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]
Language Czech Country Czech Republic Media print
Document type English Abstract, Journal Article, Randomized Controlled Trial
PubMed
20666328
- MeSH
- Anesthetics, Dissociative administration & dosage MeSH
- Atropine administration & dosage MeSH
- Cholecystectomy, Laparoscopic * MeSH
- Dexmedetomidine administration & dosage MeSH
- Double-Blind Method MeSH
- Fentanyl administration & dosage MeSH
- Hemodynamics drug effects MeSH
- Hypnotics and Sedatives administration & dosage MeSH
- Ketamine administration & dosage MeSH
- Anesthetics, Combined administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Meperidine administration & dosage MeSH
- Analgesics, Non-Narcotic MeSH
- Analgesics, Opioid administration & dosage MeSH
- Pain, Postoperative prevention & control MeSH
- Anesthesia Recovery Period MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Anesthetics, Dissociative MeSH
- Atropine MeSH
- Dexmedetomidine MeSH
- Fentanyl MeSH
- Hypnotics and Sedatives MeSH
- Ketamine MeSH
- Anesthetics, Combined MeSH
- Meperidine MeSH
- Analgesics, Non-Narcotic MeSH
- Analgesics, Opioid 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.
