Perioperative Effect of Continuous Infusion of Dexmedetomedine on Indirect Gas Calorimetry Monitoring in Liver Transplantation
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
Objective: To study the perioperative effect of Dexmedetomidine on indirect calorimetry in recipients of adult living donor liver transplantation. Background: Dexmedetomidine is newly used in liver transplant. Material and Methods: forty patients were assigned randomly to get Dexmedetomidine (Dex) beginning at 0.5 μg/kg/h(0.2-0.7μg/ kg/h) or placebo (C) Anesthesia was guided by Enotropy (40-60) with Desflurane. Indirect calorimetry parameters, arterial blood gasses, hemodynamics were taken at base line, dissection, an hepatic, reperfusion and 3 hours after end of operation. Transoesophageal Doppler was used for fluid optimization. Results: No significant difference was noticed in either group regarding demographic data, and operative data , Dexmedetomidine affects oxygen consumption(Vo2) and carbon dioxide production (Vco2) significantly at at reperfusion and 3hours postreperfusion; Mean ±SD for VO2 (273.1±36.1/227.1±82), (252.4 ±39/189.5±75) ml/min/m2 and P=0.019,0.005 for control /DEX groups at reperfusion and intensive care unit(I.C.U)respectively , VCO2(238.4±18/181.5±72), (210.5±27/159.0±63) ±78.77 ml/min/m2:p =0.002, 0.001 also for control /DEX respectively. Respiratory Quotient RQ and Energy expenditure EE were significant in C versus DEX at reperfusion and in intensive care, for RQ in C/DEX (0.7 9±0.08/0.73±0.08),(0.75±0.8/0.70±0.10) with p=0.014,0.001. EE for C/DEX (1358.5±152.4/1231.5±84.9), (1264.3±147.0/1068.1±122.9) and P=0.000, 0.001 sequentially. Haemodynamics were insignificantly decreased in DEX versus C .DEX decreased the utilization of desflurane in DEX/C (179±59/221±5 p=0.016) ml, fentanyl (988±202/1241±390p=0.041) μg, and insignificantly increased amounts of fluids needed and the in otropic support. pH and Paco2,HCO3 were insignificantly affected in both groups, except in reperfusion, where pH and HCO3 decreased and Paco2 increased significantly. The I.C.U. stay was comparable.As clinicians in operations with significant phases of fluctuations, we are normally concerned about hemodynamic solidity. While anesthesia and intubation are the principal components animating the neuronal and endocrinal responses [1-3]. Hepatectomy phase have significant blood loss, anhepatic phase is characterized by accumulation of acid metabolites and unclamping, is marked by vasodilatation of the splanchnic bed creating an insufficient preload and critical hemodynamic instability particularly in chirrotic patients with hyperdynamic circulation and fragile peripheral resistance [4]. Dexmedetomidine; a novel sedative profoundly selective α2 anesthetic agent may provide more hemodynamic stability [5,6] At low doses the dominant action of α2 -adrenoreceptor agonist activation is a reduction in sympathetic tone, The net effect of dexmedetomidine action is a significant reduction in circulating catecholamine with a slight decrease in blood pressure and a modest reduction in heart rate [7]. When dexmedetomidine is administered as a nonstop infusion, it is associated with an expected and stable hemodynamic reaction [8].
Authors and Affiliations
Magdy Khalil, Hanaa Mohamed Afifi, Essam Ismael, Nirmen Fayed, Nahla Gaballa
Keywords
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- EP ID EP566247
- DOI 10.26717/BJSTR.2017.01.000163
- Views 327
- Downloads 0
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