Organoprotective effects of the α2-adrenoreceptor agonist dexmedetomidine (literature review)

Vitik A.A.1, Shen N.P.2

Tyumen State Medical University, Tyumen

2 The branch of the Tomsk national research medical center “Tyumen Cardiology Research Center”, Tyumen

For correspondence: Shen N.P. — MD, Professor, head of Department of Obstetrics, Gynecology and critical care medicine with a course of KDL of the Institute of Continuing Professional Development of Tyumen State Medical University, Tyumen; e-mail: nataliashen@rambler.ru

For citation: Vitik A.A., Shen N.P. Organoprotective effects of the α2-adrenoreceptor agonist dexmedetomidine (literature review). Alexander Saltanov Intensive Care Herald. 2018;4:74–79.

DOI: 10.21320/1818-474X-2018-4-74-79


Currently, in experimental and clinical studies of critical states, scientists attend to the issues of protecting and preserving the functions of vital organs and systems. The pharmacological aspects of organoprotection with various drugs are considered separately. In this question, α2-adrenoreceptor agonists are of the greatest interest. The study is devoted to the analysis of domestic and foreign literature covering the efficacy of using dexmedetomidine adrenergic mimetic, its mechanisms of action and organ-preventive properties in ECMO patients with organic and mental disorders. Formulated aspects need to study the use of this drug in order to prevent neurocognitive and organ dysfunction in surgical and therapeutic patients who are in intensive care units.

Keywords: organoprotection, dexmedetomidine, α2-adrenoreceptor agonists, multiple organ dysfunction, delirium

Received: 05.10.2018


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Dexmedetomidine and Propofol Sedation in Carotid Endarterectomy Under Regional Anesthesia: What’s Better for the Patient? (Study of Patient Satisfaction)

D.I. Tomashchuk, D.V. Martynov, V.M. Zhenilo

Rostov State Medical University, Ministry of Healthcare of the Russian Federation, Rostov-on-Don

For correspondence: Dmitry Ivanovich Tomaschuk — Anesthesia and Intensive Care physician, Department of Anesthesiology and Intensive Care № 1, Rostov State Medical University, e-mail: trakrium12345@yandex.ru 

For citation: Tomashchuk DI, Martynov DV, Zhenilo VM. Dexmedetomidine and Propofol Sedation in Carotid Endarterectomy Under Regional Anesthesia: What’s Better for the Patient? (Study of Patient Satisfaction). Intensive Care Herald. 2017;4:36–41.


Introduction. Carotid endarterectomy under regional anesthesia with sedation allows to realize dynamic neurologic monitoring. The main drawback of this approach is patient’s discomfort. Thus, qualitative sedation at the operation of carotid endarterectomy in case of regional anesthesia is necessary. The use of dexmedetomidine as a basic preparation for perioperative sedation is especially interesting as it has a unique effect on the central nervous system. Material and methods. 112 patients were involved and divided into two groups: group № 1 (propofol group) and group № 2 (dexmedetomidine group) in proportion 53 vs 59. There were no differences between the groups (p = 0.36). In the group № 1 after performing regional anesthesia we started the propofol infusion (TCI) up to the target level of 1.7 mg/ml in plasma. The patents from group № 2 began to receive dexmedetomidine at the rate from 0.2 mkg/kg/h to 0.9–1 mkg/kg/h by the end of regional anesthesia. Patient’s satisfaction with anesthesia was assessed according to their answers to the questionnaire on the next day after the operation. Results. Almost two thirds of patients, 38 people (64.40 %), from group № 2 expressed their satisfaction (13–15 points) with anesthesia they received, while in the group № 1 only 11 people (20.75 %) got 13–15 points (p < 0.0001); 37 people (69.81 %) from group № 1 got 10–12 points and 19 people (32.20 %) from group № 2 (p = 0.0001). Less than 10 points (“unsatisfied”) were given by 5 (9.43 %) patients from group № 1, and 2 (3.38 %) patients from group № 2, there are no significant differences between the groups (p = 0.3). It should be mentioned that all patients who considered their presence in the operating room to be uncomfortable (3 people) had also a low sum of points (< 10), which indicates the imperfection of the offered questionnaire. Conclusion. Though the patients who received dexmedetomidine as a sedative agent, had a less deep sedation and had more memories of DNM stage, in total showed comparative satisfaction with the group receiving propofol. Moreover, there were significantly more patients completely satisfied with anesthesia in the dexmedetomidine group.

Keywords: dexmedetomidine, carotid endarterectomy, regional anesthesia with sedation, patient satisfaction

Received: 08.11.2017


References

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Modern Possibilities of Safe Use of Dexmedetomidine in Premedication for Endoscopic Cholecystectomy

I.Z. Kitiashvili1,2, V.Yu. Kireev1,2, S.V. Сhukarev1, D.I. Kitiashvili1, A.A. Salo1, I.I. Timirbulatov1

1 Astrakhan State Medical University Russian Ministry of Health, Astrakhan

2 Occupational Health Facility, Astrakhan 

For correspondence: I.Z. Kitiashvili — MD, professor, head of Department of Anesthesiology and Intensive Care of State Budget Educational Institution of Higher Professional Education “The Astrakhan State Medical University”, Astrakhan; e-mail: kitiashvili@mail.ru

For citation: Kitiashvili IZ, Kireev VYu, Сhukarev SV, Kitiashvili DI, Salo AA, Timirbulatov II. Modern Possibilities of Safe Use of Dexmedetomidine in Premedication for Endoscopic Cholecystectomy. Intensive Care Herald. 2017;3:42–47. 


Study objective. To assess the clinical efficacy of dexmedetomidine as part of a premedication protocol for elective laparoscopic surgery. Study design. This was a prospective, comparative, randomized study. Materials and methods. Patients undergoing elective laparoscopic cholecystectomy (n = 70) were divided into two groups. In Group I (n = 32) patients were given dexmedetomidine as a 1-hour intravenous infusion (4.0 μg/mL; 1.0 μg/kg/h) before anesthesia induction. In Group II (n = 38) patients received diazepam (10 mg) as an intramuscular injection 30 minutes before anesthesia induction. The following clinical and laboratory parameters were monitored during the perioperative period: peripheral hemodynamics, respiratory rate, saturation levels, arterial blood gases and acid-base status, serum glucose and cortisol. Time to post-anesthesia recovery was also evaluated. Study results. Monitoring of the parameters of peripheral hemodynamics, saturation levels, glycemia, arterial blood gases and acid-base status did not reveal any significant differences between the groups. In Group I, the following parameters differed from those in Group II with a significance level p < 0.05: time to full emergence (4.1 ± 1.1 vs. 12.2 ± 1.2 min), frequency of nausea and vomiting (2.6 % vs. 37.5 %), and frequency of chills and shivering (5.3 % vs. 46.9 %). Conclusion. Premedication with infusion of dexmedetomidine has no effect on hemodynamics or gas exchange, pro- vides good protection from stress, and ensures earlier emergence than conventional premedication with diazepam.

Keywords: premedication, dexmedetomidine, diazepam

Received: 28.02.2017


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Syndrome of Postnarcosis Excitation and its Prophylaxis in Anesthesia with Sevoflurane in Pediatric Oncology

S.V. Tumanyan, E.Yu. Semiletkina, D.A. Rozenko

Rostov Research Oncology Institute, Russian Federation Ministry of Healthcare of the Russian Federation, Rostov-on-Don

For correspondence: Tumanyan Sergey Vartanovich — MD, professor, head of the Department of Anesthesiology and Reanimatology of the Rostov Research Oncology Institute, Federal Ministry of Health, Rostov-on-Don; e-mail: stv53@mail.ru

For citation: Tumanyan SV, Semiletkina EYu, Rozenko DA. Syndrome of Postnarcosis Excitation and Its Prophylaxis in Anesthesia with Sevoflurane in Pediatric Oncology. Intensive Care Herald. 2017;2:31–36.


Sevoflurane is the «gold standard» in pediatric anesthesia, because Does not irritate the upper respiratory tract, has a cardioprotec- tive effect, is easily controlled. Along with this, sevoflurane also has side effects, of which the most interesting is the syndrome of post- narcotic excitement, expressed by expressed anxiety, motor excitement, negativism. For its prevention, dexmedetomidine can be used. The goal is to select the optimal method of prevention of post-nasal exacerbation syndrome (SPNV) in young children with oncological pathology with sevoflurane inhalation anesthesia. Materials and methods. 90 children with oncological pathology aged from 1 year to 4 years, body weight from 9 to 18 kg, physical status according to ASA II–III were examined. Depending on the method of prevention of SPNV, children were divided into three groups: 1st group of children who had undergone sevoflurane inhalation anesthesia; 2nd group of children who, after anesthesia with sevoflurane, received propofol, 3rd group — children who, prior to anesthesia with sevoflurane, intranasally injected dexmedetomidine. Conclusions. Administration of propofol at the end of inhalation with sevoflurane prevents the development of SPNV in children in 82.8% of cases, prolongs the phase of medicamentous sedation, reduces hypersympathicoto- nia. Short-term depression of respiration in response to the administration of propofol requires 100 % oxygen inhalation. Intranasal administration of dexmedetomidine 30 minutes prior to the onset of anesthesia prevents the development of SPNV in children after inhalation anesthesia with sevoflurane in 90% of cases.

Keywords: postnarcosis excitation syndrome, children, dexmedetomidine, sevoflurane, oncology

Received: 10.03.2017


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Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery

P.A. Volkov1,2, V.A. Guryanov1

1 Chair of Anesthesiology and Critical Care, State Federal-Funded Educational Institution of Higher Professional Training, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow

2 Closed Joint Stock Company Medical Rehabilitation Unit «Clinic K+31», Moscow

For correspondence: Pavel Aleksandrovich Volkov — anesthesiologist-resuscitator of Department of anesthesiology and reanimatology, JSC Inter Regional Center «Klinka K+31», Moscow; e-mail: volkovpavel@ymail.com

For citation: Volkov PA, Guryanov VA. Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery. Intensive Care Herald. 2017;2:26–30.


Adequacy of nonspecific perioperative adaptive reactions of the adaptation syndrome, in the first place, depends on the initial state and interaction of the autonomic nervous system. The satisfactory state of the regulation of physiological system, based on the principles of functional synergy and the relative antagonism of its sympathetic and parasympathetic components, can easily be disrupted by unbalanced pharmacological effects during anesthesia. As a result of autonomic dysfunction, regardless of the cause of its development, the initial or iatrogenic, adaptation failure may occur with the development of hemodynamic changes and postoperative complications. Recently, the number of publications by domestic and foreign authors that demonstrate the advantages of intraoperative use of a new selective alpha2-adrenoagonist drug, dexmedetomidine, has significantly increased. Nevertheless, the appointment of a drag with such pronounced effect on the autonomic nervous system, without regard to the initial vegetative status, can lead to catastrophic consequences. We conducted a comparative analysis of the relationship between changes in hemodynamic parameters and vegetative status during balanced anesthesia, where dexmedetomidine was used as part of the analgesia component. It has been shown that cholinolytic premedication and a decrease in the rate of dexmedetomidine administration in patients with parasympatotonia not only allow to avoid a decrease in the cardiac index during the operation, but also are accompanied by a physiologically more beneficial redistribution of blood circulation determinants. In addition, the results of the work indicate an unchanged quality of analgesia in the case of a decrease in the dose of dexmedetomidine in patients with parasympatotonia.

Keywords: autonomic nervous system, dexmedetomidine, multimodal analgesia

Received: 15.01.2017


References

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Dexmedetomidine as the Component of Multimodal Analgesia in Vitreoretinal Surgery

V.V. Berlinsky, V.Yu. Maksimov, L.A. Chumakov, S.A. Kozlov

State autonomous healthcare institution of Saratov region, Regional Ophthalmologic Hospital, Saratov 

For correspondence: Berlinsky Vadim Viktorovich — Candidate of Medical Sciences, Head of department of anaesthesiology and intensive care, State autonomous healthcare institution of Saratov region «Regional Ophthalmologic Hospital», Saratov; anaesthetist and expert in resuscitation, Clinical Hospital n.a. S.R. Mirotvortsev of Saratov State Medical University, Saratov; e-mail: berlinsk64@mail.ru

For citation: Berlinsky VV, Maksimov VYu, Chumakov LA, Kozlov SA. Dexmedetomidine as the Component of Multimodal Analgesia in Vitreoretinal Surgery. Intensive Care Herald. 2017;1:28–31.


The study of efficacy and safety of using of the dexmedetomidine related to the group of central agonists of α2-adrenoceptor as the component of multimodal analgesia in vitreoretinal surgery was carried out. For this purpose 2 groups of patients after vitreoretinal surgical interventions were examined prospectively. Evaluation of anesthesia adequacy was performed using the following parameters: depth of sedation level and consciousness depression, which were estimated by means of Richmond Agitation-Sedation Scale. The degree of collaboration with physician was also evaluated. Monitoring of arterial pressure, heart rate, respiratory rate and SpO2 were conducted. Assessment of pain syndrome was performed with use of verbal descriptive scale of pain intraoperatively and at early postoperative period. The perioperative consumption of fentanyl was taken into consideration. Analysis of the results allowed to conclude that the usage of dexmedetomidine reduced perioperative consumption of opioid analgesics and severity of hemodynamic responses, it helped to maintain consciousness at a comfortable level both for patients and operators.

Keywords: dexmedetomidine, multimodal analgesia, agonist α2-adrenoceptor, anesthesia in ophthalmosurgery

Received: 26.01.2017


References

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Stress response during combined anaesthesia xenon and dexmedetomidine in radical surgery for gastric cancer

V.V. Faltin, S.V. Avdeev, S.G. Afanasiev, K.V. Shalygina, I.P. Puteev

Cancer Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk

For correspondence: Vladimir V. Faltin — junior researcher of the Department of anesthesiology and critical care of the Cancer Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences; e-mail: faltin.vladimir@yandex.ru

For citation: Faltin VV, Avdeev SV, Afanas’ev SG, et al. Stress response during combined anaesthesia xenon and dexmedetomidine in radical surgery for gastric cancer. Alexander Saltanov Intensive Care Herald. 2018;2:40–5.

DOI: 10.21320/1818-474X-2018-2-40-45


The prospective randomized study included 53 patients with operable II–III stage gastric cancer. The age range was from 26 to 75 years. The patients underwent gastrectomy (n = 21) and subtotal distal gastrectomy (n = 32). The study group comprised 27 patients who received anesthesia with xenon and dexmedetomidine combined with epidural analgesia. The control group consisted of 26 patients who received anesthesia with sevoflurane in combination with epidural analgesia. The effectiveness of the compared methods of anesthesia was assessed by the parameters of hemodynamic, oxygenation, hormone level and cytokine profile. In the perioperative period, the combination of xenon and dexmedetomidine in combination with epidural analgesia was characterized by significant inhibition of systemic inflammatory reactions and a lower release of stress hormones as components of a surgical stress response. The use of the combination of xenon and dexmedetomidine during surgery for gastric cancer provides a more adequate course of the perioperative period.

Keywords: xenon, dexmedetomidine, a cytokine, surgical stress, stomach cancer

Received: 20.03.2017


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