The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia

Abstract

Background: The effects of dexmedetomidine on the propofol-sparing effect and intraoperative hemodynamics during remifentanil-based propofol-supplemented anesthesia have not been well investigated.

Methods: Twenty patients undergoing breast surgery were randomly allocated to receive dexmedetomidine (group DEX) or placebo (group C). In the DEX group, dexmedetomidine was loaded (1 µg/kg) before anesthesia induction and was infused (0.6 µg/kg/h) during surgery. Anesthesia was induced with a target-controlled infusion (TCI) of propofol (effect site concentration, Ce; 3 µg/ml) and remifentanil (plasma concentration, Cp, 10 ng/ml). The Ce of TCI-propofol was adjusted to a bispectral index of 45-55, and Cp of TCI-remifentanil was fixed at 10 ng/ml in both groups. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline (T-control), after the loading of study drugs (T-loading), 3 min after anesthesia induction (T-induction), tracheal intubation (T-trachea), incision (T-incision), 30 min after incision (T-incision30), and at tracheal extubation (T-extubation). MAP% and HR% (MAP and HR vs. T-control) were determined and the propofol infusion rate was calculated.

Results: The propofol infusion rate was significantly lower in the DEX group than in group C (63.9 ± 16.2 vs. 96.4 ± 10.0 µg/kg/min, respectively; P < 0.001). The changes in MAP% at T-induction, T-trachea and T-incision in group DEX (-10.0 ± 3.9%, -9.4 ± 4.6% and -11.2 ± 6.3%, respectively) were significantly less than those in group C (-27.6 ± 13.9%, -21.7 ± 17.1%, and -25.1 ± 14.1%; P < 0.05, respectively).

Conclusions: Dexmedetomidine reduced the propofol requirement for remifentanil-based anesthesia while producing more stable intraoperative hemodynamics.

Keywords: Dexmedetomidine; Propofol; Remifentanil.

Fig. 1

Inter-group comparison of supplemental propofol requirements. C: remifentanil-propofol, DEX: remifentanil-propofol-dexmedetomidine. ^*Indicates P < 0.05 vs. group C.

Fig. 2

Inter-group comparisons of the changes in mean arterial blood pressure and heart rate compared with control values (ΔMAP% and ΔHR%). C: remifentanil-propofol, DEX: remifentanil-propofol-dexmedetomidine, MAP: mean arterial blood pressure, HR: heart rate, T-control: at the arrival to operation theater, T-loading: at after the loading of study drugs, T-induction: at 3 min after the start of anesthesia induction, T-trachea: at tracheal intubation, T-incision: at surgical incision, T-incision30: at 30 min after surgical incision, T-extubation: at tracheal extubation. ^*Indicates P < 0.05 vs. group C.