Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis

Abstract

Background: Dexmedetomidine, an α2 agonist, when used as an adjuvant in general anaesthesia attenuates stress response to various noxious stimuli, maintains perioperative haemodynamic stability and provides sedation without significant respiratory depression postoperatively.

Methods: Sixty patients were randomly divided into two groups of 30 each. In group A, fentanyl 2 μg/kg and in group B dexmedetomidine were given intravenously as loading dose of 1 μg/kg over 10 min prior to induction. After induction with thiopentone, in group B, dexmedetomidine was given as infusion at a dose of 0.2-0.8 μg/kg. Sevoflurane was used as inhalation agent in both groups. Haemodynamic variables and entropy (response entropy and state entropy) were recorded continuously. Postoperative sedation and recovery were assessed by sedation score and modified Aldrete's score, respectively.

Results: Dexmedetomidine significantly attenuates stress response at intubation with lesser increase in heart rate (10% vs. 17%), systolic blood pressure (6% vs. 23%) and diastolic blood pressure (7% vs. 20%) as compared to the control group (P<0.05). Intraoperatively, an average of 8% fall in systolic blood pressure and 8.16% fall in diastolic pressure in the test group as compared to 3.6% rise in systolic and 3.3% in diastolic pressure of the control group was observed. Postoperatively, the test group showed significant sedation at 2 h as compared to the control group (P=0.00) and recovery was better in the control group for the first 2 h post extubation.

Conclusion: Dexmedetomidine attenuates various stress responses during surgery and maintains the haemodynamic stability when used as an adjuvant in general anaesthesia. Also, the sedative action of dexmedetomidine delays recovery for the first few hours post extubation.

Keywords: Dexmedetomidine; entropy; perioperative haemodynamics; recovery.

Figure 1

Changes in heart rate (mean±SE): 5 and 10 min after the start of dexmedetomidine; at induction; at intubation; at 5, 10, 15, 30, 45 and 60 min post intubation; at extubation; at 5, 10, 15 and 30 min post extubation (DA - Dexmedetomidine administration; PI - Post intubation; E - Post extubation)

Figure 2

Changes in systolic and diastolic blood pressure (mean±SE): 5 and 10 min after the start of dexmedetomidine; at induction; at intubation; at 5, 10, 15, 30, 45 and 60 min post intubation; at extubation; at 5, 10, 15 and 30 min post extubation (DA - Dexmedetomidine administration; PI - Post intubation; E - Post extubation; SBP - Systolic blood pressure; DBP - Diastolic blood pressure)