Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation.
OBJECTIVE
To evaluate the effect of dexmedetomidine combined with fentanyl on hemodynamics.


METHODS
Prospective, double-blinded, randomized study.


METHODS
Operating room of a university hospital.


METHODS
30 ASA physical status II and III patients with mild-to-moderate cardiovascular disease.


METHODS
Patients were assigned to one of three groups: Group D-F2 [dexmedetomidine, effect-site concentration (ESC) of fentanyl = two ng/mL]; Group F2 (placebo, ESC of fentanyl = two ng/mL), or Group F4 (placebo, ESC of fentanyl = 4 ng/mL).


METHODS
Dexmedetomidine (an initial dose of 1.0 microg/kg for 10 min, followed by a continuous infusion of 0.7 microg x kg(-1) x hr(-1)) or placebo saline was administered 15 minutes before anesthetic induction. Anesthesia was induced with propofol and fentanyl using a target-controlled infusion system. Hemodynamic parameters: systolic (SBP) and diastolic blood pressures (DBP), and heart rate (HR) during anesthetic induction were measured and the percent changes were calculated for both induction and intubation.


RESULTS
After inducing anesthesia, SBP was significantly higher in Group D-F2 (127 +/- 24 mmHg) than Group F2 (90 +/- 20 mmHg) or Group F4 (77 +/- 21 mmHg). The SBP in Groups F2 and F4 reached 160 +/- 31 mmHg and 123 +/- 36 mmHg, respectively, after intubation, but no significant change in SBP was noted in Group D-F2. The percent increase in SBP due to tracheal intubation in Group D-F2 was 3% +/- 4% and was significantly lower than that of Group F2 (70% +/- 34%) or Group F4 (45% +/- 36%).


CONCLUSIONS
Dexmedetomidine combined with fentanyl during anesthetic induction suppresses the decrease in blood pressure due to anesthetic induction and also blunts the cardiovascular response to tracheal intubation.
Kunisawa
Takayuki
T
Department of Anesthesiology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan. taka.kunisawa@nifty.ne.jp
Nagata
Osamu
O
Nagashima
Michio
M
Mitamura
Sayuri
S
Ueno
Megumi
M
Suzuki
Akihiro
A
Takahata
Osamu
O
Iwasaki
Hiroshi
H
D000316:Adrenergic alpha-Agonists / Q000494:pharmacology*; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D020927:Dexmedetomidine / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies
D000316:Adrenergic alpha-Agonists; D018686:Anesthetics, Intravenous; D020927:Dexmedetomidine; D005283:Fentanyl; D015742:Propofol