The Effect of Dexmedetomidine on Hemodynamic Response During Double Lumen Endotracheal Intubation

The Effect of Prophylactic Dexmedetomidine on Hemodynamic Disturbances During Double Lumen Endotracheal Intubation. A Double-blinded, Randomized, Placebo-Controlled Trial.

The purpose of this study is to evaluate the effect of dexmedetomidine on hemodynamic responses during laryngoscopy and double lumen endotracheal intubation and assess the adverse effect related to complications of dexmedetomidine.

The cardiovascular responses to laryngoscopy and tracheal intubation are mediated by both sympathetic and parasympathetic nervous system. The hemodynamic responses resulting from sympathetic nervous system stimulation are tachycardia, cardiac arrhythmias, hypertension, increased intraocular pressure, increased intracranial pressure, bronchospasm and myocardial ischemia. Tachycardia is one of the major predictor of intraoperative myocardial ischemia and causes an imbalance of myocardial oxygen supply and demand. Although hemodynamic responses to laryngoscopy and intubation is transient, these effect may be harmful to patients suffering from myocardial and cerebrovascular diseases. The placement of double lumen endotracheal tube may produce similar or greater pressor response than endotracheal tube because of larger sizes and greater carinal stimulation.

Intubation Complication, Tracheal Intubation Morbidity, Anesthesia Intubation Complication, Hypertension, High Blood Pressure, Tachycardia

(day 1) before induction, before intubation and every minute for the first 10 minutes after endotracheal intubation

(day 1) before induction, before intubation and every minute for the first 10 minutes after endotracheal intubation

(day 1) before induction, before intubation and every minute for the first 10 minutes after endotracheal intubation

(day 1) before induction, before intubation and every minute for the first 10 minutes after endotracheal intubation

Inclusion Criteria: ASA Physical Status I-III Undergoing Elective Thoracotomy or Thoracoscopy Required Left Sided-double Lumen Endotracheal Intubation Exclusion Criteria: Patients with bradycardia (heart rate < 50 beat per minute) or heart block Suspected of Difficult Intubation Patients Who Are at Risk for Rapid Change of Hemodynamics Allergic to Dexmedetomidine Hepatic or Renal Impairment (Preoperative Serum Creatinine > 1.5 mg/dl) Pregnancy

Department of Anesthesiology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand,50200

Basar H, Akpinar S, Doganci N, Buyukkocak U, Kaymak C, Sert O, Apan A. The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters. J Clin Anesth. 2008 Sep;20(6):431-6. doi: 10.1016/j.jclinane.2008.04.007.

Maguire A, Thompson JP, Guest C, Sadler PJ, Strupish JW, West KJ. Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double-lumen endobronchial intubation. Anaesthesia. 2001 Apr;56(4):319-25. doi: 10.1046/j.1365-2044.2001.01917.x.

Pipanmekaporn T, Punjasawadwong Y, Charuluxananan S, Lapisatepun W, Bunburaphong P. The effect of prophylactic dexmedetomidine on hemodynamic disturbances to double-lumen endotracheal intubation: a prospective, randomized, double-blind, and placebo-controlled trial. Anesthesiol Res Pract. 2013;2013:236089. doi: 10.1155/2013/236089. Epub 2013 Jul 29.