Bhagat Nandlal, Yunus Md, Karim Habib Md Reazaul, Hajong Ranendra, Bhattacharyya Prithwis, Singh Manorama
Senior Resident, Department of Anaesthesiology, S N Medical College , Jodhpur, Rajasthan, India .
Additional Professor, Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong, Meghalaya, India .
J Clin Diagn Res. 2016 Nov;10(11):UC01-UC05. doi: 10.7860/JCDR/2016/21501.8815. Epub 2016 Nov 1.
Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period.
To evaluate the ability of pre and intraoperative dexmedetomidine to attenuate stress induced haemodynamic responses, quantifying the anaesthetic agents sparing as well as its cost-effectiveness in patients undergoing laparoscopic cholecystectomy.
The present single blind randomized study was conducted with 120 ASA I and II consented patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into 2 groups (i.e., group D and group N). Prior to induction, group D received 1 μg/kg of Dexmedetomidine and group N received Normal saline infusion over 20 minutes. Group D also received maintenance Dexmedetomidine intraoperatively. Bispectral index and minimum alveolar concentration monitoring was done in both the groups. Haemodynamic parameters were noted till 100 minutes post laryngoscopy. Opioid and anaesthetic agent consumptions were also noted and cost analysis was done. Medcalc-Version 12.5.0.0 software was used for statistics and p <0.05 was considered significant.
Dexmedetomidine attenuated the stress induced haemodynamics responses and produced stable, relatively non fluctuating haemodynamics throughout. The Minimum Alveolar Concentration (MAC) requirement and the consumptions of Fentanyl and Isoflurane were significantly less in the Dexmedetomidine group (p<0.0001). However, despite anaesthetic dose sparing effect the anaesthetic technique was not cost-effective.
Dexmedetomidine is effective in attenuating haemodynamic responses in laparoscopic surgery and having dose sparing effect on Fentanyl, Propofol and Isoflurane. However, overall this technique is not cost-effective.
围手术期操作会带来压力，并导致血流动力学不稳定，可能产生毁灭性后果。右美托咪定具有围手术期所需的许多理想特性。
评估术前及术中使用右美托咪定减轻应激诱导的血流动力学反应的能力，量化其节省麻醉药物的效果以及在接受腹腔镜胆囊切除术患者中的成本效益。
本单盲随机研究纳入了120例自愿接受腹腔镜胆囊切除术的美国麻醉医师协会（ASA）分级为I级和II级的患者。患者被随机分为两组（即D组和N组）。诱导前，D组接受1μg/kg右美托咪定，N组在20分钟内输注生理盐水。D组术中也接受右美托咪定维持治疗。两组均进行脑电双频指数和最低肺泡浓度监测。记录喉镜检查后100分钟内的血流动力学参数。还记录阿片类药物和麻醉药物的消耗量，并进行成本分析。使用Medcalc-12.5.0.0版软件进行统计学分析，p<0.05被认为具有统计学意义。
右美托咪定减轻了应激诱导的血流动力学反应，并在整个过程中产生稳定、相对波动较小的血流动力学。右美托咪定组的最低肺泡浓度（MAC）需求以及芬太尼和异氟烷的消耗量显著更低（p<0.0001）。然而，尽管有节省麻醉剂量的效果，但该麻醉技术并不具有成本效益。
右美托咪定在减轻腹腔镜手术中的血流动力学反应方面有效，并且对芬太尼、丙泊酚和异氟烷有剂量节省作用。然而，总体而言该技术不具有成本效益。
