Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in patients undergoing lower limb surgeries: A randomized controlled study

Hsuan Chih Lao, Pei Shan Tsai, Jung Yuan Su, Tiew Guan Kwok, Chun Jen Huang

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Activation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia. Materials and methods: We included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg-1 over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg-1.h -1) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine. Results: Tourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P <0.001), systolic arterial pressure (P = 0.002), mean arterial pressure (P = 0.042), diastolic arterial pressure (P = 0.012), rate pressure product (P <0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable. Conclusions: Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries.

Original languageEnglish
JournalJournal of Surgical Research
Volume179
Issue number1
DOIs
Publication statusPublished - Jan 2013

Fingerprint

Dexmedetomidine
Tourniquets
Lower Extremity
Arterial Pressure
Economic Inflation
General Anesthesia
Blood Pressure
Control Groups
Hemodynamics
Cardiac Output
Stroke Volume
Heart Rate
Sympatholytics
Pressure
Adrenergic Agonists
Cardiac Volume
Sympathetic Nervous System
Placebos

Keywords

  • Dexmedetomidine
  • Hypertension
  • Lower limb
  • Orthopedic surgery
  • Tourniquet

ASJC Scopus subject areas

  • Surgery

Cite this

@article{4d411cad972b4c8ab36173de051be832,
title = "Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in patients undergoing lower limb surgeries: A randomized controlled study",
abstract = "Background: Activation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia. Materials and methods: We included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg-1 over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg-1.h -1) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine. Results: Tourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P <0.001), systolic arterial pressure (P = 0.002), mean arterial pressure (P = 0.042), diastolic arterial pressure (P = 0.012), rate pressure product (P <0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable. Conclusions: Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries.",
keywords = "Dexmedetomidine, Hypertension, Lower limb, Orthopedic surgery, Tourniquet",
author = "Lao, {Hsuan Chih} and Tsai, {Pei Shan} and Su, {Jung Yuan} and Kwok, {Tiew Guan} and Huang, {Chun Jen}",
year = "2013",
month = "1",
doi = "10.1016/j.jss.2012.01.008",
language = "English",
volume = "179",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
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T1 - Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in patients undergoing lower limb surgeries

T2 - A randomized controlled study

AU - Lao, Hsuan Chih

AU - Tsai, Pei Shan

AU - Su, Jung Yuan

AU - Kwok, Tiew Guan

AU - Huang, Chun Jen

PY - 2013/1

Y1 - 2013/1

N2 - Background: Activation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia. Materials and methods: We included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg-1 over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg-1.h -1) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine. Results: Tourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P <0.001), systolic arterial pressure (P = 0.002), mean arterial pressure (P = 0.042), diastolic arterial pressure (P = 0.012), rate pressure product (P <0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable. Conclusions: Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries.

AB - Background: Activation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia. Materials and methods: We included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg-1 over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg-1.h -1) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine. Results: Tourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P <0.001), systolic arterial pressure (P = 0.002), mean arterial pressure (P = 0.042), diastolic arterial pressure (P = 0.012), rate pressure product (P <0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable. Conclusions: Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries.

KW - Dexmedetomidine

KW - Hypertension

KW - Lower limb

KW - Orthopedic surgery

KW - Tourniquet

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