Hemodynamic and coronary vascular effects of dexmedetomidine in the anesthetized goat

Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study

BACKGROUND

Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with haematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension and may reduce blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries.

METHODS

The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level; intraoperative heart rate and blood pressure (T1: at incision; T2: 30 min after incision; T3: 60 min after incision; T4: 120 min after incision); dosage of fentanyl, remifentanil, urapidil, and esmolol; operation time; and incidence of allogeneic blood transfusion.

RESULTS

A total of 1247 patients were included in this study, and 540 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1-T4, blood pressure at T1, and remifentanil and esmolol dosage in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group.

CONCLUSIONS

Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery.

TRIAL REGISTRATION

ChiCTR1800018794 (retrospectively registered) Name of registry: Chinese Clinical Trial Registry Date of registration: 2018/10/09 URL: www.chictr.org.cn/showproj.aspx?proj=30612.

Inhibition and facilitation of nociceptively evoked muscular activity by fentanyl or dexmedetomidine in isoflurane-anaesthetized pigs

OBJECTIVE

To investigate motor and cardiovascular responses to dexmedetomidine or fentanyl in isoflurane-anaesthetized pigs.

STUDY DESIGN

Experimental, balanced, block randomized, two-group design.

ANIMALS

A group of 16 crossbred pigs, 55 ± 8 days (mean ± standard deviation) old.

METHODS

Deltoid electromyography (EMG) was recorded during isoflurane anaesthesia. Electrical stimulation using 5, 10, 20 and 40 mA of the distal right thoracic limb elicited a nociceptive withdrawal reflex (NWR), quantified by the area under the curve (AUC) for the simulation intensity versus EMG amplitude response curve. Latency to movement evoked by clamping a claw for maximum 60 seconds was noted. Arterial blood pressure and pulse rate were recorded. Data were sampled at baseline and during dexmedetomidine 0.25, 0.5, 1.0, 2.0, 4.0 and 8.0 μg kg^-1 hour^-1 or fentanyl 5, 10, 20, 40, 80 and 160 μg kg^-1 hour^-1 infusions. The influence of infusion rate on NWR AUC and spontaneous EMG was analysed using a mixed model, with p < 5%.

RESULTS

NWR AUC increased at fentanyl 5 μg kg^-1 hour^-1 but decreased at fentanyl 40, 80 and 160 μg kg^-1 hour^-1 and dexmedetomidine 4.0 and 8.0 μg kg^-1 hour^-1. All pigs at fentanyl 80 μg kg^-1 hour^-1, and three pigs at dexmedetomidine 8.0 μg kg^-1 hour^-1 had mechanical latencies greater than 60 seconds. Spontaneous EMG activity increased accompanied by visually evident 'shivering' at fentanyl 5, 10 and 20 μg kg^-1 hour^-1 but decreased at dexmedetomidine 2, 4 and 8 μg kg^-1 hour^-1. Clinically relevant effects of increasing infusion rates on blood pressure or pulse rate were not observed.

CONCLUSION AND CLINICAL RELEVANCE

If anaesthetic plane or antinociception is evaluated in pigs, response to claw clamping and NWR will not necessarily give uniform results when comparing drugs. If only one method is used, results should be interpreted cautiously.

Dexmedetomidine attenuates hypoxia/reoxygenation injury in primary neonatal rat cardiomyocytes

Systemic administration of dexmedetomidine provides cardioprotection against ischemia/reperfusion (I/R) injury; however, the direct effects of dexmedetomidine on cardiomyocytes have not been clarified. The present study investigated the effects of dexmedetomidine on primary neonatal rat cardiomyocytes under hypoxic/reoxygenation (H/R) conditions. In order to simulate in vivo I/R injury, primary neonatal rat cardiomyocytes were cultured under hypoxic conditions for 1 h and subsequently reoxygenated for 24 h. The effects of preconditioning with dexmedetomidine 2 h before hypoxia and postconditioning during reoxygenation were also examined. Cellular viability and activity were analyzed by monitoring the dynamic response profile of living cells using a real-time cell analyzer system. A special scaled index, defined as the normalized cell index (NCI), was used to minimize the influence of inter-experimental variations. The dose-effect curve was generated from the area under the time-course curve values of NCI. H/R exposure markedly decreased cell viability and activity. Furthermore, no cytotoxicity was associated with a clinically relevant concentration of dexmedetomidine. Preconditioning with dexmedetomidine concentration-dependently ameliorated the reductions in NCI in cardiomyocytes following H/R injury. Additionally, postconditioning with dexmedetomidine improved the reductions in NCI at concentrations between 3 and 200 nM. Finally, the effect of 3–40 nM dexmedetomidine postconditioning was greater than preconditioning. These results indicated that preconditioning and postconditioning with dexmedetomidine attenuated H/R injury in primary neonatal rat cardiomyocytes at the cellular level.

Physiologic and biochemical effects of electroacupuncture combined with intramuscular administration of dexmedetomidine to provide analgesia in goats

OBJECTIVE

To investigate physiologic and biochemical effects of electroacupuncture and dexmedetomidine administration to goats.

ANIMALS

30 healthy adult goats.

PROCEDURES

Goats were allotted to 5 groups (6 goats/group) and received electroacupuncture, dexmedetomidine (5 or 20 μg/kg, IM), electroacupuncture plus dexmedetomidine (5 μg/kg, IM), or saline (0.9% NaCl) solution (IM [control treatment]). Pain threshold, cardiorespiratory effects, rectal temperature, and hematologic and biochemical variables were assessed.

RESULTS

Dexmedetomidine (20 μg/kg) increased pain threshold and decreased heart rate, respiratory rate, and rectal temperature. Pain threshold of goats receiving electroacupuncture plus dexmedetomidine (5 μg/kg) was higher than that of goats receiving electroacupuncture or of goats receiving dexmedetomidine at 5 μg/kg at 30 minutes, but did not differ from that of goats receiving dexmedetomidine at 20 μg/kg. Compared with goats administered dexmedetomidine at 20 μg/kg, goats receiving electroacupuncture plus dexmedetomidine at 5 μg/kg had a higher heart rate from 30 to 60 minutes and a higher respiratory rate from 5 to 60 minutes. Electroacupuncture plus dexmedetomidine (5 μg/kg) did not affect rectal temperature. Serum glucose concentrations of goats receiving electroacupuncture plus dexmedetomidine (5 μg/kg) were higher than for goats receiving dexmedetomidine at 5 μg/kg at 30 minutes but not for goats receiving dexmedetomidine at 20 μg/kg. Creatinine and BUN concentrations, alanine or aspartate aminotransferase activities, and hematologic variables of treated goats did not change.

CONCLUSIONS AND CLINICAL RELEVANCE

Electroacupuncture in combination with a low dose of dexmedetomidine (5 μg/kg, IM) administered to goats provided antinociception.

Dexmedetomidine inhibits vasoconstriction via activation of endothelial nitric oxide synthase

Despite the complex vascular effects of dexmedetomidine (DEX), its actions on human pulmonary resistance arteries remain unknown. The present study tested the hypothesis that DEX inhibits vascular tension in human pulmonary arteries through the endothelial nitric oxide synthase (eNOS) mediated production of nitric oxide (NO). Pulmonary artery segments were obtained from 62 patients who underwent lung resection. The direct effects of DEX on human pulmonary artery tension and changes in vascular tension were determined by isometric force measurements recorded on a myograph. Arterial contractions caused by increasing concentrations of serotonin with DEX in the presence or absence of L-NAME (endothelial nitric oxide synthase inhibitor), yohimbine (α₂-adrenoceptor antagonist) and indomethacin (cyclooxygenase inhibitor) as antagonists were also measured. DEX had no effect on endothelium-intact pulmonary arteries, whereas at concentrations of 10^–8~10^–6 mol/L, it elicited contractions in endothelium-denuded pulmonary arteries. DEX (0.3, 1, or 3×10^–9 mmol/L) inhibited serotonin-induced contraction in arteries with intact endothelium in a dose-dependent manner. L-NAME and yohimbine abolished DEX-induced inhibition, whereas indomethacin had no effect. No inhibitory effect was observed in endothelium-denuded pulmonary arteries. DEX-induced inhibition of vasoconstriction in human pulmonary arteries is mediated by NO production induced by the activation of endothelial α₂-adrenoceptor and nitric oxide synthase.

Age-related effects of dexmedetomidine on myocardial contraction and coronary circulation in isolated guinea pig hearts

Dexmedetomidine is a selective α2 adrenergic agonist. Although dexmedetomidine is widely used for sedation and analgesia, it frequently produces hypotension and bradycardia. The present study aimed to evaluate the effects of dexmedetomidine on cardiac function and coronary circulation using Langendorff-perfused guinea pig hearts. Coronary perfusion pressure (CPP) and left ventricular pressure (LVP) were continuously monitored, and electric field stimulation (EFS) was applied to stimulate sympathetic nerve terminals. Dexmedetomidine almost completely inhibited the EFS-induced increase in LVP at all ages. The effect of dexmedetomidine on coronary artery resistance varied according to postnatal age, i.e., dexmedetomidine had little effect on CPP in young hearts (<4 weeks) but increased CPP by 10 mmHg at 4-8 weeks and by 15 mmHg at >8 weeks. The increase in CPP in adult hearts was inhibited by imiloxan, an α2B antagonist, and prazosin, an α1 antagonist. The results suggest that dexmedetomidine acts on α2 adrenergic receptors at sympathetic nerve terminals to suppress the release of norepinephrine. In addition, the findings suggest that dexmedetomidine directly affects α1 adrenoceptors and/or α2B adrenoceptors on coronary smooth muscles to increase CPP. The age-related changes in α adrenoceptor subtypes may be linked to the cardiodepressant effects of dexmedetomidine.

Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery

Background

In endoscopic sinus surgery, visualization of the surgical field is a major concern, as surgical bleeding is the cause of many complications. The purpose of this study was to compare the effects of dexmedetomidine and remifentanil on the visualization of the surgical field in endoscopic sinus surgery.

Methods

Forty-three patients were prospectively enrolled and randomly allocated to the dexmedetomidine or remifentanil group and general anesthesia was induced and maintained using a propofol target-controlled infusion. In the dexmedetomidine group, dexmedetomidine was loaded for 5 min and a continuous infusion was administered. In the remifentanil group, a remifentanil target-controlled infusion was used. After completion of the operation, the satisfaction with the visualization of the surgical field was assessed on a numeric rating scale, from 0 (= worst) to 10 (= best). The mean blood pressure, heart rate, recovery profiles, and postoperative pain score were recorded.

Results

Satisfaction score for visualization by numeric rating scale was not significantly different between the two groups (P = 0.95). There were no differences in the mean blood pressure and heart rate. The extubation time was significantly shorter in the dexmedetomidine group (8.4 ± 1.8 min) than in the remifentanil group (11.9 ± 5.4 min) (P = 0.04). Except for the extubation time, the recovery profiles of the two groups were comparable.

Conclusions

Continuous infusions of dexmedetomidine provide a similar visualization of the surgical field and hemodynamic stability as remifentanil target-controlled infusions in patients undergoing endoscopic sinus surgery.

Dexmedetomidine-induced contraction involves c-Jun NH2 -terminal kinase phosphorylation through activation of the 5-lipoxygenase pathway in the isolated endothelium-denuded rat aorta

Vasoconstriction induced by dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist, mainly involves c-Jun NH2 -terminal kinase (JNK) phosphorylation in the isolated endothelium-denuded aorta. We carried out an in vitro study to determine the main arachidonic acid metabolic pathway that is involved in dexmedetomidine-induced JNK activation. Cumulative dexmedetomidine concentration-contractile response curves were generated in the endothelium-denuded rat aorta in the presence or absence of the following inhibitors: the JNK inhibitor SP600125, the phospholipase A2 inhibitor quinacrine dihydrochloride, the non-specific lipoxygenase (LOX) inhibitor nordihydroguaiaretic acid, the 5-LOX inhibitor AA-861, the dual 5-LOX and cyclooxygenase (COX) inhibitor phenidone, the non-specific COX inhibitor indomethacin, the cytochrome p450 epoxygenase inhibitor fluconazole, the COX-1 inhibitor SC-560, and the COX-2 inhibitor NS-398. The effect of the alpha-2 adrenoceptor inhibitor rauwolscine and other inhibitors, such as quinacrine dihydrochloride, nordihydroguaiaretic acid, AA-861, phenidone, indomethacin and the protein kinase C inhibitor GF 109203X, on dexmedetomidine-induced JNK phosphorylation was investigated in rat aortic vascular smooth muscle cells with western blotting. The effect of dexmedetomidine on 5-LOX and COX-2 expression was investigated in vascular smooth muscle cells. SP600125, quinacrine dihydrochloride, nordihydroguaiaretic acid, AA-861, phenidone, rauwolscine and chelerythrine attenuated dexmedetomidine-induced contraction. Indomethacin slightly attenuated dexmedetomidine-induced contraction. Fluconazole and SC-560 had no effect on dexmedetomidine-induced contraction, whereas NS-398 attenuated contraction. SP600125, rauwolscine, quinacrine dihydrochloride, nordihydroguaiaretic acid, AA-861, phenidone and GF 109203X attenuated dexmedetomidine-induced JNK phosphorylation. 5-LOX and COX-2 were upregulated by dexmedetomidine. Thus, dexmedetomidine-induced alpha-2 adrenoceptor-mediated contraction is mediated mainly by 5-LOX and partially by COX-2, which leads to JNK phosphorylation.

Dexmedetomidine-Induced Contraction in the Isolated Endothelium-Denuded Rat Aorta Involves PKC-δ-mediated JNK Phosphorylation

Vasoconstriction mediated by the highly selective alpha-2 adrenoceptor agonist dexmedetomidine leads to transiently increased blood pressure and severe hypertension. The dexmedetomidine-induced contraction involves the protein kinase C (PKC)-mediated pathway. However, the main PKC isoform involved in the dexmedetomidine-induced contraction remains unknown. The goal of this in vitro study was to examine the specific PKC isoform that contributes to the dexmedetomidine-induced contraction in the isolated rat aorta. The endothelium-denuded rat aorta was suspended for isometric tension recording. Dexmedetomidine dose-response curves were generated in the presence or absence of the following inhibitors: the pan-PKC inhibitor, chelerythrine; the PKC-α and -β inhibitor, Go6976; the PKC-α inhibitor, safingol; the PKC-β inhibitor, ruboxistaurin; the PKC-δ inhibitor, rottlerin; the c-Jun NH2-terminal kinase (JNK) inhibitor, SP600125; and the myosin light chain kinase inhibitor, ML-7 hydrochloride. Western blot analysis was used to examine the effect of rottlerin on dexmedetomidine-induced PKC-δ expression and JNK phosphorylation in rat aortic vascular smooth muscle cells (VSMCs) and to investigate the effect of dexmedetomidine on PKC-δ expression in VSMCs transfected with PKC-δ small interfering RNA (siRNA) or control siRNA. Chelerythrine as well as SP600125 and ML-7 hydrochloride attenuated the dexmedetomidine-induced contraction. Go6976, safingol, and ruboxistaurin had no effect on the dexmedetomidine-induced contraction, whereas rottlerin inhibited the dexmedetomidine-induced contraction. Dexmedetomidine induced PKC-δ expression, whereas rottlerin and PKC-δ siRNA transfection inhibited dexmedetomidine-induced PKC-δ expression. Dexmedetomidine also induced JNK phosphorylation, which was inhibited by rottlerin. Taken together, these results suggest that the dexmedetomidine-induced contraction involves PKC-δ-dependent JNK phosphorylation in the isolated rat aorta.

Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients

Laparoscopic cholecystectomy is performed with increasing frequency in aging populations. However, in elderly patients, cognitive dysfunction following surgery may impair the outcome of surgical procedures. Dexmedetomidine (DEX) has been demonstrated to have a neuroprotectve effect in animal experiments. However, it is unclear whether DEX also has a neuroprotective effect in human patients. The present study was a randomized, placebo-controlled double-blind trial of 126 patients who had undergone laparoscopic cholecystectomy, using clinical interviews to determine whether intravenously administrated DEX during general anesthesia ameliorates cognitive function impairment. The cognitive deficit of each patient was assessed using the Mini-Mental State Examination (MMSE). The scores on the MMSE for the DEX and control groups one week after surgery (DEX group, 27.6±1.2; control group, 25.7±1.5) were significantly different (P=0.005). The MMSE scores of patients ≤65 years old were significantly higher than those of patients >65 one week after surgery. The MMSE scores were significantly different between the two age groups in the control patients (≤65 years old, 28.3±1.2; >65 years old, 26.6±2.1; P=0.036), while the difference was not statistically significant in the DEX-treated patients. Eight patients in the DEX group and 15 patients in the control group had mild cognitive impairment (26≥ MMSE score ≥21) although the difference was not statistically significant. The findings of the present study support the hypothesis that DEX administration may be an effective method for ameliorating postoperative cognitive impairment in elderly patients who have undergone laparoscopic cholecystectomy. Further research is required to confirm the findings of the present study.

c-Jun NH₂-terminal kinase contributes to dexmedetomidine-induced contraction in isolated rat aortic smooth muscle

PURPOSE

Dexmedetomidine, a full agonist of α2B-adrenoceptors, is used for analgesia and sedation in the intensive care units. Dexmedetomidine produces an initial transient hypertension due to the activation of post-junctional α2B-adrenoceptors on vascular smooth muscle cells (SMCs). The aims of this in vitro study were to identify mitogen-activated protein kinase (MAPK) isoforms that are primarily involved in full, α2B-adrenoceptor agonist, dexmedetomidine-induced contraction of isolated rat aortic SMCs.

MATERIALS AND METHODS

Rat thoracic aortic rings without endothelium were isolated and suspended for isometric tension recording. Cumulative dexmedetomidine (10⁻⁹ to 10⁻⁶ M) dose-response curves were generated in the presence or absence of extracellular signal-regulated kinase (ERK) inhibitor PD 98059, p38 MAPK inhibitor SB 203580, c-Jun NH₂-terminal kinase (JNK) inhibitor SP 600125, L-type calcium channel blocker (verapamil and nifedipine), and α₂-adrenoceptor inhibitor atipamezole. Dexmedetomidine-induced phosphorylation of ERK, JNK, and p38 MAPK in rat aortic SMCs was detected using Western blotting.

RESULTS

SP 600125 (10⁻⁶ to 10⁻⁵ M) attenuated dexmedetomidine-evoked contraction in a concentration- dependent manner, whereas PD 98059 had no effect on dexmedetomidine- induced contraction. SB 203580 (10⁻⁵ M) attenuated dexmedetomidine-induced contraction. Dexmedetomidine-evoked contractions were both abolished by atipamezole and attenuated by verapamil and nifedipine. Dexmedetomidine induced phosphorylation of JNK and p38 MAPK in rat aortic SMCs, but did not induce phosphorylation of ERK.

CONCLUSION

Dexmedetomidine-induced contraction involves a JNK- and p38 MAPK-mediated pathway downstream of α₂-adrenoceptor stimulation in rat aortic SMCs. In addition, dexmedetomidine-induced contractions are primarily dependent on calcium influx via L-type calcium channels.

Dexmedetomidine Produces Dual α2-Adrenergic Agonist and α1-Adrenergic Antagonist Actions on Human Isolated Internal Mammary Artery

OBJECTIVE

To investigate the direct effects of dexmedetomidine (DEX) on isolated human internal mammary artery (IMA).

DESIGN

In vitro experimental study.

SETTING

Cardiovascular Pharmacology Laboratory, Department of Pharmacology, Gulhane School of Medicine, Ankara, Turkey.

PARTICIPANTS

IMA segments were obtained from 18 patients undergoing coronary artery bypass surgery.

INTERVENTIONS

The response in IMA was recorded isometrically by a force displacement transducer in isolated organ baths. DEX-induced contractions were tested in the presence of the alpha2-adrenoceptor antagonist yohimbine (10(-7) mol/L) and the alpha1-adrenoceptor antagonist prazosin (10(-8) M). The effect of DEX (10(-7), 10(-6), and 10(-5) mol/L) on phenylephrine (10(-9)-3 x 10(-4) mol/L)-induced contactions was also tested.

MEASUREMENT AND MAIN RESULTS

DEX (10(-9) mol/L-3 x 10(-5) mol/L) caused contraction in IMA segments. The contraction at lower concentrations of DEX (10(-9) mol/L-3 x 10(-7) mol/L) was attenuated by yohimbine (10(-7) mol/L), whereas prazosin (10(-8) mol/L) attenuated the contractions at higher concentrations of DEX (10(-6) mol/L-3 x 10(-5) mol/L). Incubation of IMA segments with high concentrations of DEX (10(-6) mol/L and 10(-5) mol/L) caused an inhibition of phenylephrine (10(-9) mol/L-3 x 10(-4) mol/L)-induced contraction.

CONCLUSION

These data suggest that DEX causes contraction by activating alpha2-adrenoceptors at lower concentrations, but it may also activate alpha1-adrenoceptors at higher concentrations in IMA. The action of DEX on phenylephrine-induced contraction may be related to an alpha1-adrenoceptor antagonistic effect produced via partial alpha1-adrenoceptor agonistic action.

The cardioprotective effect of dexmedetomidine on global ischaemia in isolated rat hearts

AIM

Dexmedetomidine is a highly specific and selective alpha-2 adrenergic agonist that is now widely used in the intensive care setting. Many intensive care unit (ICU) patients are at risk of respiratory or cardiac arrest. This study was conducted to determine whether dexmedetomidine exhibits a cardioprotective effect on global ischaemia and subsequent myocardial infarction.

METHODS

Isolated rat hearts were subjected to 30 min of global ischaemia followed by 120 min reperfusion, with administration of 0, 1 and 10nM dexmedetomidine during the pre-ischaemic period (n=7 each group). Secondly, 1 microM yohimbine, an alpha-2 antagonist, was given during the pre-ischaemic period, alone or in combination with 10 nM dexmedetomidine (n=7 each group).

RESULTS

Dexmedetomidine administration reduced coronary flow significantly (103.6+/-4.7%, 77.9+/-3.7, 63.7+/-6.1%, of the baseline values for 0, 1 and 10 nM dexmedetomidine, respectively), and yohimbine administration reversed this effect (88.0+/-2.2%). Dexmedetomidine improved the infarct size at each concentration (45.3+/-3.6, 30.2+/-3.3, and 21.2+/-2.3% of the total left ventricular mass for 0, 1, and 10nM dexmedetomidine, respectively), which was also reversed by yohimbine (43.6+/-1.4%).

CONCLUSION

Dexmedetomidine exhibited a cardioprotective effect on global ischaemia in the isolated rat heart model, which was mediated by alpha-2 adrenergic stimulation.

Anticoagulation of juvenile sheep and goats with heparin, warfarin, and clopidogrel

Little data exist on anticoagulation of young sheep and goats. We tested the effect of heparin, warfarin, and clopidogrel in two sheep and two goats weighing 17-35 kg. Each animal received heparin boluses of 80, 100, and 200 units/kg; goats also received 300, 350, and 400 units/kg. All animals received continuous heparin 40, 60, and 80 units/kg/hour; oral warfarin 0.3, 0.6, and 0.9 mg/kg/day; and oral clopidogrel 75 and 150 mg/day (2.8-3.4 and 5.6-6.9 mg/kg/day). Results were in the form of complete blood counts, activated clotting times (ACT), partial thromboplastin times, prothrombin times, thromboelastograms, and whole-blood lumiaggregometry. After heparin boluses of 200 units/kg, sheep and goats reached mean peak ACTs over 400 seconds. After continuous infusions of 40, 60 and 80 units/kg/hour, sheep and goats exceeded our therapeutic range for ACTs (195-215 seconds for sheep, 155-175 seconds for goats). For warfarin therapy, both sheep and goats required treatment with >0.6 mg/kg/day to achieve INRs over 2.5. Clopidogrel treatment, after 14-17 days of 75-150 mg/day, inhibited sheep platelets by 25-36% and goat platelets by 35-46%. We conclude that young sheep and goats can be safely and effectively anticoagulated with heparin and warfarin, and can also show a modest antiplatelet response to clopidogrel. Doses for each drug were generally higher than those used for humans, and warfarin therapy in sheep may be unpredictable. These results should be useful for developing anticoagulation protocols to test pediatric mechanical circulatory support devices.

Comparison of variability in cardiorespiratory measurements following desflurane anesthesia at a multiple of the minimum alveolar concentration for each dog versus a multiple of a single predetermined minimum alveolar concentration for all dogs in a group

OBJECTIVE

To determine whether the variability of cardiorespiratory measurements is smaller when administering desflurane at a multiple of the individual's minimum alveolar concentration (MAC) or at a predetermined, identical concentration in all subjects.

ANIMALS

10 dogs.

PROCEDURES

Desflurane was administered at 1.5 times the individual's MAC (iMAC) and 1.5 times the group's MAC (gMAC). The order of concentrations was randomly selected. Heart rate, respiratory rate, arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary artery occlusion pressure, arterial and mixed-venous blood gas tensions and pH, and cardiac output were measured. The desflurane concentration required to achieve a mean arterial pressure (MAP) of 60 mm Hg was then determined. Finally, the desflurane concentration required to achieve an end-tidal PCO(2) of 55 mm Hg was measured.

RESULTS

Variances when administering 1.5 iMAC or 1.5 gMAC were not significantly different for any variable studied. Differences between the MAC multiples needed to reach an MAP of 60 mm Hg and the mean of the sample were significantly larger when gMAC was used, compared with iMAC, indicating that a multiple of iMAC better predicted the concentration resulting in a MAP of 60 mm Hg.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that, in a small group of dogs, variability in cardiorespiratory measurements among dogs is unlikely to differ whether an inhalant anesthetic is administered at a multiple of the iMAC in each dog or at an identical gMAC in all dogs.

The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery

BACKGROUND

The aim of this study was to investigate the effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery.

METHODS

Patients were randomly divided into placebo (group P, n= 16) and dexmedetomidine (group D, n= 16) groups. In group D, a 1 microg/kg bolus dose of dexmedetomidine was administered 10 min before the induction of anesthesia, followed by a 0.4 microg/kg/h infusion until the surgical incision. Anesthesia was induced with lidocaine (1 mg/kg), midazolam (0.2 mg/kg) and fentanyl (5 microg/kg) in both groups. Anesthesia was maintained with 0.5% isoflurane and fentanyl depending on the hemodynamic situation. The hemodynamic values during the investigation were obtained.

RESULTS

In group D, the mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were decreased effectively in comparison with the values in the placebo group (P < 0.05), and there was an attenuation in the increase in the systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) at the post-sternotomy period.

CONCLUSIONS

The pre-operative administration of the alpha(2)-agonist dexmedetomidine decreases the fentanyl requirement and attenuates the increase in SVRI and PVRI at the post-sternotomy period relative to the baseline levels, and decreases effectively MAP, MPAP and PCWP in comparison with the values in the placebo group, in patients with pulmonary hypertension undergoing mitral valve replacement surgery.

Cardiopulmonary effects of dexmedetomidine in sevoflurane-anesthetized sheep with and without nitric oxide inhalation

OBJECTIVE

To determine whether inhaled nitric oxide (NO) prevents pulmonary hypertension and improves oxygenation after i.v. administration of a bolus of dexmedetomidine in anesthetized sheep.

ANIMALS

6 healthy adult sheep.

PROCEDURE

In a crossover study, sevoflurane-anesthetized sheep received dexmedetomidine (2 microg/kg, i.v.) without NO (DEX treatment) or with inhaled NO (DEX-NO treatment). Cardiopulmonary variables, including respiratory mechanics, were measured before and for 120 minutes after bolus injection of dexmedetomidine.

RESULTS

Dexmedetomidine induced a transient decrease in heart rate and cardiac output. A short-lived increase in mean arterial pressure (MAP) and systemic vascular resistance (SVR) was followed by a significant decrease in MAP and SVR for 90 minutes. Mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance increased transiently after dexmedetomidine injection. The Pao2 was significantly decreased 3 minutes after injection and reached a minimum of (mean +/- SEM) 13.3 +/- 78 kPa 10 minutes after injection. The decrease in Pao2 was accompanied by a sudden and prolonged decrease in dynamic compliance and a significant increase in airway resistance, shunt fraction, and alveolar dead space. Peak changes in MPAP did not differ between the 2 treatments. For the DEX-NO treatment, Pao2 was significantly lower and the shunt fraction significantly higher than for the DEX treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

Inhalation of NO did not prevent increases in pulmonary arterial pressures induced by i.v. administration of dexmedetomidine. Preemptive inhalation of NO intensified oxygenation impairment, probably through increases in intrapulmonary shunting.

Management of gastrointestinal pain

Choice of an analgesic for gastrointestinal pain requires consideration of the cause of the pain, desired duration of pain relief, need for sedation, and potential side effects and toxicity, particularly in light of other drugs being used and effects on the gastrointestinal tract. It is imperative that close monitoring be continued to ensure that surgical lesions or worsening conditions are detected. Recent research in the field may lead to new drugs, drug combinations, and avenues of treatment that minimize the side effects of these drugs while maximizing their efficacy.

Comparison of medetomidine and dexmedetomidine as premedication in isoflurane anaesthesia for orthopaedic surgery in domestic sheep

The objective of the present study was to determine the potency of dexmedetomidine in relation to medetomidine in sheep undergoing orthopaedic surgery by comparing the anaesthetic requirements and cardiovascular changes at a dose relationship that represented equipotency in vitro. Twenty-four non-pregnant, female sheep were used. The study was carried out as a blind, randomized, experimental trial. Group 1 received 5 micrograms/kg bodyweight (BW) dexmedetomidine and group 2 received 10 micrograms/kg BW medetomidine intravenously 5 min prior to induction of anaesthesia. Anaesthesia was induced with ketamine (2.0 mg/kg BW intravenously) and maintained with isoflurane in 100% oxygen. End expired anaesthetic concentration (FEIso), end expired carbon dioxide concentration (FECO2), respiratory frequency (fR), direct arterial blood pressures, heart rates (HR) and arterial blood gases were monitored. Data were averaged over time and tested for differences between groups by independent t-tests, and analysis of variance for repeated measures. Average FEIso concentrations required to maintain a surgical plane of anaesthesia were not different between groups (1: 1.02 +/- 0.04%; 2: 0.99 +/- 0.07%). There was no difference in HR, arterial blood pressures, fR, FECO2 and arterial blood gases between groups. Average mean PaO2 were 279.54 +/- 113.37 mmHg and 220.21 +/- 102.15 mmHg with individual minimum values of 27.2 mmHg and 58.5 mmHg in groups 1 and 2, respectively. In conclusion, intravenous dexmedetomidine at 5 micrograms/kg BW and medetomidine at 10 micrograms/kg BW have the same effects on isoflurane requirements and cardiopulmonary parameters in sheep, indicating an equipotent dose relationship. Both preparations induced moderate to severe hypoxaemia in individual sheep.