الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Hemodynamic responses of laryngoscopy and laparoscopy
should be attenuated by the appropriate premedication, smooth
induction, and rapid intubation. Moreover, Postoperative pain is
difficult to be managed with the use of opioids analgesia alone, so
multimodal pain management is a method to improve postoperative
analgesia with minimal side effects. Dexmedetomidine has sedative
and anxiolytic effects and decrease the need for intraoperative
analgesic drug requirement. It also decreases the need for analgesics
in postoperative period. The present study evaluated the effect of
dexemeditomedine infusion on recovery characteristics, post-operative
pain relief, opioid sparing effect, and peri-operative stress response in
the form of catecholamine serum levels during lumbar fixation.
The present study was performed on 80 adult patients aged 18
to 60 years old with American Society of Anesthesiologist (ASA)
physical status I and II of both sexes scheduled for elective lumbar
fixation surgeries under general anesthesia. The dose of
Dexmedetomidine that was used ranged from 0.2 to 0.8 μg / kg/hr IV.
The patients were randomly divided into one of four groups,
group1 received saline 4 ml/hr IV, group 2 received
Dexmedetomidine 0.2 μg / kg/hr IV, group 3 received
Dexmedetomidine 0.4 μg / kg/hr IV and group 4 received
Dexmedetomidine 0.8 μg / kg/hr IV.
Anesthetic technique was standardized and all groups were
assessed for changes of heart rate and mean arterial pressure prior to
premedication, before induction, after laryngoscopy and extubation.
Intraoperative fentanyl requirement, catecholamine serum levels and any postoperative complications were also recorded. Patients were
studied at 4h interval for 24 hour postoperatively for Visual Analogue
Scale (VAS), and ketorolac and pethidine consumption.
Significant increase in heart rate and mean arterial pressure was
observed in Groups 1 after airway instrumentation, while statistically
significant attenuation of mean arterial pressure and hemodynamic
responses to laryngoscopy and endotracheal intubation, but with
increased the incidence of bradycardia. The incidence of postoperative
nausea and vomiting was statistically decreased in the premedicated
groups. The incidence of postoperative shivering also decreased in
the premedicated groups. The VAS scores of the Dex groups were
significantly lower than the control group. The total ketolac and
pethidine consumption at 24 h postoperatively of premedicated groups
were significantly lower than the control group.
Adjunctive use of an intraoperative Dexmedetomidine infusion
(0.2– 0.8 μg/kg/h infusion) decreased intraoperative fentanyl use.
Dexmedetomidine also helped to maintain intraoperative
hemodynamic stability and to decrease the stress response to
laryngoscopy and endotracheal intubation. It decreased incidence of
PONV, shivering and the length of stay in the PACU. It also reduced
the requirement for postoperative analgesia in patients undergoing
lumbar fixation.