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Randomized Controlled Trial
. 2020 May-Jun;40(3):183-190.
doi: 10.5144/0256-4947.2020.183. Epub 2020 Jun 4.

Dexmedetomidine aggravates hypotension following mesenteric traction during total gastrectomy: a randomized controlled trial

Zheng Chen  1 , Dong-Hua Shao  1 , Xiao-Dong Ma  1 , Zu-Min Mao  1
Affiliations
Randomized Controlled Trial

Dexmedetomidine aggravates hypotension following mesenteric traction during total gastrectomy: a randomized controlled trial

Zheng Chen et al. Ann Saudi Med. 2020 May-Jun.

Abstract

Background: Mesenteric traction syndrome (MTS), which is characterized by arterial hypotension and tachycardia following mesenteric traction (MT), frequently occurs during abdominal surgery. Dexmedetomidine, commonly used in general anesthesia during major surgery, has a sympatholytic effect and attenuates the compensatory response to hypotension.

Objective: Assess the effect of dexmedetomidine on hypotension following mesenteric traction.

Design: Prospective, randomized, controlled clinical trial.

Setting: Department of Anesthesiology, Zhenjiang First People's Hospital in China.

Patients and methods: Patients were randomly divided into three groups. Dexmedetomidine, 0.5 or 1.0 µg/kg, was intravenously administered over 15 minutes before skin incision followed by a maintenance rate of 0.5 µg/kg/h in groups D1 and D2, respectively; saline was administered in group C.

Main outcome measure(s): The duration of hypotension, heart rate and plasma norepinephrine level in patients with MTS were recorded within 60 minutes following MT.

Sample size: 75 patients.

Results: The duration of hypotension in the MTS patients in group D1 and D2 was significantly longer than that in groups C (D1 vs. C, P<.05; D2 vs. C, P<.01). Significantly more phenylephrine was required to treat hypotension in group D1 and D2 than was required for patients in group C (P<.05). The increase in heart rate during the first 15 minutes of MT in group D2 was significantly attenuated compared to that in group C (P<.0083). The increases in norepinephrine levels during the first 15 minutes of MT in group C were significantly higher than those in groups D1 and D2 (P<.0167).

Conclusion: Adjunctive dexmedetomidine in general anesthesia aggravates hypotension during MTS in open total gastrectomy.

Limitations: Postoperative complications were not evaluated.

Conflict of interest: None.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Trend for changes in heart rate. T0 is the time point at the moment of mesenteric traction. T15, T30, T45, and T60 are at 15, 30, 45, and 60 minutes after mesenteric traction. * P<.0083 compared with T0.
Figure 3.
Figure 3.
Trend for changes in SBP. T0 is the time point at the moment of mesenteric traction. T15, T30, T45, and T60 are at 15, 30, 45, and 60 minutes after mesenteric traction. * P<.0083 compared with baseline.
Figure 4.
Figure 4.
Trend for changes in remifentanil concentration. T0 is the time point at the moment of mesenteric traction. T15, T30, T45, and T60 are at 15, 30, 45, and 60 minutes after mesenteric traction. *P<.0083 compared with baseline.
Figure 5.
Figure 5.
The plasma concentrations of 6-keto-PGF1α and norepinephrine were determined before anesthesia induction and at 15 minutes and 60 minutes following MT. * P<.0083 compared with baseline.
Figure 6.
Figure 6.
The plasma concentrations of 6-keto-PGF1α and norepinephrine were determined before anesthesia induction and at 15 minutes and 60 minutes following MT. * P<.0083 compared with baseline.
See this image and copyright information in PMC

References

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