The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period

Zhao,Junhui; Zhou,Chuixian

doi:10.3892/etm.2016.3711

The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period

Authors:
- Junhui Zhao
- Chuixian Zhou
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Affiliations: Department of Anesthesiology, Weifang Medical University, Weifang, Shandong 261053, P.R. China, Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
Published online on: September 16, 2016 https://doi.org/10.3892/etm.2016.3711
Pages: 2903-2908
Copyright: © Zhao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to analyze the protective and hemodynamic effects of dexmedetomidine in hypertensive cerebral hemorrhage (HCH) patients during perioperative period. In total, 50 HCH patients were selected and randomly divided into two groups, one group was administered with dexmedetomidine and the other groups with midazolam. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were monitored in the two groups of patients before and during the operation. The MAP, HR, SpO2 and PETCO2 recorded 5 min after admission into the operation room was considered T1, the same parameters recorded 10 min after drug administration were considered T2, just after starting the operation were considered T3 and 30 min after start of operation were considered T4. The preoperative sedation and analgesia were evaluated by the Ramsay scoring method and the neuron‑specific enolase (NSE) and S100 protein (S100β) were estimated using ELISA. The patients of the midazolam group experienced mild respiratory depression during the period of sedation. Levels of, MAP, HR and PETCO2 were significantly increased whereas SPO2 was decreased (P<0.05). The MAP, HR, SPO2 and PETCO2 were stable during the period of sedation (P>0.05). The plasma concentrations of epinephrine and norepinephrine at T1 were similar in the two groups (P>0.05), but decreased after drug administration. This decrease was more prominent in the dexmedetomidine group patients (P<0.05) than midazolam group patients. The epinephrine and norepinephrine concentrations just after starting operation (T3) were higher than the basal level (T1) in the midazolam group, but close to the basal level in the dexmedetomidine group (P<0.05). The serum concentration of NSE and S100β in the two groups showed no difference (P>0.05) at the end of operation (T5), but after 24 h of operation (T7) NSE and S100β in the dexmedetomidine group were significantly lower compared to the midazolam group (P<0.05). In conclusion, the administration of dexmedetomidine for patients with HCH during perioperative period is safe and serves as an effective sedative, without causing respiratory depression and does not influence stable haemodynamics with certain brain protective effect.

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1	Chen ST, Chen SD, Hsu CY and Hogan EL: Progression of hypertensive intracerebral hemorrhage. Neurology. 39:1509–1514. 1989. View Article : Google Scholar : PubMed/NCBI
2	Murthy JM, Chowdary GV, Murthy TV, Bhasha PS and Naryanan TJ: Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care. 2:258–262. 2005. View Article : Google Scholar : PubMed/NCBI
3	Kanno T, Nagata J, Nonomura K, Asai T, Inoue T, Nakagawa T and Mitsuyama F: New approaches in the treatment of hypertensive intracerebral hemorrhage. Stroke. 24:I96–I100, I107-I108. 1993.PubMed/NCBI
4	Ma D, Hossain M, Rajakumaraswamy N, Arshad M, Sanders RD, Franks NP and Maze M: Dexmedetomidine produces its neuroprotective effect via the alpha 2A-adrenoceptor subtype. Eur J Pharmacol. 502:87–97. 2004. View Article : Google Scholar : PubMed/NCBI
5	Calderon LM, Guyette FX, Doshi AA, Callaway CW and Rittenberger JC: Combining NSE and S100B with clinical examination findings to predict survival after resuscitation from cardiac arrest. Resuscitation. 85:1025–1029. 2014. View Article : Google Scholar : PubMed/NCBI
6	Keating GM: Dexmedetomidine: A review of its use for sedation in the intensive care setting. Drugs. 75:1119–1130. 2015. View Article : Google Scholar : PubMed/NCBI
7	Gerlach AT and Dasta JF: Dexmedetomidine: An updated review. Ann Pharmacother. 41:245–252. 2007. View Article : Google Scholar : PubMed/NCBI
8	Bagatini A, Gomes CR, Masella MZ and Rezer G: Dexmedetomidine: Pharmacology and clinical application. Rev Bras Anestesiol. 52:606–617. 2002.(In Portuguese). View Article : Google Scholar : PubMed/NCBI
9	Su F and Hammer GB: Dexmedetomidine: Pediatric pharmacology, clinical uses and safety. Expert Opin Drug Saf. 10:55–66. 2011. View Article : Google Scholar : PubMed/NCBI
10	Sallinen J, Haapalinna A, Viitamaa T, Kobilka BK and Scheinin M: Adrenergic alpha2C-receptors modulate the acoustic startle reflex, prepulse inhibition, and aggression in mice. J Neurosci. 18:3035–3042. 1998.PubMed/NCBI
11	Brown BJ, Zakhary S, Rogers L, Ellis-Stoll C, Gable D and Ramsay MA: Use of dexmedetomidine versus general anesthesia for endovascular repair of abdominal aortic aneurysms. Proc (Bayl Univ Med Cent). 19:213–215. 2006.PubMed/NCBI
12	Naaz S and Ozair E: Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 8:E1–E4. 2014.
13	Coull JT, Jones ME, Egan TD, Frith CD and Maze M: Attentional effects of noradrenaline vary with arousal level: Selective activation of thalamic pulvinar in humans. Neuroimage. 22:315–322. 2004. View Article : Google Scholar : PubMed/NCBI
14	Eisenach JC, De Kock M and Klimscha W: alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology. 85:655–674. 1996. View Article : Google Scholar : PubMed/NCBI
15	Shehabi Y, Ruettimann U, Adamson H, Innes R and Ickeringill M: Dexmedetomidine infusion for more than 24 hours in critically ill patients: Sedative and cardiovascular effects. Intensive Care Med. 30:2188–2196. 2004. View Article : Google Scholar : PubMed/NCBI
16	Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, et al: Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 54:1136–1142. 1999. View Article : Google Scholar : PubMed/NCBI
17	Venn RM and Grounds RM: Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth. 87:684–690. 2001. View Article : Google Scholar : PubMed/NCBI
18	Tobias JD: Dexmedetomidine: Applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 8:115–131. 2007. View Article : Google Scholar : PubMed/NCBI
19	Snapir A, Posti J, Kentala E, Koskenvuo J, Sundell J, Tuunanen H, Hakala K, Scheinin H, Knuuti J and Scheinin M: Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects. Anesthesiology. 105:902–910; quiz 1069–1070. 2006. View Article : Google Scholar : PubMed/NCBI
20	Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A and Otelcioglu S: Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: Perioperative haemodynamics and anaesthetic requirements. Drugs R D. 7:43–52. 2006. View Article : Google Scholar : PubMed/NCBI
21	Chu KS, Wang FY, Hsu HT, Lu IC, Wang HM and Tsai CJ: The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation. Eur J Anaesthesiol. 27:36–40. 2010. View Article : Google Scholar : PubMed/NCBI
22	Magalhães E, Govêia CS, Ladeira LC and Espíndola BV: Relationship between dexmedetomidine continuous infusion and end-tidal sevoflurane concentration, monitored by bispectral analysis. Rev Bras Anestesiol. 54:303–310. 2004.(In Portuguese). View Article : Google Scholar : PubMed/NCBI
23	Khalil MA and Abdel AM: The impact of dexmedetomidine infusion in sparing morphine consumption in off-pump coronary artery bypass grafting. Semin Cardiothorac Vasc Anesth. 17:66–71. 2013. View Article : Google Scholar : PubMed/NCBI
24	Keniya VM, Ladi S and Naphade R: Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 55:352–357. 2011. View Article : Google Scholar : PubMed/NCBI
25	Bekker AY, Basile J, Gold M, Riles T, Adelman M, Cuff G, Mathew JP and Goldberg JD: Dexmedetomidine for awake carotid endarterectomy: Efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol. 16:126–135. 2004. View Article : Google Scholar : PubMed/NCBI
26	Arain SR and Ebert TJ: The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 95:461–466. 2002. View Article : Google Scholar : PubMed/NCBI