Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-27T22:45:23.419Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia

Published online by Cambridge University Press:  01 January 2008

S. Goksu ,
H. Arik ,
S. Demiryurek ,
S. Mumbuc ,
U. Oner  and
A. T. Demiryurek
S. Goksu*
Affiliation:
University of Gaziantep, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Gaziantep, Turkey
H. Arik
Affiliation:
University of Gaziantep, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Gaziantep, Turkey
S. Demiryurek
Affiliation:
Gazi University, Faculty of Medicine, Department of Physiology, Ankara, Turkey
S. Mumbuc
Affiliation:
University of Gaziantep, Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Gaziantep, Turkey
U. Oner
Affiliation:
University of Gaziantep, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Gaziantep, Turkey
A. T. Demiryurek
Affiliation:
University of Gaziantep, Faculty of Medicine, Department of Pharmacology, Gaziantep, Turkey
*
Correspondence to: Sitki Goksu, Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Gaziantep, 27310 Gaziantep, Turkey. E-mail: sitkigoksu@yahoo.com; Tel/Fax: 90 342 360 22 44
Get access

Summary

Background and objectives

Functional endoscopic sinus surgery can be performed under either local or general anaesthesia. The objective of this study was to investigate the haemodynamic effects of perioperatively administered dexmedetomidine, a new generation α-2-agonist, in patients for functional endoscopic sinus surgery.

Methods

Sixty-two patients who were planned to undergo functional endoscopic sinus surgery under local anaesthesia were included in the study. Following meperidine premedication, both groups were monitored in a standard manner with electrocardiogram, non-invasive blood pressure and percentages of peripheral saturation of oxygen. Saline intravenous infusion was started in the placebo group, and dexmedetomidine bolus intravenous infusion (an initial loading dose of 1 μg kg−1 given for a 10-min period followed by 0.7 μg kg−1 h−1) was administered to the treatment group. Maintenance dose infusion was stopped 15 min before the end of the surgical procedure.

Results

Systolic, diastolic and mean arterial pressures, and heart rate markedly decreased in the dexmedetomidine group. However, dexmedetomidine had no effect on serum nitric oxide levels, measured by a nitric oxide/ozone chemiluminescence method. No significant difference was found in oxygen saturation levels of the two groups. Postoperative nausea and vomiting rates were significantly lower in the dexmedetomidine group. No adverse effects were observed with this α-2-agonist. Dexmedetomidine provided appropriate levels of sedation.

Conclusion

These results suggest that dexmedetomidine provides analgesia, adequate sedation and surgical comfort without adverse effects for patients undergoing functional endoscopic sinus surgery under local anaesthesia.

Keywords

AMBULATORY SURGICAL PROCEDURESSEDATIONDEXMEDETOMIDINESURGERYOTORHINOLARYNGOLOGICAL SURGICAL PROCEDURESNITRIC OXIDE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 1 , January 2008 , pp. 22 - 28
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Slack, R, Bates, G. Functional endoscopic sinus surgery. Am Fam Phys 1998; 58: 707–718.Google ScholarPubMed
2.Danielsen, A, Gravningsbraten, R, Olofsson, J. Anaesthesia in endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2003; 260: 481–486.CrossRefGoogle ScholarPubMed
3.Lee, WC, Kapur, TR, Ramsden, WN. Local and regional anesthesia for functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol 1997; 106: 767–769.CrossRefGoogle ScholarPubMed
4.Fedok, FG, Ferraro, RE, Kingsley, CP, Fornadley, JA. Operative times, postanesthesia recovery times, and complications during sinonasal surgery using general anesthesia and local anesthesia with sedation. Otolaryngol Head Neck Surg 2000; 122: 560–566.Google ScholarPubMed
5.Kamibayashi, T, Maze, M. Clinical uses of α2-adrenergic agonists. Anesthesiology 2000; 93: 1345–1349.CrossRefGoogle ScholarPubMed
6.Paris, A, Tonner, PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol 2005; 18: 412–418.CrossRefGoogle ScholarPubMed
7.Ramsay, MA, Savege, TM, Simpson, BR, Goodwin, R. Controlled sedation with alphaxalone–alphadolone. Br Med J 1974; 2: 656–659.CrossRefGoogle ScholarPubMed
8.Chernik, DA, Gillings, D, Laine, H et al. . Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google ScholarPubMed
9.Baylis, C, Vallance, P. Measurement of nitrite and nitrate levels in plasma and urine – what does this measure tell us about the activity of the endogenous nitric oxide system? Curr Opin Nephrol Hypertens 1998; 7: 59–62.CrossRefGoogle ScholarPubMed
10.Alasehirli, B, Demiryurek, S, Arica, E, Gursoy, S, Demiryurek, AT. No evidence for an association between the Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and fibromyalgia syndrome. Rheumatol Int 2007; 27: 275–280.CrossRefGoogle ScholarPubMed
11.Memis, D, Turan, A, Karamanlioglu, B, Pamukcu, Z, Kurt, I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004; 98: 835–840.Google ScholarPubMed
12.Sato, J, Perl, ER. Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science 1991; 251: 1608–1610.CrossRefGoogle ScholarPubMed
13.Esmaoglu, A, Mizrak, A, Akin, A, Turk, Y, Boyaci, A. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia. Eur J Anaesthesiol 2005; 22: 447–451.CrossRefGoogle ScholarPubMed
14.Talke, P, Richardson, CA, Scheinin, M, Fisher, DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg 1997; 85: 1136–1142.CrossRefGoogle ScholarPubMed
15.Kallio, A, Scheinin, M, Koulu, M et al. . Effects of dexmedetomidine, a selective α2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther 1989; 46: 33–42.CrossRefGoogle Scholar
16.Talke, P, Lobo, E, Brown, R. Systemically administered α2-agonist-induced peripheral vasoconstriction in humans. Anesthesiology 2003; 99: 65–70.CrossRefGoogle ScholarPubMed
17.Piascik, MT, Soltis, EE, Piascik, MM, Macmillan, LB. α-Adrenoceptors and vascular regulation: molecular, pharmacologic and clinical correlates. Pharmacol Ther 1996; 72: 215–241.CrossRefGoogle ScholarPubMed
18.De Jonge, A, Timmermans, PB, Van Zwieten, PA. Participation of cardiac presynaptic α2-adrenoceptors in the bradycardic effects of clonidine and analogues. Naunyn Schmiedebergs Arch Pharmacol 1981; 317: 8–12.CrossRefGoogle Scholar
19.Vulliemoz, Y. The nitric oxide-cyclic 3′,5′-guanosine monophosphate signal transduction pathway in the mechanism of action of general anesthetics. Toxicol Lett 1998; 100–101: 103–108.CrossRefGoogle Scholar
20.JrBryan, RM, Steenberg, ML, Eichler, MY, Johnson, TD, Swafford, MW, Suresh, MS. Permissive role of NO in α2-adrenoceptor-mediated dilations in rat cerebral arteries. Am J Physiol 1995; 269: H1171–H1174.Google Scholar
21.JrBryan, RM, Eichler, MY, Swafford, MW, Johnson, TD, Suresh, MS, Childres, WF. Stimulation of α2-adrenoceptors dilates the rat middle cerebral artery. Anesthesiology 1996; 85: 82–90.CrossRefGoogle Scholar
22.Miller, VM, Flavahan, NA, Vanhoutte, PM. Pertussis toxin reduces endothelium-dependent and independent responses to α2-adrenergic stimulation in systemic canine arteries and veins. J Pharmacol Exp Ther 1991; 257: 290–293.Google Scholar
23.Ishiyama, T, Dohi, S, Iida, H, Watanabe, Y, Shimonaka, H. Mechanisms of dexmedetomidine-induced cerebrovascular effects in canine in vivo experiments. Anesth Analg 1995; 81: 1208–1215.Google ScholarPubMed
24.McPherson, RW, Kirsch, JR, Traystman, RJ. Inhibition of nitric oxide synthase does not affect α2-adrenergic-mediated cerebral vasoconstriction. Anesth Analg 1994; 78: 67–72.CrossRefGoogle ScholarPubMed
25.Coughlan, MG, Lee, JG, Bosnjak, ZJ, Schmeling, WT, Kampine, JP, Warltier, DC. Direct coronary and cerebral vascular responses to dexmedetomidine. Significance of endogenous nitric oxide synthesis. Anesthesiology 1992; 77: 998–1006.CrossRefGoogle ScholarPubMed