Application of Dexmedetomidine Combined with Etomidate for Elderly Patient Undergoing thyroidectomy_West China Medical Journal

Authors：

 SHIJin-lin ¹ ,  GANJian-hui ² , AOLi ³

1. Department of Graduate School, Hebei United University, Tangshan, Hebei 063000, P. R. China;
2. Department of Anesthesia, the Affiliated Tangshan People's Hospital, Hebei United University, Tangshan, Hebei 063000, P. R. China;
Department of Anesthesia, Tangshan Maternal & Child Care Hospital, Hebei 063000, P. R. China;

Corresponding?author：

GANJian-hui, Email: gjh71@163.com

Keywords：

Dexmedetomidine; Etomidate; Thyroidectomy; Sedation

DOI：

10.7507/1002-0179.20140215

Video：

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Objective To observe the effect of dexmedetomidine combined with etomidate on the clinical safety and the tracheal extubation response after general anesthesⅠa in elderly patient undergoing thyroidectomy. Methods Fifty patients (aged between 65 and 75 years, ASAⅠor Ⅱ) scheduled for thyroid surgery between July 2012 and January 2013 were randomly divided into two groups:dexmedetomidine group (group D) and control group (group C) with 25 patients in each group. Group D received dexmedetomidine of 0.5 μg/(kg·h) through intravenous infusion after anesthesia induction, and the intravenous infusion was stopped five minutes before the end of surgery. Normal saline was infused at the same volume in group C at the same time. Patients were induced with etomidate at 0.2 mg/kg for anesthesia, and etomidate and remifentanil were used for the anesthesia maintenance during the operation. Heart rate (HR), systolic blood pressure SBP), diastolic blood pressure (DBP) and bispectral index (BIS) were recorded 5 (T₁), 15 (T₂) and 30 (T₃) minutes after the beginning of the operation, and 15 (T₄) and 5 (T₅) minutes before the end of the operation. Moreover, the time of eye opening, time of extubation, the number of patients with restlessness and etomidate requirement were recorded. Results Compared with group C, HR and MAP at the time points of T₂ and T₅ in group D did not obviously change, but the number of restlessness patients in group D was significantly less than in group C (P<0.05). There was no statistically significant difference in time of eye opening and time of extubation between the two groups (P>0.05). Etomidate requirement in group D was[(8.6±2.1) μg/(kg·min)], which was significantly lower than that in group C[(14.4±3.4) μg/(kg·min)] (P<0.05). Conclusion Dexmedetomidine combined with etomidate is efficient and safe for elderly patients undergoing thyroidectomy, and this method can effectively reduce cardiovascular responses to tracheal extubation, decrease the incidence of postoperative restlessness, and reduce the requirement of etomidate during the operation.

Citation： SHIJin-lin, GANJian-hui, AOLi. Application of Dexmedetomidine Combined with Etomidate for Elderly Patient Undergoing thyroidectomy. West China Medical Journal, 2014, 29(4): 721-724. doi: 10.7507/1002-0179.20140215 Copy

1.	Sarkar M, Laussen PC, Zurakowski D, et al. Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients[J]. Anesth Analg, 2005, 101(3):645-650.
2.	Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years[J]. J Clin Anesth, 1999, 11(6):466-470.
3.	Lin TF, Yeh Y, Lin FS, et a1. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia[J]. Br J Anaesth, 2009, 102(1):117-122.
4.	V?lzke H, Lüdemann J, Robinson DM, et a1. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area[J]. Thyroid, 2003, 13(8):803-810.
5.	甘建輝, 史金麟, 胡萬寧, 等. 右美托咪定在乳腺癌前哨淋巴結活檢術中的臨床應用[J]. 中國藥房, 2013, 24(10):921-922.
6.	閆懷軍, 李巖. 依托咪酯對心血管系統功能的影響[J]. 中國藥物與臨床, 2010, 10(11):1255-1258.
7.	Walls RM, Murphy MF. Clinical controversies:etomidate as an induction agent for endotracheal intubation in patients with sepsis:continue to use etomidate for intubation of patients with septic shock[J]. Ann Emerg Med, 2008, 52(1):13-14.
8.	莊心良, 曾因明, 陳伯鑾. 現代麻醉學[M]. 3版. 北京:人民衛生出版社, 2003:487-492.
9.	Bhana N, Goa KL, Mcclellan KJ. Dexmedetomidine[J]. Drugs, 2000, 59(2):263-268.
10.	Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients:the MENDS randomized controlled trial[J]. JAMA, 2007, 298(22):2644-2653.
11.	Turgut N, Turkmen A, G?kkaya S, et al. Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy[J]. Minerva Anestesiol, 2008, 74(9):469-474.
12.	Tufanogullari B, White PF, Peixoto MP, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery:the effect on recovery outcome variables[J]. Anesth Analg, 2008, 106(6):1741-1748.
13.	Ayoglu H, Yapakci O, Ugur MB, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations[J]. J Clin Anesth, 2008, 20(6):437-441.
14.	方寧寧, 侯躍東, 于金貴. 不同劑量右美托咪啶對甲狀腺手術患者全身麻醉拔管期心血管反應的影響[J]. 山東醫藥, 2012, 52(38):58-60.

1. Sarkar M, Laussen PC, Zurakowski D, et al. Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients[J]. Anesth Analg, 2005, 101(3):645-650.
2. Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years[J]. J Clin Anesth, 1999, 11(6):466-470.
3. Lin TF, Yeh Y, Lin FS, et a1. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia[J]. Br J Anaesth, 2009, 102(1):117-122.
4. V?lzke H, Lüdemann J, Robinson DM, et a1. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area[J]. Thyroid, 2003, 13(8):803-810.
5. 甘建輝, 史金麟, 胡萬寧, 等. 右美托咪定在乳腺癌前哨淋巴結活檢術中的臨床應用[J]. 中國藥房, 2013, 24(10):921-922.
6. 閆懷軍, 李巖. 依托咪酯對心血管系統功能的影響[J]. 中國藥物與臨床, 2010, 10(11):1255-1258.
7. Walls RM, Murphy MF. Clinical controversies:etomidate as an induction agent for endotracheal intubation in patients with sepsis:continue to use etomidate for intubation of patients with septic shock[J]. Ann Emerg Med, 2008, 52(1):13-14.
8. 莊心良, 曾因明, 陳伯鑾. 現代麻醉學[M]. 3版. 北京:人民衛生出版社, 2003:487-492.
9. Bhana N, Goa KL, Mcclellan KJ. Dexmedetomidine[J]. Drugs, 2000, 59(2):263-268.
10. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients:the MENDS randomized controlled trial[J]. JAMA, 2007, 298(22):2644-2653.
11. Turgut N, Turkmen A, G?kkaya S, et al. Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy[J]. Minerva Anestesiol, 2008, 74(9):469-474.
12. Tufanogullari B, White PF, Peixoto MP, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery:the effect on recovery outcome variables[J]. Anesth Analg, 2008, 106(6):1741-1748.
13. Ayoglu H, Yapakci O, Ugur MB, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations[J]. J Clin Anesth, 2008, 20(6):437-441.
14. 方寧寧, 侯躍東, 于金貴. 不同劑量右美托咪啶對甲狀腺手術患者全身麻醉拔管期心血管反應的影響[J]. 山東醫藥, 2012, 52(38):58-60.

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Application of Dexmedetomidine Combined with Etomidate for Elderly Patient Undergoing thyroidectomy

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