Dexmedetomidine infusion for prevention of hypertension and agitation during awakening after transsphenoidal resection of pituitary adenoma

Arefiev A.M.; Kulikov A.S.; Kurnosov A.B.; Gadzhieva O.A.; Lubnin A.Yu.

doi:https://doi.org/10.17116/anaesthesiology202006130

Arefiev A.M.

Burdenko Neurosurgery Center

ORCID: 0000-0001-5864-3795

Kulikov A.S.

Burdenko Neurosurgical Center

Kurnosov A.B.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9943-6829

Gadzhieva O.A.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9850-050X

Lubnin A.Yu.

Burdenko Neurosurgical Center

RSCI AuthorID: 370609
Scopus AuthorID: 57192157123
ORCID: 0000-0003-2595-5877

Dexmedetomidine infusion for prevention of hypertension and agitation during awakening after transsphenoidal resection of pituitary adenoma

Authors:

Arefiev A.M., Kulikov A.S., Kurnosov A.B., Gadzhieva O.A., Lubnin A.Yu.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2020;(6): 30‑36

DOI: 10.17116/anaesthesiology202006130

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To cite this article:

Arefiev AM, Kulikov AS, Kurnosov AB, Gadzhieva OA, Lubnin AYu. Dexmedetomidine infusion for prevention of hypertension and agitation during awakening after transsphenoidal resection of pituitary adenoma. Russian Journal of Anesthesiology and Reanimatology. 2020;(6):30‑36. (In Russ.)
https://doi.org/10.17116/anaesthesiology202006130

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OBJECTIVE

To analyze efficacy and safety of dexmedetomidine infusion for hemodynamic stabilization and prevention of arterial hypertension and excitation of patients upon awakening after transsphenoidal neurosurgical interventions.

MATERIAL AND METHODS

A prospective study included 40 adults with pituitary adenoma and baseline arterial hypertension. In the main group, dexmedetomidine was prescribed at a dose of 0.5 μg/kg/hour, in the control group — placebo in an equivalent volume of 0.9% saline solution. Hemodynamic analysis implied invasive blood pressure measurements during key surgical stages and postoperative awakening, as well as level of stress hormones (prolactin and cortisol).

RESULTS

Dexmedetomidine significantly reduces the incidence of arterial hypertension and tachycardia upon awakening of patients after transsphenoidal neurosurgical interventions. Moreover, this drug also reduces serum prolactin during surgery. In addition, patients in the main group had more comfortable awakening without severe agitation.

CONCLUSION

The positive effects of dexmedetomidine should be used more widely in routine clinical practice to optimize anesthetic management of transsphenoidal procedures. At the same time, this pharmacological approach requires further analysis regarding influence on the incidence of severe postoperative complications and postoperative outcomes.

Keywords:

dexmedetomidine

transsphenoidal surgery

postoperative awakening

arterial hypertension

neuroendocrine stress

hemodynamic stability

Authors:

Arefiev A.M.

Burdenko Neurosurgery Center

ORCID: 0000-0001-5864-3795

Kulikov A.S.

Burdenko Neurosurgical Center

Kurnosov A.B.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9943-6829

Gadzhieva O.A.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9850-050X

Lubnin A.Yu.

Burdenko Neurosurgical Center

RSCI AuthorID: 370609
Scopus AuthorID: 57192157123
ORCID: 0000-0003-2595-5877

Received:

16.05.2020

Accepted:

26.06.2020

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References:

Kulikov AS, Lubnin AYu. Dexmedetomidin: new opportunities in anesthesiology. Anesteziologiya i reanimatologiya. 2013;1:37-41. (In Russ.).
Aref’ev AM, Lubnin AYu, Kulikov AS. Dexmedetomidine vs clonidine. The optimal means of preventing hemodynamic reactions during awakening after craniotomy. Regionarnaya anesteziya i lechenie ostroj boli. 2018;12(4):222-226. (In Russ.).
Berg C, Petersenn S, Lahner H, Herrmann BL, Buchfelder M, Droste M, Stalla GK, Strasburger CJ, Roggenbuck U, Lehmann N, Moebus S, Jöckel KH, Möhlenkamp S, Erbel R, Saller B, Mann K; Investigative Group of the Heinz Nixdorf Recall Study and the German Pegvisomant Observational Study Board and Investigators. Cardiovascular risk factors in patients with uncontrolled and long-term acromegaly: comparison with matched data from the general population and the effect of disease control. The Journal of Clinical Endocrinology and Metabolism. 2010;95(8):3648-3656. https://doi.org/10.1210/jc.2009-2570
Mosca S, Paolillo S, Colao A, Bossone E, Cittadini A, Iudice FL, Parente A, Conte S, Rengo G, Leosco D, Trimarco B, Filardi PP. Cardiovascular involvement in patients affected by acromegaly: an appraisal. International Journal of Cardiology. 2012;167(5):1712-1718. https://doi.org/10.1016/j.ijcard.2012.11.109
Dunn LK, Nemergut EC. Principles and Pitfalls of Anesthesia for Trans-sphenoidal Surgery. In: Laws JrE, Cohen-Gadol A, Schwartz T, Sheehan J, eds. Transsphenoidal Surgery. Springer, Cham. 2017;244-248. https://doi.org/10.1007/978-3-319-56691-7_3
«Anesteziya» Ronal’da Millera. Pod red. R. Millera. Per. s angl. Pod obshchej red. Lebedinskogo K.M. v 4 t. T. 1. SPb.: Chelovek; 2015. (In Russ.).
Gopalakrishna KN, Dash PK, Chatterjee N, Easwer HV, Ganesamoorthi A. Dexmedetomidine as an Anesthetic Adjuvant in Patients Undergoing Transsphenoidal Resection of Pituitary Tumor. Journal of Neurosurgical Anesthesiology. 2015;27(3):209-215. https://doi.org/10.1097/ANA.0000000000000144
Salimi A, Sharifi G, Bahrani H, Mohajerani SA, Jafari A, Safari F, Jalessi M, Mirkheshti A, Mottaghi K. Dexmedetomidine could enhance surgical satisfaction in Trans-sphenoidal resection of pituitary adenoma. Journal of Neurosurgical Sciences. 2017;61:46-52. https://doi.org/10.23736/S0390-5616.16.02792-2
Soliman R, Fouad E. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study. Indian Journal of Anaesthesia. 2017;61(5):410-417. https://doi.org/10.4103/ija.ija_581_16
Jan S, Ali Z, Nisar Y, Naqash IA, Zahoor SA, Langoo SA, Azhar K. Comparison of Dexmedetomidine and Clonidine in Attenuating the Hemodynamic Responses at Various Surgical Stages in Patients Undergoing Elective Transnasal Transsphenoidal Resection of Pituitary Tumors. Anesthesia, Essays and Researches. 2017;11(4):1079-1083. https://doi.org/10.4103/0259-1162.194575
Snidvongs K, Tingthanathikul W, Aeumjaturapat S, Chusakul S. Dexmedetomidine improves the quality of the operative field for functional endoscopic sinus surgery: systematic review. The Journal of Laryngology and Otology. 2015;129(3):8-13. https://doi.org/10.1017/s0022215115001334
Renganathan T, Venkatesan G. Comparative study to evaluate effect the dexmedetomidine in attenuating the haemodynamic and neuroendocrine responses to skull-pin head holder application during craniotomy. Journal of Evidence Based Medicine and Healthcare. 2017;4(31):1814-1819. https://doi.org/10.18410/jebmh/2017/353
Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in postoperative patients needing sedation in the intensive care unit. British Journal of Anaesthesia. 2001;86(5):650-656. https://doi.org/10.1093/bja/86.5.650
Mushtaq K, Ali Z, Shah N, Syed S, Naqash IA, Ramzan AU. A randomized controlled study to compare the effectiveness of intravenous dexmedetomidine with placebo to attenuate the hemodynamic and neuroendocrine responses to fixation of skull pin head holder for craniotomy. Northern Journal of ISA. 2016;1:16-23.
Desborough JP. The stress response to trauma and surgery. British Journal of Anaesthesia. 2000;85(1):109-117. https://doi.org/10.1093/bja/85.1.109
Maze M, Virtanen R, Daunt D, Banks SJ, Stover EP, Feldman D. Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: In vivo and in vitro studies. Anesthesia and Analgesia. 1991;73(2):201-208. https://doi.org/10.1213/00000539-199108000-00015
Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: A meta-analysis. The Ame-rican Journal of Medicine. 2003;114(9):742-752. https://doi.org/10.1016/j.accreview.2003.08.062
Wang XW, Cao JB, Lv BS, Mi WD, Wang ZQ, Zhang C, Wang HL, Xu Z. Effect of perioperative dexmedetomidine on the endocrine modulators of stress response: a meta-analysis. Clinical and Experimental Pharmacology and Physiology. 2015;42(8):828-836. https://doi.org/10.1111/1440-1681.12431
Albert SG, Ariyan S, Rather A. The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Medicine. 2011;37(6):901-910. https://doi.org/10.1007/s00134-011-2160-1
Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H, Viinamäki O, Scheinin H. Effects of dexmedetomidine,a selective alpha 2-adrenoceptor agonist, on hemodynamic controlmechanisms. Clinical Pharmacology and Therapeutics. 1989;46(1):33-42. https://doi.org/10.1038/clpt.1989.103
Karhuvaara S, Kallio A, Koulu M, Scheinin H, Scheinin M. Noinvolvement of alpha 2-adrenoceptors in the regulation of basal prolactin secretion in healthy men. Psychoneuroendocrinology. 1990;15(2):125-129. https://doi.org/10.1016/0306-4530(90)90020-a
Gala RR. The physiology and mechanisms of the stress-inducedchanges in prolactin secretion in the rat. Life Sciences. 1990;46(20):1407-1420. https://doi.org/10.1016/0024-3205(90)90456-2
Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine, an α2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology. 1990;73(2):230-235. https://doi.org/10.1097/00000542-199008000-00007
Sarpkaya A, Karaaslan K, Koçoğlu H, Bugdayci G, Colak C. The Effects of perioperative use of Dexmedetomidine on hemodynamic parameters and surgical stress response in chronic hypertensive patients. European Journal of Anaesthesiology. 2010;27:86-87. https://doi.org/10.1097/00003643-201006121-00275
Uyar AS, Yagmurdur H, Fidan Y, Topkaya C, Basar H. Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy. Journal of Neurosurgical Anesthesiology. 2008;20(3):174-179. https://doi.org/10.1097/ANA.0b013e318177e5eb