Effect of Different Doses of Dexmedetomidine on Hemodynamics during Endotracheal Extubation of Laparoscopic Cholecystectomy in Patients with Hypertension_West China Medical Journal

Authors：

 WANGXin-yuan ¹ ,  GANJian-hui ¹ , YUHong ¹ , QIANBao-min ² , ZHENGZhi-wen ¹ , WANXiang-xue ¹

1. Department of Anesthesia, Tangshan People's Hospital Affiliated to Hebei Union University, Tangshan, Heibei 063000, P. R. China;
2. Department of Anesthesia, Central Hopsital of Tangshang, Tangshan, Hebei 063000, P. R. China;

Corresponding?author：

GANJian-hui, Email: gjh71@163.com

Keywords：

Dexrnedetomidine; Hypertension; Laproscopic cholecystectomy; Tracheal extubation; Cardiovascular response

DOI：

10.7507/1002-0179.20150584

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Objective To evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. Methods A total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D₁), moderate-dose dexmedetomidine hydrochloride injection group (group D₂), and high-dose dexmedetomidine hydrochloride injection group (group D₃). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D₁, D₂, and D₃ respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T₁), immediately after administration (T₂), extubation after administration (T₃), one minute after extubation (T₄), and 5 minutes after extubation (T₅). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. Results Compared at with, MAP and HR increased significantly at the times points of T₃, T₄, T₅ compared with T₁ and T₂ in Group C and group D₁ (P<0.05), while the correspondent difference was not statistically significant in group D₂ and D₃ (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T₃, T₄, T₅ in group D₁ (P>0.05). However, MAP and HR decrease at times points of T₃, T₄, T₅ in group D₂ and D₃ were significantly different from group C and D₁ (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D₃, but there were no cases of dysphoria, nausea or shiver in group D₁, D₂, D₃. Conclusion Intravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.

Citation： WANGXin-yuan, GANJian-hui, YUHong, QIANBao-min, ZHENGZhi-wen, WANXiang-xue. Effect of Different Doses of Dexmedetomidine on Hemodynamics during Endotracheal Extubation of Laparoscopic Cholecystectomy in Patients with Hypertension. West China Medical Journal, 2015, 30(11): 2059-2062. doi: 10.7507/1002-0179.20150584 Copy

1.	Schlichter RA. Dexmedetomidine is an excellent agent for sedation status-post lung transplant[J]. J Clin Anesth, 2010, 22(1):1-2.
2.	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.
3.	宋玉美, 蔣紅, 張瀾. 高血壓患者應激反應特點及應對方式[J]. 中國健康心理學雜志, 2012, 20(11):1641-1643.
4.	匡佳偉, 吳多志. 單用瑞芬太尼與芬太尼、瑞芬太尼復合應用對全麻蘇醒拔管期心血管反應的影響[J]. 海南醫學, 2009, 7(9):24-25, 23.
5.	陳永亮, 肖水平, 曹濟宏, 等. 腹腔鏡下膽囊切除氣腹對呼吸和循環的影響[J]. 中國實用醫藥, 2010, 13(2):68-69.
6.	Hamer M, Steptoe A. Cortisol responses to mental stress and incident hypertension in healthy men and women[J]. J Clin Endocrinol Metab, 2012, 97(1):E29-E34.
7.	Dexheimer Neto FL, Vesz PS, Cremonese RV, et al. Out-of-bed extubation:a feasibility study[J]. Rev Bras Ter Intensiva, 2014, 26(3):263-268.
8.	仇琳, 嚴偉民, 姜虹. 右美托咪定用于困難氣道患者蘇醒期拔管時的鎮靜效果[J]. 中國口腔頜面外科雜志, 2011, 9(1):51-55.
9.	Menda F, K?ner O, Sayin M, et al. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG[J]. Ann Card Anaesth, 2010, 13(1):16-21.
10.	Kubota T, Fukasawa T, Kitamura E, et al. Epileptic seizures induced by dexmedetomidine in a neonate[J]. Brain Dev, 2013, 35(4):360-362.
11.	冀翔宇, 王世端, 張麗娜, 等. 不同劑量右美托咪定對上腹部手術患者七氟烷最低肺泡有效濃度影響[J]. 中國新藥與臨床雜志, 2011, 30(11):868-872.
12.	Kothari D, Tandon N, Singh M, et al. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions:dexmedetomidine versus lignocaine[J]. Anesth Essay Res, 2015, 8(1):78-82.
13.	Gupta S, Singh D, Sood D, et al. Role of dexmedetomidine in early extubation of the intensive care unit patients[J]. J Anaesthesiol Clin Pharmacol, 2015, 31(1):92-98.
14.	李辛潔, 甘建輝, 葉玉軍, 等. 右美托咪定對老年高血壓患者全身麻醉拔管期血流動力學的影響[J]. 華西醫學, 2014, 29(4):732-733.
15.	賴慶利, 何偉, 原慶會, 等. 右美托咪定對體外循環患者體循環阻力的影響[J]. 華西醫學, 2014, 29(8):1504-1507.
16.	Turunen H, Jakob SM, Ruokonen E, et al. Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care:an economic evaluation[J]. Crit Care, 2015, 19(1):67.
17.	Souter MJ, Manno EM. Ventilatory management and extubation criteria of the neurological/neurosurgical patient[J]. Neurohospitalist, 2013, 3(1):39-45.
18.	康于慶, 冷玉芳, 薛興, 等. 右美托咪定對高血壓患者全麻氣管拔管反應及蘇醒時間的影響[J]. 臨床麻醉學雜志, 2011, 32(8):800-802.
19.	張珍妮, 雷曉鳴, 呂建瑞, 等. 右美托咪定對全麻下老年患者全膝關節置換術應激反應和拔管反應的影響[J]. 臨床麻醉學雜志, 2013, 32(10):941-944.
20.	Patel A, Davidson M, Tran MC, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy[J]. Anesth Analg, 2010, 111(4):1004-1010.

1. Schlichter RA. Dexmedetomidine is an excellent agent for sedation status-post lung transplant[J]. J Clin Anesth, 2010, 22(1):1-2.
2. 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.
3. 宋玉美, 蔣紅, 張瀾. 高血壓患者應激反應特點及應對方式[J]. 中國健康心理學雜志, 2012, 20(11):1641-1643.
4. 匡佳偉, 吳多志. 單用瑞芬太尼與芬太尼、瑞芬太尼復合應用對全麻蘇醒拔管期心血管反應的影響[J]. 海南醫學, 2009, 7(9):24-25, 23.
5. 陳永亮, 肖水平, 曹濟宏, 等. 腹腔鏡下膽囊切除氣腹對呼吸和循環的影響[J]. 中國實用醫藥, 2010, 13(2):68-69.
6. Hamer M, Steptoe A. Cortisol responses to mental stress and incident hypertension in healthy men and women[J]. J Clin Endocrinol Metab, 2012, 97(1):E29-E34.
7. Dexheimer Neto FL, Vesz PS, Cremonese RV, et al. Out-of-bed extubation:a feasibility study[J]. Rev Bras Ter Intensiva, 2014, 26(3):263-268.
8. 仇琳, 嚴偉民, 姜虹. 右美托咪定用于困難氣道患者蘇醒期拔管時的鎮靜效果[J]. 中國口腔頜面外科雜志, 2011, 9(1):51-55.
9. Menda F, K?ner O, Sayin M, et al. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG[J]. Ann Card Anaesth, 2010, 13(1):16-21.
10. Kubota T, Fukasawa T, Kitamura E, et al. Epileptic seizures induced by dexmedetomidine in a neonate[J]. Brain Dev, 2013, 35(4):360-362.
11. 冀翔宇, 王世端, 張麗娜, 等. 不同劑量右美托咪定對上腹部手術患者七氟烷最低肺泡有效濃度影響[J]. 中國新藥與臨床雜志, 2011, 30(11):868-872.
12. Kothari D, Tandon N, Singh M, et al. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions:dexmedetomidine versus lignocaine[J]. Anesth Essay Res, 2015, 8(1):78-82.
13. Gupta S, Singh D, Sood D, et al. Role of dexmedetomidine in early extubation of the intensive care unit patients[J]. J Anaesthesiol Clin Pharmacol, 2015, 31(1):92-98.
14. 李辛潔, 甘建輝, 葉玉軍, 等. 右美托咪定對老年高血壓患者全身麻醉拔管期血流動力學的影響[J]. 華西醫學, 2014, 29(4):732-733.
15. 賴慶利, 何偉, 原慶會, 等. 右美托咪定對體外循環患者體循環阻力的影響[J]. 華西醫學, 2014, 29(8):1504-1507.
16. Turunen H, Jakob SM, Ruokonen E, et al. Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care:an economic evaluation[J]. Crit Care, 2015, 19(1):67.
17. Souter MJ, Manno EM. Ventilatory management and extubation criteria of the neurological/neurosurgical patient[J]. Neurohospitalist, 2013, 3(1):39-45.
18. 康于慶, 冷玉芳, 薛興, 等. 右美托咪定對高血壓患者全麻氣管拔管反應及蘇醒時間的影響[J]. 臨床麻醉學雜志, 2011, 32(8):800-802.
19. 張珍妮, 雷曉鳴, 呂建瑞, 等. 右美托咪定對全麻下老年患者全膝關節置換術應激反應和拔管反應的影響[J]. 臨床麻醉學雜志, 2013, 32(10):941-944.
20. Patel A, Davidson M, Tran MC, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy[J]. Anesth Analg, 2010, 111(4):1004-1010.

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Effect of Different Doses of Dexmedetomidine on Hemodynamics during Endotracheal Extubation of Laparoscopic Cholecystectomy in Patients with Hypertension

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