Dexmedetomidine-ketamine intravenous sedation during local anaesthesia
Authors:
Málek Jiří 1; Hess Ladislav 2; Hrehorová Zuzana 1; Šklíba Vojtěch 1
Authors‘ workplace:
Klinika anesteziologie a resuscitace 3. LF UK Praha a FNKV
1; IKEM Praha
2
Published in:
Anest. intenziv. Med., 19, 2008, č. 2, s. 87-90
Category:
Anaesthesiology - Original Paper
Overview
Objective:
To evaluate the combination of dexmedetomidine and ketamine for analgesic sedation.
Design:
Prospective randomised clinical study.
Setting:
Department of Anaesthesiology and Intensive Care, University Hospital.
Materials and methods:
Patients scheduled for Dupuytren’s contracture repair under local anaesthesia were randomly divided to groups C and D. Group D patients were administered an infusion of dexmedetomidine 1 μg . ml⁻¹ and ketamine 1 mg . ml⁻¹ in normal saline as follows: 10 minutes before surgery a bolus of 0.04 ml . kg⁻¹ (e. g. dexmedetomidine 0.04 µg . kg⁻¹, ketamine 0.04 mg . kg⁻¹) was given, followed by infusion of 2 ml . kg⁻¹. h⁻¹ for the first 10 minutes (dexmedetomidine 2 μg . kg⁻¹ . h⁻¹, ketamine 2 mg . kg⁻¹ . h⁻¹) and 1 ml . kg⁻¹ . h⁻¹ (dexmedetomidine 1 μg . kg⁻¹ . h⁻¹, ketamine 1 mg . kg⁻¹ . h⁻¹) for the rest of surgery. Group C patients were given normal saline. Vital functions, analgesia and Ramsay score were measured.
Results:
There were 7 patients in group C and 8 patients in group D. The demographic characteristics were comparable between the groups. We found differences between groups C and D in Ramsay score (all group C patients scored 1 point vs. 7 group D patients scored 2 points and one patient scored 3 points, p < 0.001), absence of reaction to painful application of local anaesthetic and tourniquet (0 vs. 6, p = 0.02), amnesia (0 vs. 6, p = 0.02) and light-headedness 1 hour after surgery (0 vs. 7, p = 0.005). Five patients in group D remembered dreams (NS). There was a slight fall in blood pressure (25–30% below base-line) in 4 patients in group D (NS) and no change in ventilation.
Conclusions:
The combination of dexmedetomidine and ketamine provides analgesia, amnesia and catatonia with preserved cooperation, and has no respiratory effects.
Keywords:
analgesic sedation – dexmedetomidine – ketamine
Sources
1. Docherty, J. R. Subtypes of functional alpha-1 and alpha-2 adrenoceptors. Eur. J. Pharmacol., 1998, 361, p. 1–15.
2. Pandharipande, P., Ely, E. W., Maze, M. Alpha-2 agonists: can they modify the outcomes in the Postanesthesia Care Unit? Curr. Drug Targets, 2005, 6, p. 749–754.
3. Arain, S. R., Ebert, T. J. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth. Analg., 2002, 95, p. 461–466.
4. Hall, J. E., Uhrich, T. D., Barney, J. A. et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth. Analg., 2000, 90, p. 699–705.
5. Ebert, T. J., Hall, J. E., Barney, J. A. et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology, 2000, 93, p. 382–394.
6. Coursin, D. B., Coursin, D. B., Maccioli, G. A. Dexmedetomidine. Curr. Opin. Crit. Care, 2001, 7, p. 221–226.
7. Wahlander, S., Frumento, R. J., Wagener, G. et al. A prospective, double-blind, randomized, placebo-controlled study of dexmedetomidine as an adjunct to epidural analgesia after thoracic surgery. J. Cardiothorac. Vasc. Anesth., 2005, 19, p. 630–635.
8. Unlugenc, H., Gunduz, M., Guler, T. et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur. J. Anaesthesiol., 2005, 22, p. 386–391.
9. Correa-Sales, C., Rabin, B. C., Maze, M. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology, 1992, 76, p. 948–952.
10. Willigers, H. M., Prinzen, F. W., Roekaerts, P. M. Comparison of the effects of dexmedetomidine and esmolol on myocardial oxygen consumption in dogs. Eur. J. Anaesthesiol., 2004, 21, p. 957–966.
11. Málek, J., Hess, L., Starec, M., Vokálek, P. Clonidin při analgosedacích u korektivní a kosmetické chirurgie. Anesteziol. neodkl. Péče, 1997, 8, p. 134–136.
12. Britto, J. A., McCoy, D., Fourie, L. R. Clonidine as premedication for rhinoplasty. Plast. Reconstr. Surg., 1997, 100, p. 548–549.
13. Man, D. Premedication with oral clonidine for facial rhytidectomy. Plast. Reconstr. Surg., 1994, 94, p. 214–215.
14. Taittonen, M. T., Kirvela, O. A., Aantaa, R., Kanto, J. H. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br. J. Anaesth., 1997, 78, p. 400–406.
15. Bitar, G., Mullis, W., Jacobs, W. et al. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast. Reconstr. Surg., 2003, 111, p. 150–156.
16. Cortinez, L. I., Hsu, Y. W., Sum-Ping, S. T. et al. Dexmedetomidine pharmacodynamics: part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 2004, 101, p. 1077–1083.
17. Hsu, Y. W., Cortinez, L. I., Robertson, K. M. et al. Dexmedetomidine pharmacodynamics: part I: Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 2004, 101, p. 1066–1076.
18. Wijeysundera, D. N., Naik, J. S., Beattie, W. S. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am. J. Med., 2003, 114, p. 742–752.
19. Bekker, A. Y., Basile, J., Gold, M. et al. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J. Neurosurg. Anesthesiol., 2004, 16, p. 126–135.
20. Bekker, A., Sturaitis, M. K. Dexmedetomidine for neurological surgery. Neurosurgery, 2005, 57, Suppl., p. 1–10.
21. Guler, G., Akin, A., Tosun, Z. et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr. Anaesth., 2005, 15, p. 762–766.
22. Oliver, M. F., Goldman, L., Julian, D. G., Holme, I. Effect of mivazerol on perioperative cardiac complications during non--cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT). Anesthesiology, 1999, 91, p. 951–961.
23. Levanen, J., Makela, M. L., Scheinin, H. Dexmedetomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anesthesiology, 1995, 82, p. 1117–1125.
24. Málek, J., Hess, L., Jandová, J., Šimánková, E. Použití intramuskulárního podání dexmedetomidinu u popálených – předběžné výsledky. Anest. intenziv. Med. 2008, 19, č. 2, s. 82–86.
25. Bonnet, F., Marret, E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br. J. Anaesth., 2005, 95, p. 52–58.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2008 Issue 2
Most read in this issue
- Epidemiology of invasive candidiasis and candidemia – a persistent problem
- Tri-level pulmonary ventilation (3LV®) – initial clinical experience
- LMA-ProSeal™ laryngeal mask is a safe option for securing the airways for laparoscopic cholecystectomy
- The theory and simplified mathematical model of multi-level intermittent positive pressure ventilation