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The Effects of Dexmedetomidine on Target-controlled Infusion of Propofol and Stress Reaction for Laparoscopic Cholecystectomy

Author: DuanJing
Tutor: LiLi
School: Central South University
Course: Anesthesiology
Keywords: dexmedetomidine propofol target-controlled infusion stress respones
CLC: R614
Type: Master's thesis
Year: 2011
Downloads: 87
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Abstract

Objective:To evaluate the effects of dexmedetomidine on target-controlled infusion of propofol and stress reaction for laparoscopic cholecystectomy.Methods:A total number of 45 patients (ASAⅠ-Ⅱ)undergoing laparoscopic cholecystectomy in total intravenous anesthesia were randomly allocated to three equal groups with 15 patients in each group:Dexmedetomidine groupⅠ(group D1) and dexmedetomidine groupⅡ(group D2). Dexmedetomidine were determined by 0.3μg/kg and 0.6μg/kg diluted to 10ml with normal saline before the induction of anesthesia.while The control group (group C) treated with normal saline before the induction of anesthesia.The three groups were given continuous dexmedetomidine infusion with 60ml/h infusion rate of finished within 10min.Then the three groups adopted the same method of induction with target-controlled infusion of propofol and the maintenance of anesthesia:Intravenous injection of fentanyl 3-5μg/kg, midazolam 0.04mg/kg, starting propofol target-controlled infusion (TCI). Cis atracurium 0.2mg/kg was intravenous injected Until BIS<70.Patients were given Mask ventilation and endotracheal intubation when BIS <55.Fentanyl 1μg/kg was given before skin incision and the propofol target concentration was adjusted by the BIS values which was according to 50±5. Stop giving the medication after stopping pneumoperitoneum.In three groups, the BP, HR, BIS and propofol target concentration were recorded at time points burglary (T0), after study drug infusion before induction of anesthesia (T1), before intubation (T2), after intubation 1min (T3), pneumoperitoneum after 5min (T4),30min after pneumoperitoneum (T5), lifting of pneumoperitoneum after 5min (T6), after extubation 1min (T7). The awakening time (from the stop of propofol TCI pump to the call of the eye opening) was also recorded.Blood samples were taken from the upper radial artery at T0, T3, T4, T6, T7 time point to measure blood cortisol and epinephrine levels.Result:(1)Propofol target concentration:From the establishment of pneumoperitoneum to surgery, three groups were significantly higher (p<0.05) compared with the target concentration before tracheal intubation (T2). Time points throughout surgery, group C was significantly higher than group D1 and group D2 (p<0.05). group D1 was higher than group D2 (p<0.05).(2)Hemodynamic:The BP, HR after intubation were significantly higher than before intubation (p<0.05)in group C.The BP, HR in group D1 and D2 maintained a relatively stable level during the anesthesia, between groups No significant difference (p> 0.05).There was no significant difference between group D1 and D2 (p> 0.05). At 1min after extubation (T7), the BP, HR in three groups were higher than the baseline (p<0.05). (3) Plasma hydrocortisone concentration:Cortisol:Group D1 and D2 were lower than TO and groupC at T4 (p<0.05), and were significantly lower than C group at each time point after pneumoperitoneum (p<0.05).Epinephrine:group C was significantly higher at each time point after intubation than the baseline (p <0.05), group D1 and D2 had no significant change after intubation compared with the baseline, and were Significantly lower than group C at T3, T6 (p<0.05). There was no significant difference between Group D1 and D2 (p> 0.05). (4) Recovery time:The breathing recovery time, eye opening and extubation time slightly extended in group D1 and D2, but it was not statistically significant compared with group C (p> 0.05).Conclusion:Infusion dexmedetomidine preoperative can decrease the target-effect propofol concentration, stabilize the hemodynamics and reduce the increase of Plasma cortisol and epinephrine.It doesn’t significantly prolong the recovery time of emergence, eye opening and extubation time after surgery.

The Effects of Dexmedetomidine on Target-controlled Infusion of Propofol and Stress Reaction for Laparoscopic Cholecystectomy

Abstract

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