Dexmedetomidine in the Program of Multimodal Low-opioid Anesthesia During Laparoscopic Surgery in Urology
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic and analgesic effects.
The objective: to evaluate the effectiveness of using dexmedetomidine in a multimodal low opioid anesthesia program for laparoscopic renal surgery.
Materials and methods. 55 patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anesthesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC – 1.44±0.25 vol.%).
In group 1 analgesia was provided with fentanyl 3.89±2.1 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl 2.38±1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2.
The efficacy of antinociceptive protection was assessed by the dynamics of changes in the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations.
Results. The total average doses of fentanyl used during the entire period of anesthesia were: 369.23±16.42 μg in group 1, 272.41±10,98 μg in group 2 (p<0.001).
In patients of the control group 1, an increase in the plasma concentration of adrenocorticotropic hormone by 111.86% (p<0.01) from 25.7±2.1 pg/ml to 54.45±5.43 pg/ml was recorded (the study was conducted before the start of surgery and after the end of the operation), which was accompanied by a statistically significant increase cortisol concentration from 371.0±32.32 nmol/l to 562.72±45.37 nmol/l (by 51.67%) (p<0.01).
In patients of the second group (dexmedetomidine group), an intraoperative increase in the plasma concentration of adrenocorticotropic hormone was recorded from 26.25±2.3 pg/l to 46.88±2.36 pg/l (by 78.59%) (p<0.01), which was accompanied by a statistically insignificant intraoperative increase in cortisol concentration from 393.51±25.0 nmol/l to 436.37±34.92 nmol/l – only by 10.89% (p>0.05).
Blood glucose concentrations in the early postoperative period in the both groups were 6.79±0.31 mmol/l and 6.29±0.24 mmol/l, respectively (p>0.05).
Hemodynamic parameters and BIS, which was maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in both groups.
Conclusions. The use of dexmedetomidine in multimodal low-opioid anesthesia for laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery.
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588–93. doi: 10.1097/ACO.0b013e328330373a.
Helander EM, Billeaud CB, Kline RJ, Chris M Harmon, Prabhakar A, Urman RD, et al. Multimodal Approaches to Analgesia in Enhanced Recovery After Surgery Pathways. Int Anesthesiol Clin. 2017;55(4):51–69. doi: 10.1097/AIA.0000000000000165.
Rajan S, Hutcherson MT, Sessler DI, Kurz A, Yang D, Ghobrial M, et al. The Effects of Dexmedetomidine and Remifentanil on Hemodynamic Stability and Analgesic Requirement After Craniotomy: A Randomized Controlled Trial. J Neurosurg Anesthesiol. 2016;28(4):282–90. doi: 10.1097/ANA.0000000000000221.
Naik BI, Nemergut EC, Kazemi A, Fernandez L, Cederholm SK, McMurry TL, et al. The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery. Anesth Analg. 2016;122(5):1646–53. doi: 10.1213/ANE.0000000000001226.
Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiol. 2012;116(6):1312–22. doi:10.1097/ALN.0b013e31825681cb.
Singh PM, Panwar R, Borle A, Mulier JP, Sinha A, Goudra B. Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis. Surg Obes Relat Dis. 2017;13(8):1434–46. doi: 10.1016/j.soard.2017.02.025.
Wang X, Liu N, Chen J, Xu Z, Wang F, Ding C. Effect of intravenous dexmedetomidine during general anesthesia on acute postoperative pain in adults. Clin J Pain. 2018;34(12):1180–91. doi: 10.1097/AJP.0000000000000630.
Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of preanaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22(5):386–91. doi: 10.1017/s0265021505000669.
Lightman SL, Birnie MT, Conway-Campbell BL. Dynamics of ACTH and Cortisol Secretion and Implications for Disease. Endocr Rev. 2020;41(3):bnaa002. doi: 10.1210/endrev/bnaa002.
Davis G, Fayfman M, Reyes-Umpierrez D, Shahzeena H, Pasquel FJ, Vellanki P, et al. Stress hyperglycemia in general surgery: Why should we care? J Diabetes Complications. 2018;32(3):305–09. doi: 10.1016/j.jdiacomp.2017.11.010.
Saadat-Gilani K, Zarbock A, Meersch M. Perioperative Renoprotection: Clinical Implications. Anesth Analg. 2020;131(6):1667–78. doi: 10.1213/ANE.0000000000004995.
Prete A, Yan Q, Al-Tarrah K, Akturk HK, Prokop LJ, Fares A, et al. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;89(5):554–67. doi: 10.1111/cen.13820.
Weerink MA, Struys MM, Hannivoort LN, Barends CR, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin pharmacokin. 2017;56(8):893–913. doi: 10.1007/s40262-017-0507-7.
Fan W, Yang H, Sun Y, Zhang J, Li G, Zheng Y, Liu Y. Comparison of the pro-postoperative analgesia of intraoperative dexmedetomidine with and without loading dose following general anesthesia: a prospective, randomized, controlled clinical trial. Medicine. 2017;96(7):e6106. doi: 10.1097/MD.0000000000006106.
Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 2014;8(10):GE01–GE4. doi: 10.7860/JCDR/2014/9624.4946.
Shariffuddin II, Teoh WH, Wahab S, Wang CY. Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study. BMC Anesthesiol. 2018;18(1):1–8. doi: 10.1186/s12871-017-0464-6.
Bellon M, Le Bot A, Michelet D, Hilly J, Maesani M, Brasher C, et al. Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies. Pain Ther. 2016;5(1):63–80. doi: 10.1007/s40122-016-0045-2.
Le Bot A, Michelet D, Hilly J, Dilly MP, Brasher C, Mantz J, et al. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies. Minerva Anestesiol. 2015;81(10):1105–17.
Panchgar V, Shetti AN, Sunitha HB, Dhulkhed VK, Nadkarni AV. The effectiveness of intravenous dexmedetomidine on perioperative hemodynamics, analgesic requirement, and side effects profile in patients undergoing laparoscopic surgery under general anesthesia. Anesth Essays Res. 2017;11(1):72–7. doi: 10.4103/0259-1162.200232.
Xu SQ, Li YH, Wang SB, Hu SH, Ju X, Xiao JB. Effects of intravenous lidocaine, dexmedetomidine and their combination on postoperative pain and bowel function recovery after abdominal hysterectomy. Minerva Anestesiol. 2017;83(7):685–94. doi: 10.23736/S0375-9393.16.11472-5.
Peng K, Zhang J, Meng XW, Liu HY, Ji FH. Optimization of Postoperative Intravenous Patient-Controlled Analgesia with Opioid-Dexmedetomidine Combinations: An Updated Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Pain Physician. 2017;20(7):569–96.
Wang X, Liu W, Xu Z, Wang F, Zhang C, Wang B, et al. Effect of dexmedetomidine alone for intravenous patient-controlled analgesia after gynecological laparoscopic surgery: a consort-prospective, randomized, controlled trial. Medicine. 2016;95(19):e3639.
Song Y, Shim JK, Song JW, Kim EK, Kwak YL. Dexmedetomidine added to an opioid-based analgesic regimen for the prevention of postoperative nausea and vomiting in highly susceptible patients: A randomised controlled trial. Eur J Anaesthesiol. 2016;33(2):75–83. doi: 10.1097/EJA.0000000000000327.
Davy A, Fessler J, Fischler M, LE GM. Dexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery. Minerva Anestesiol. 2017;83(12):1294–308. doi: 10.23736/S0375-9393.17.12040-7.
Gurbet A, Basagan-Mogol E, Turker G, Ugun F, Kaya FN, Ozcan B. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth. 2006;53(7):646–52. doi: 10.1007/BF03021622.
