Perioperative dexmedetomidine infusion in vascular surgery patients reduced postoperative tachycardia compared to placebo (e.g., 0.5 vs 23 min/h, P=0.004) but required more intraoperative vasoactive support.
RCT (n=24)
Does perioperative dexmedetomidine infusion improve hemodynamic stability in vascular surgery patients at high risk for coronary artery disease?
Perioperative dexmedetomidine infusion in high-risk vascular surgery patients reduces postoperative tachycardia but increases the need for intraoperative vasoactive support to maintain blood pressure.
BACKGROUND: Dexmedetomidine, a highly selective alpha 2-adrenergic agonist, increases perioperative hemodynamic stability in healthy patients but decreases blood pressure and heart rate. The goal of this study was to evaluate, in a preliminary manner, the hemodynamic effects of perioperatively administered dexmedetomidine in surgical patients at high risk for coronary artery disease. METHODS: Twenty-four vascular surgery patients received a continuous infusion of placebo or one of three doses of dexmedetomidine, targeting plasma concentrations of 0.15 ng/ml (low dose), 0.30 ng/ml (medium dose), or 0.45 ng/ml (high dose) from 1 h before induction of anesthesia until 48 h postoperatively. All patients received standardized anesthesia and hemodynamic management. Blood pressure, heart rate, and Holter ECG were monitored; additional monitoring included continuous 12-lead ECG preoperatively, anesthetic concentrations and myocardial wall motion (echocardiography) intraoperatively, and cardiac enzymes postoperatively. RESULTS: Preoperatively, there was a decrease in heart rate (low dose 11%, medium dose 5%, high dose 20%) and systolic blood pressure (low dose 3%, medium dose 12%, high dose 20%) in patients receiving dexmedetomidine. Intraoperatively, dexmedetomidine groups required more vasoactive medications to maintain hemodynamics within predetermined limits. Postoperatively, demedetomidine groups had less tachycardia (minutes/monitored hours) than the placebo group (placebo 23 min/h; low dose 9 min/h, P = 0.006; medium dose 0.5 min/h, P = 0.004; high dose 2.3 min/h, P = 0.004). Bradycardia was rare in all groups. There were no myocardial infarctions or discernible trends in the laboratory results. CONCLUSIONS: Infusion of dexmedetomidine up to a targeted plasma concentration of 0.45 ng/ml appears to benefit perioperative hemodynamic management of surgical patients undergoing vascular surgery but required greater intraoperative pharmacologic intervention to support blood pressure and heart rate.
Talke et al. (1995) conducted an RCT in Vascular surgery at high risk for coronary artery disease (n=24). Dexmedetomidine vs. Placebo was evaluated on Postoperative tachycardia (minutes/monitored hours). Perioperative dexmedetomidine infusion in vascular surgery patients reduced postoperative tachycardia compared to placebo (e.g., 0.5 vs 23 min/h, P=0.004) but required more intraoperative vasoactive support.