A Combination of Dexmedetomidine with Ketamine and Opioids Results in Significant Inhibition of Hemodynamic Changes Associated with Laparoscopic Cholecystectomy and in Prolongation of Postoperative Analgesia

Česká verzia

Authors: J. Málek; F. Mareček; L. Hess ^*; A. Kurzová; M. Očadlík ^**; M. Votava ^***
Authors place of work: Klinika anesteziologie a resuscitace 3. LF UK a FNKV, přednosta: prof. MUDr. Jan Pachl, CSc. ; Pracoviště experimentální medicíny IKEM ^*; Chirurgická klinika 3. LF UK a FNKV, přednosta: prof. MUDr. Robert Gürlich, CSc. ^**; Ústav farmakologie 3. LF UK, přednosta ústavu: prof. MUDr. Miloslav Kršiak, DrSc. ^***
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 5, s. 275-281.
Category: Monothematic special - Original

Summary

The aim of the study:
Recently, alpha2 sympathoadrenergic drugs are used in premedication to improve the perioperative course. The aim of our study was to compare a premedication with a new alpha2 sympathoadrenergic drug and standard premedication.

Methods:
After ethic committee approval and written patient consent, in a randomised, double-blinded study, combination of dexmedetomidine 1.0 μg.kg^-1 + ketamine 0.5 mg.kg^-1 + fentanyl 1.0 μg.kg^-1 + atropine 0.5 mg (group FNT), dexmedetomidine 1.0 μg.kg^-1 + ketamine 0.5 mg.kg^-1 + alfentanil 5.0 μg.kg^-1 + atropine 0.5 mg (group ALFNT), or pethidine 1.0 mg.kg^-1 + atropine 0.5 mg (group Dolsin) was administered to a deltoid muscle 15 min. before anaesthesia (GA) in patients elicited for laparoscopic cholecystectomy (LCHE). GA was performed in a standard way, ECG, NIBP, respiration rate, SpO₂, onset of effect, Observers Assessment of Alertness Sedation Score (OAASS) before GA, circulatory reaction to intubation and capnoperitoneum, fentanyl consumption during GA, time to the first request for post-operative analgesia and postoperative nausea and vomiting were measured. The data were processed by Kruskal-Wallis and Fisher tests. P-value < 0.05 was considered significant.

Results:
There were 16 patients in FNT and Dolsin and 15 patients in ALFNT with no differences in demography except for younger age in ALFNT. The main differences were in hypertension during capnoperitoneum: 0/16 FNT and 1/15 ALFNT vs. 11/16 Dolsin, both p < 0.001, per-operative fentanyl consumption: FNT 31.5 μg vs. Dolsin 165.0 μg, p < 0.001 and ALFNT 50.0 μg, p < 0.05 (ALFNT vs. Dolsin, p < 0.01) and request to the first analgesic post surgery: FNT 1.3 h. vs. Dolsin 0.45 h., p < 0.05 vs. ALFNT 0.8 h., p < 0.01. There were no differences in side effects except for bradycardia in ALFNT (p < 0.05).

Conclusions:
Dexmedetomidine-ketamine-fentanyl-atropine combination is superior to pethidine-atropine combination in suppressing of adverse hemodynamic effects of capnoperitoneum, decreased need for analgesia during GA and prolonged postoperative analgesia.

Key words:
surgery – hemodynamic changes – premedication – dexmedetomidine – ketamine – fentanyl – alfentanil

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