Kombinace dexmedetomidinu s ketaminem a opioidy významne potlacuje hemodynamické zmeny způsobené laparoskopickou cholecystektomií a prodluzuje trváiní pooperacní analgezie
[A combination of dexmedetomidine with ketamine and opioids results in significant inhibition of hemodynamic changes associated with laparoscopic cholecystectomy and in prolongation of postoperative analgesia]
Jazyk čeština Země Česko Médium print
Typ dokumentu anglický abstrakt, časopisecké články, randomizované kontrolované studie
PubMed
20666328
- MeSH
- anestetika disociativní aplikace a dávkování MeSH
- atropin aplikace a dávkování MeSH
- cholecystektomie laparoskopická * MeSH
- dexmedetomidin aplikace a dávkování MeSH
- dvojitá slepá metoda MeSH
- fentanyl aplikace a dávkování MeSH
- hemodynamika účinky léků MeSH
- hypnotika a sedativa aplikace a dávkování MeSH
- ketamin aplikace a dávkování MeSH
- kombinace anestetik aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- meperidin aplikace a dávkování MeSH
- neopioidní analgetika MeSH
- opioidní analgetika aplikace a dávkování MeSH
- pooperační bolest prevence a kontrola MeSH
- probouzení z anestezie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- anestetika disociativní MeSH
- atropin MeSH
- dexmedetomidin MeSH
- fentanyl MeSH
- hypnotika a sedativa MeSH
- ketamin MeSH
- kombinace anestetik MeSH
- meperidin MeSH
- neopioidní analgetika MeSH
- opioidní analgetika MeSH
THE AIM OF THE STUDY: Recently, alpha2 sympathoadrenergic drugs are used in premedication to improve the perioperative course. The aim of our study was to compare a premedication with a new alpha2 sympathoadrenergic drug and standard premedication. METHODS: After ethic committee approval and written patient consent, in a randomised, double-blinded study, combination of dexmedetomidine 1.0 microg x kg(-1) + ketamine 0.5 mg x kg(-1) + fentanyl 1.0 microg x kg(-1) + atropine 0.5 mg (group FNT), dexmedetomidine 1.0 microg x kg(-1) + ketamine 0.5 mg x kg(-1) + alfentanil 5.0 microg x kg(-1) + atropine 0.5 mg (group ALFNT), or pethidine 1.0 mg x kg(-1) + atropine 0.5 mg (group Dolsin) was administered to a deltoid muscle 15 min. before anaesthesia (GA) in patients elicited for laparoscopic cholecystectomy (LCHE). GA was performed in a standard way, ECG, NIBP, respiration rate, SpO2, onset of effect, Observers Assessment of Alertness Sedation Score (OAASS) before GA, circulatory reaction to intubation and capnoperitoneum, fentanyl consumption during GA, time to the first request for post-operative analgesia and postoperative nausea and vomiting were measured. The data were processed by Kruskal-Wallis and Fisher tests. P-value < 0.05 was considered significant. RESULTS: There were 16 patients in FNT and Dolsin and 15 patients in ALFNT with no differences in demography except for younger age in ALFNT. The main differences were in hypertension during capnoperitoneum: 0/16 FNT and 1/15 ALFNT vs. 11/16 Dolsin, both p < 0.001, per-operative fentanyl consumption: FNT 31.5 microg vs. Dolsin 165.0 microg, p < 0.001 and ALFNT 50.0 microg, p < 0.05 (ALFNT vs. Dolsin, p < 0.01) and request to the first analgesic post surgery: FNT 1.3 h. vs. Dolsin 0.45 h., p < 0.05 vs. ALFNT 0.8 h., p < 0.01. There were no differences in side effects except for bradycardia in ALFNT (p < 0.05). CONCLUSIONS: Dexmedetomidine-ketamine-fentanyl-atropine combination is superior to pethidine-atropine combination in suppressing of adverse hemodynamic effects of capnoperitoneum, decreased need for analgesia during GA and prolonged postoperative analgesia.
