Dexmedetomidine and Desflurane Consumption
Study Details
Study Description
Brief Summary
The aim of this study is to calculate desflurane consumption when combined with intraoperative dexmedetomidine infusion guided by bispectral index (BIS)
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Forty patients will be randomly allocated into two equal groups as Group 'D' (Dexmedetomidine group) and Group 'P' (Placebo group) using computer generated random numbers. After arrival in the operating room, ondansetron 0.15 mg/kg intravenous (IV) will be given as a pre-medication. Ringer's acetate solution (500 ml) will be infused as a preload then at a rate of 6-8 ml/kg/h during surgery for supplying maintenance and deficit. Monitoring consisted of continuous electrocardiogram (EKG), non-invasive blood pressure (NIBP), pulse oximetry (SpO2), CO2 expired fraction (ETCO2), desflurane inspired fraction (FIdes), and desflurane expired fraction (ETdes) (Infinity Kappa, Dräger, Lübeck, Germany) will be attached to the patient. BIS module (InfinityR BISxTM SmartPodR, smoothing rate: 15 or 30 seconds, software revision: VF5) will also be attached for detection of consciousness level.
All patients will be preoxygenated with 100% oxygen for 3 minutes. The patients in group D will receive dexmedetomidine (2 ml diluted in 18 ml of saline) IV in a dose of 1 mcg/kg over10 minutes through infusion pump prior to induction. Group P patients will receive similar volume of normal saline over 10 min. The study drug and placebo infusions will be prepared by an anesthesiologist who is not involved in the study and the anesthesiologist recording the details is unaware of the type of infusion patients received. Anesthesia will be induced with IV fentanyl 1.5 μg/kg and propofol in a dose of 10 mg every 5 seconds until the BIS level dropped below 60 and confirmed with loss of response to verbal commands. In both groups, Atracurium 0.5 mg/kg IV will be administered, and trachea will be intubated. Fresh gas flow oxygen in air 30-40% at a rate of 3 L/min for 10 minutes will be administered then the flow will be decreased at a rate of 1 L/min using a closed system (Fabius GS, Dräger, Lübeck, Germany) and ventilation will be adjusted to maintain end-tidal carbon dioxide at 30-35 mmHg. Patients in study groups will receive the volatile agent at a concentration of 1 MAC (Minimum Alveolar Concentration). The MAC of desflurane is defined as an expired fraction of 6.0 vol%. Then the dial-up desflurane percentage will be adjusted to establish a BIS value between 40- 50. A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour made to 20 mL with normal saline will be administered in group D patients and a similar volume of normal saline will be administered in Group P, till the end of surgery. Top up doses of Atracurium will be given as needed. When heart rate and blood pressure exceeds 20% of baseline in spite of adequate level of anesthesia guided by BIS, boluses of 0.5 μg/kg will be given. While decrease in heart rate and blood pressure more than 20% of baseline, will be treated by ephedrine 5 mg.
In both groups, dexmedetomidine or saline will be stopped approximately 15-20 minutes before completion of surgery, diclofenac sodium 1 mg/kg will be given IM at the time of skin closure. Desflurane will be discontinued after skin closure in both groups. Reversal of neuromuscular blockade will be achieved with neostigmine 0.05 mg/kg and atropine 0.02 mg/kg. Tracheal extubation will be done when respiration is satisfactory and adequate muscle tone is achieved
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: Group 'D' Dexmedetomidine group Patients received dexmedetomidine (2 ml diluted in 18 ml of saline) IV in a dose of 1 mcg/kg over 10 minutes. A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour was infused. Ondansetron: 0.15 mg/kg intravenous preoperative. Fentanyl: 1.5 μg/kg intraoperative Propofol: 10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia. Atracurium: 0.5 mg/kg IV. Desflurane: 1 MAC concentration. Diclofenac sodium: 1 mg/kg for postoperative analgesia. |
Drug: Dexmedetomidine
A maintenance dose of Dexmedetomidine infusion at 0.5 mcg/kg/hour made to 20 mL with normal saline will be administered
Other Names:
Procedure: Ondansetron
0.15 mg/kg intravenous (IV) will be given as a pre-medication
Other Names:
Procedure: fentanyl
1.5 μg/kg intraoperative
Other Names:
Procedure: propofol
10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia
Other Names:
Procedure: Atracurium
0.5 mg/kg IV for endotracheal intubation
Other Names:
Procedure: diclofenac sodium
1 mg/kg for postoperative analgesia
Other Names:
Procedure: desflurane
1 MAC concentration (expired fraction of 6.0 vol%) for maintenance of anesthesia
Other Names:
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Placebo Comparator: Group 'P' Placebo group Patients received similar volume of normal saline as the bolus and maintenance infusion as group D. Ondansetron: 0.15 mg/kg intravenous preoperative. Fentanyl: 1.5 μg/kg intraoperative Propofol: 10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia. Atracurium: 0.5 mg/kg IV. Desflurane: 1 MAC concentration. Diclofenac sodium: 1 mg/kg for postoperative analgesia. |
Drug: Placebo
A maintenance dose of 20 mL with normal saline will be administered at a rate similar to that of dexmedetomidine
Other Names:
Procedure: Ondansetron
0.15 mg/kg intravenous (IV) will be given as a pre-medication
Other Names:
Procedure: fentanyl
1.5 μg/kg intraoperative
Other Names:
Procedure: propofol
10 mg every 5 seconds until the BIS level dropped below 60 for induction of anesthesia
Other Names:
Procedure: Atracurium
0.5 mg/kg IV for endotracheal intubation
Other Names:
Procedure: diclofenac sodium
1 mg/kg for postoperative analgesia
Other Names:
Procedure: desflurane
1 MAC concentration (expired fraction of 6.0 vol%) for maintenance of anesthesia
Other Names:
|
Outcome Measures
Primary Outcome Measures
- desflurane consumption (ml) [Intraoperative]
Calculation of desflurane consumption during the intraoperative period
Secondary Outcome Measures
- Heart Rate (Beat/min) [Intraoperative]
Recording of the heart rate during the intraoperative period before induction, after induction, after intubation, and then at 5, 10, 15, 30, 45, and 60 minute after intubation and at extubation.
- Blood Pressure (mm Hg) [Intraoperative]
Recording of the heart rate during the intraoperative period before induction, after induction, after intubation, and then at 5, 10, 15, 30, 45, and 60 minute after intubation and at extubation.
- Fentanyl consumption (ug) [Intraoperative]
Total intraoperative fentanyl consumption
Eligibility Criteria
Criteria
Inclusion Criteria:
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American Society of Anesthesiologists (ASA) status of I and II
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undergoing elective laparoscopic cholecystectomy
Exclusion Criteria:
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history of psychiatric/neurological illness
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cardiovascular disease
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morbid obese patients
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pregnant and nursing women
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known allergic reaction to any of the study medication
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recent use of sedatives or analgesics
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Theodor Bilharz Research Institute | Giza | Egypt | 12411 |
Sponsors and Collaborators
- Theodor Bilharz Research Institute
Investigators
- Study Director: Abla El Hadidy, PhD, Theodor Bilharz Research Institute
Study Documents (Full-Text)
None provided.More Information
Publications
- Harsoor SS, Rani DD, Lathashree S, Nethra SS, Sudheesh K. Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia. J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):25-30. doi: 10.4103/0970-9185.125693.
- Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology. 2000 Nov;93(5):1345-9. Review.
- Nishibe S, Imanishi H, Mieda T, Tsujita M. The effects of dexmedetomidine administration on the pulmonary artery pressure and the transpulmonary pressure gradient after the bidirectional superior cavopulmonary shunt. Pediatr Cardiol. 2015 Jan;36(1):151-7. doi: 10.1007/s00246-014-0979-2. Epub 2014 Aug 12.
- Anesthesia 110T