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.	甘建辉, 史金麟, 胡万宁, 等. 右美托咪定在乳腺癌前哨淋巴结活检术中的临床应用[J]. 中国药房, 2013, 24(10):921-922.
3.	宋玉美, 蒋红, 张澜. 高血压患者应激反应特点及应对方式[J]. 中国健康心理学杂志, 2012, 20(11):1641-1643.
4.	匡佳伟, 吴多志. 单用瑞芬太尼与芬太尼、瑞芬太尼复合应用对全麻苏醒拔管期心血管反应的影响[J]. 海南医学, 2009, 7(9):24-25, 23.
5.	陈永亮, 肖水平, 曹济宏, 等. 腹腔镜下胆囊切除气腹对呼吸和循环的影响[J]. 中国实用医药, 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, 严伟民, 姜虹. 右美托咪定用于困难气道患者苏醒期拔管时的镇静效果[J]. 中国口腔颌面外科杂志, 2011, 9(1):51-55.
9.	Menda F, Köner 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, 张丽娜, 等. 不同剂量右美托咪定对上腹部手术患者七氟烷最低肺泡有效浓度影响[J]. 中国新药与临床杂志, 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.	李辛洁, 甘建辉, 叶玉军, 等. 右美托咪定对老年高血压患者全身麻醉拔管期血流动力学的影响[J]. 华西医学, 2014, 29(4):732-733.
15.	赖庆利, 何伟, 原庆会, 等. 右美托咪定对体外循环患者体循环阻力的影响[J]. 华西医学, 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.	康于庆, 冷玉芳, 薛兴, 等. 右美托咪定对高血压患者全麻气管拔管反应及苏醒时间的影响[J]. 临床麻醉学杂志, 2011, 32(8):800-802.
19.	张珍妮, 雷晓鸣, 吕建瑞, 等. 右美托咪定对全麻下老年患者全膝关节置换术应激反应和拔管反应的影响[J]. 临床麻醉学杂志, 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. 甘建辉, 史金麟, 胡万宁, 等. 右美托咪定在乳腺癌前哨淋巴结活检术中的临床应用[J]. 中国药房, 2013, 24(10):921-922.
3. 宋玉美, 蒋红, 张澜. 高血压患者应激反应特点及应对方式[J]. 中国健康心理学杂志, 2012, 20(11):1641-1643.
4. 匡佳伟, 吴多志. 单用瑞芬太尼与芬太尼、瑞芬太尼复合应用对全麻苏醒拔管期心血管反应的影响[J]. 海南医学, 2009, 7(9):24-25, 23.
5. 陈永亮, 肖水平, 曹济宏, 等. 腹腔镜下胆囊切除气腹对呼吸和循环的影响[J]. 中国实用医药, 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, 严伟民, 姜虹. 右美托咪定用于困难气道患者苏醒期拔管时的镇静效果[J]. 中国口腔颌面外科杂志, 2011, 9(1):51-55.
9. Menda F, Köner 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, 张丽娜, 等. 不同剂量右美托咪定对上腹部手术患者七氟烷最低肺泡有效浓度影响[J]. 中国新药与临床杂志, 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. 李辛洁, 甘建辉, 叶玉军, 等. 右美托咪定对老年高血压患者全身麻醉拔管期血流动力学的影响[J]. 华西医学, 2014, 29(4):732-733.
15. 赖庆利, 何伟, 原庆会, 等. 右美托咪定对体外循环患者体循环阻力的影响[J]. 华西医学, 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. 康于庆, 冷玉芳, 薛兴, 等. 右美托咪定对高血压患者全麻气管拔管反应及苏醒时间的影响[J]. 临床麻醉学杂志, 2011, 32(8):800-802.
19. 张珍妮, 雷晓鸣, 吕建瑞, 等. 右美托咪定对全麻下老年患者全膝关节置换术应激反应和拔管反应的影响[J]. 临床麻醉学杂志, 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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