The online version of this article (doi:10.1186/1471-2253-14-113) contains supplementary material, which is available to authorized users.
Gulbin Sezen, Yavuz Demiraran contributed equally to this work.
The authors declare that they have no competing interests.
GS: Design of the study, conduct the study, data analysis and manuscript drafting. YD: Design of the study, data analysis and manuscript editing. ISS: Design of the study, data acquisition. IK: Data acquisition, manuscript editing. AI: Data acquisition, manuscript HA: Design of the study, data analysis, statics. OE: Recruitement of subjects for the study, data acquisition. OO: Data analysis,manuscript editing. All authors read and approved the final manuscript.
Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.
One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg−1, and midazolam was administered at a concentration of 0.025 μg.kg−1 via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (Tbeginning, Tpreop5 min, Tpreop 10 min, Tinduction, Tintubation, Tintubation 5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation, Textubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.
SBP was significantly different between normotensive and hypertensive groups at the following time points: Tpreop 5 min, Tpreop 10 min, Tinduction, Tintubation , Tintubation 5 min and Tinitial surgery. MBP was significantly different in the hypertensive groups at Tinduction, Tintubation, Tintubation 5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation and Textubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.
In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.
Trial registration: Clinicaltrials.gov identifier: NCT02058485.
Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM: Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990, 323 (26): 1781-1788. 10.1056/NEJM199012273232601. CrossRefPubMed
Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner TJ, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Stein JH, Weitz HH, Wesley DJ: ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011, 123 (21): 2434-2506. 10.1161/CIR.0b013e31821daaf6. CrossRefPubMed
Reves JG GP, Lubarsky DA, McEvoy MD, Martinez-Ruiz R: Intravenous Anesthetics. Miller’s Anesthesia. Edited by: RD M. 2010, Philadelphia: Churchill Livingstone Elsevier, 1: 751-757. 7
Wijeysundera DN, Bender JS, Beattie WS: Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev. 2009, 4: CD004126- PubMed
Charlson ME, MacKenzie CR, Gold JP, Ales KL, Topkins M, Shires GT: Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery. Ann Surg. 1990, 212 (1): 66-81. 10.1097/00000658-199007000-00010. CrossRefPubMedPubMedCentral
Mariappan R, Narayana Prabhu AH, Kuppuswamy B: Comparing the effects of oral clonidine premedication with intraoperative dexmedetomidine infusion on anesthetic requirement and recovery from anesthesia in patients undergoing major spine surgery. J Neurosurg Anesthesiol. 2013, 26 (3): 192-197. CrossRef
Kunisawa T, Nagata O, Nagashima M, Mitamura S, Ueno M, Suzuki A, Takahata O, Iwasaki H: Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation. J Clin Anesth. 2009, 21 (3): 194-199. 10.1016/j.jclinane.2008.08.015. CrossRefPubMed
Kang WS, Kim SY, Son JC, Kim JD, Muhammad HB, Kim SH, Yoon TG, Kim TY: The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol. 2012, 62 (2): 113-118. 10.4097/kjae.2012.62.2.113. CrossRefPubMedPubMedCentral
- Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?
Ilknur Suidiye Seker
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II