds, R M Venn, J Hell, R M Grounds

Abstract

STATEMENT OF FINDINGS: The respiratory effects of dexmedetomidine were retrospectively examined in 33 postsurgical patients involved in a randomised, placebo-controlled trial after extubation in the intensive care unit (ICU). Morphine requirements were reduced by over 50% in patients receiving dexmedetomidine. There were no differences in respiratory rates, oxygen saturations, arterial pH and arterial partial carbon dioxide tension (PaCO2) between the groups. Interestingly the arterial partial oxygen tension (PaO2) : fractional inspired oxygen (FIO2) ratios were statistically significantly higher in the dexmedetomidine group. Dexmedetomidine provides important postsurgical analgesia and appears to have no clinically important adverse effects on respiration in the surgical patient who requires intensive care.

Figures

Figure 1
Figure 1
Respiratory rate for the 6-h periods before and after extubation. (Filled circle) Dexmedetomidine; (Empty circle) placebo. Values are expressed as mean ± standard deviation.
Figure 2
Figure 2
PaCO2 (PCO2) for the 6-h periods before and after extubation, and baseline values (B) on admission to ICU immediately after surgery. (Filled circle) Dexmedetomidine; (Empty circle) placebo. Values are expressed as mean ± standard deviation.
Figure 3
Figure 3
PaO2 : FIO2 ratio for the 6-h periods before and after extubation, and baseline values (B) on admission to ICU immediately after surgery. (Filled circle) Dexmedetomidine; (Empty circle) placebo. Values are expressed as mean ± standard deviation.
Figure 4
Figure 4
Requirements for rescue analgesia with morphine during the extubation period for patients receiving dexmedetomidine and placebo. Values are medians; boxes indicate 25-75th percentiles and bars indicate the range.
Figure 5
Figure 5
Oxygen saturation measured by pulse oximetry for the 6-h periods before and after extubation. (Filled circle) Dexmedetomidine; (Empty circle) placebo. Values are expressed as mean ± standard deviation.
Figure 6
Figure 6
Arterial pH for the 6 hour periods before and after extubation, and baseline values (B) on admission to ICU immediately after surgery. (Filled circle) Dexmedetomidine; (Empty circle) placebo. Values are expressed as mean ± standard deviation.

References

    1. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, Willatts SM, Grounds RM. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136–1142.
    1. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. . Anesthesiology. 1992;77:1125–1133.
    1. Jaakola ML, Ali-Melkkila T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. . Br J Anaesth. 1992;68:570–575.
    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;68:126–131.
    1. Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. . Anesthesiology. 1991;74:997–1002.
    1. Aantaa R, Jaakola ML, Kallio A, Kanto J, Scheinin M, Vuorinen J. A comparison of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynaecological surgery. . Br J Anaesth. 1991;67:402–409.
    1. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–659.
    1. Maxwell GM. The effects of 2-(2,6-dichlorphenylamine)-2-imidazoline hydrochloride (Catapres) upon the systemic and coronary haemodynamics and metabolism of intact dogs. . Arch Int Pharmacodyn Ther. 1969;181:7–14.
    1. Ooi R, Pattison J, Feldman SA. The effects of intravenous clonidine on ventilation. Anaesthesia. 1991;46:632–633.
    1. Celly CS, McDonnell WN, Black WD. Cardiopulmonary effects of the alpha-2 adrenoceptor agonists medetomidine and ST-91 in anesthetized sheep. . J Pharmacol Exp Ther. 1999;289:712–720.
    1. Bacon PJ, Jones JG, Taylor P, Stewart S, Wilson-Nunn D, Kerr M. Impairment of gas exchange due to alveolar oedema during xylazine sedation in sheep; absence of a free radical mediated inflammatory mechanism. Res Vet Sci. 1998;65:71–75.
    1. Bloor BC, Abdul-Rasool I, Temp J, Jenkins S, Valcke C, Ward DS. The effects of medetomidine, an alpha 2-adrenergic agonist, on ventilatory drive in the dog. Acta Vet Scand Suppl. 1989;85:65–70.
    1. Conti J, Smith D. Haemodynamic responses to extubation after cardiac surgery with and without continued sedation. . Br J Anaesth. 1998;80:834–836.
    1. Furst SR, Weinger MB. Dexmedetomidine, a selective alpha 2-agonist, does not potentiate the cardiorespiratory depression of alfentanil in the rat. Anesthesiology. 1990;72:882–888.
    1. Jarvis DA, Duncan SR, Segal IS, Maze M. Ventilatory effects of clonidine alone and in the presence of alfentanil, in human volunteers. Anesthesiology. 1992;76:899–905.
    1. Khan Z, Ferguson C, Jones R. Alpha-2 and imidazoline receptor agonists: their pharmacology and therapeutic role. Anaesthesia. 1999;54:146–165.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться