Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: a randomized, placebo-controlled trial.
Dexmedetomidine
Norepinephrine
Pituitary
Stress response
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
02 05 2020
02 05 2020
Historique:
received:
27
02
2020
accepted:
26
04
2020
entrez:
4
5
2020
pubmed:
4
5
2020
medline:
10
8
2021
Statut:
epublish
Résumé
Dexmedetomidine has sympatholytic effects. We investigated whether dexmedetomidine could attenuate stress responses in patients undergoing endoscopic transnasal transseptal transsphenoidal surgery. Forty-six patients were randomized to receive a continuous infusion of 0.9% saline (n = 23) or dexmedetomidine (n = 23). Immediately after general anesthesia induction, the dexmedetomidine group received a loading dose of 1 mcg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.2-0.7 mcg/kg/h and the control group received 0.9% saline at the same volume until 30 min before the end of surgery. Serum levels of epinephrine, norepinephrine, and glucose were assessed before surgery (T1) and the end of drug infusion (T2). The primary outcome was the change in norepinephrine levels between the two time points. Changes (T2-T1 values) in perioperative serum norepinephrine levels were significantly greater in the dexmedetomidine group than in the control group (median difference, 56.9 pg/dL; 95% confidence interval, 20.7 to 83.8 pg/dL; P = 0.002). However, epinephrine level changes did not show significant intergroup differences (P = 0.208). Significantly fewer patients in the dexmedetomidine group than in the control group required rescue analgesics at the recovery area (4.3% vs. 30.4%, P = 0.047). Intraoperative dexmedetomidine administration reduced norepinephrine release and rescue analgesic requirement. Dexmedetomidine might be used as an anesthetic adjuvant in patients undergoing transnasal transseptal transsphenoidal surgery. Clinical Trial Registry of Korea, identifier: KCT0003366; registration date: 21/11/2018; presenting author: Ji Seon Jeong.
Sections du résumé
BACKGROUND
Dexmedetomidine has sympatholytic effects. We investigated whether dexmedetomidine could attenuate stress responses in patients undergoing endoscopic transnasal transseptal transsphenoidal surgery.
METHODS
Forty-six patients were randomized to receive a continuous infusion of 0.9% saline (n = 23) or dexmedetomidine (n = 23). Immediately after general anesthesia induction, the dexmedetomidine group received a loading dose of 1 mcg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.2-0.7 mcg/kg/h and the control group received 0.9% saline at the same volume until 30 min before the end of surgery. Serum levels of epinephrine, norepinephrine, and glucose were assessed before surgery (T1) and the end of drug infusion (T2). The primary outcome was the change in norepinephrine levels between the two time points.
RESULTS
Changes (T2-T1 values) in perioperative serum norepinephrine levels were significantly greater in the dexmedetomidine group than in the control group (median difference, 56.9 pg/dL; 95% confidence interval, 20.7 to 83.8 pg/dL; P = 0.002). However, epinephrine level changes did not show significant intergroup differences (P = 0.208). Significantly fewer patients in the dexmedetomidine group than in the control group required rescue analgesics at the recovery area (4.3% vs. 30.4%, P = 0.047).
CONCLUSIONS
Intraoperative dexmedetomidine administration reduced norepinephrine release and rescue analgesic requirement. Dexmedetomidine might be used as an anesthetic adjuvant in patients undergoing transnasal transseptal transsphenoidal surgery.
TRIAL REGISTRATION
Clinical Trial Registry of Korea, identifier: KCT0003366; registration date: 21/11/2018; presenting author: Ji Seon Jeong.
Identifiants
pubmed: 32359367
doi: 10.1186/s12871-020-01025-7
pii: 10.1186/s12871-020-01025-7
pmc: PMC7195722
doi:
Substances chimiques
Blood Glucose
0
Dexmedetomidine
67VB76HONO
Norepinephrine
X4W3ENH1CV
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
100Subventions
Organisme : Hana Pharmacy, Seoul, Korea
ID : SMCTSADEX_2018
Pays : International
Références
Am J Physiol. 1984 Aug;247(2 Pt 1):E145-56
pubmed: 6147092
World Neurosurg. 2016 Mar;87:162-9
pubmed: 26732950
Br J Anaesth. 2019 Dec;123(6):777-794
pubmed: 31668347
Minerva Anestesiol. 2019 May;85(5):468-477
pubmed: 30226342
Proc (Bayl Univ Med Cent). 2001 Jan;14(1):13-21
pubmed: 16369581
Anesth Analg. 2000 Mar;90(3):699-705
pubmed: 10702460
Anesth Essays Res. 2017 Oct-Dec;11(4):1079-1083
pubmed: 29284879
Reg Anesth Pain Med. 2018 Jul;43(5):488-495
pubmed: 29630034
Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44
pubmed: 12421743
Korean J Anesthesiol. 2019 Aug;72(4):323-330
pubmed: 31220910
Anesth Analg. 1992 Dec;75(6):932-9
pubmed: 1359808
Anesth Analg. 2019 Oct;129(4):1093-1099
pubmed: 31008751
Br J Anaesth. 2001 May;86(5):650-6
pubmed: 11575340
Indian J Anaesth. 2011 Jul;55(4):352-7
pubmed: 22013250
J Neurosurg Anesthesiol. 2008 Jul;20(3):174-9
pubmed: 18580347
J Neurosurg Anesthesiol. 2019 Oct;31(4):366-377
pubmed: 30363004
Can J Neurol Sci. 2019 Jul;46(4):415-422
pubmed: 31293233
J Neurosurg Anesthesiol. 2015 Jul;27(3):209-15
pubmed: 25493927
Indian J Anaesth. 2011 Mar;55(2):135-40
pubmed: 21712869
Hypertension. 1986 Jul;8(7):611-7
pubmed: 3721561
Clin Pharmacokinet. 2017 Aug;56(8):893-913
pubmed: 28105598
Br J Anaesth. 2000 Jul;85(1):109-17
pubmed: 10927999
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):25-30
pubmed: 24574589