The Effect of Prophylactic Dexmedetomidine on Hemodynamic Disturbances to Double-Lumen Endotracheal Intubation: A Prospective, Randomized, Double-Blind, and Placebo-Controlled Trial
The purpose of this study was to determine the effect of dexmedetomidine on hemodynamic responses to DLT intubation compared to placebo and to assess the adverse effects related to dexmedetomidine. Sixty patients were randomly allocated to receive 0.7？μg/kg dexmedetomidine ( ) or normal saline ( ) 10 minutes before general anesthesia. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) between groups were recorded. During intubation and 10 minutes afterward (T1-T10), the mean SBP, DBP, MAP, HR, and RPP in the control group were significantly higher than those in the dexmedetomidine group throughout the study period except at T1. The mean differences of SBP, DBP, MAP, HR, and RPP were significantly higher in the control group, with the value of 15.2？mmHg, 10.5？mmHg, 14？mmHg, 10.5 beats per minute, and 2,462.8？mmHg？min？1. Four patients in the dexmedetomidine group and 1 patient in the control group developed hypotension, while 2 patients in the dexmedetomidine group had bradycardia. Prophylactic dexmedetomidine can attenuate the hemodynamic responses to laryngoscopy and DLT intubation with minimal adverse effects. This trial is registered with ClinicalTrials.gov NCT01289769. 1. Introduction A double-lumen endotracheal tube (DLT) is a device frequently used in thoracic surgery. It effectively provides lung separation and facilitates changing from two- to one-lung ventilation [1]. A previous study found that both laryngoscopy and DLT intubation could stimulate significant hemodynamic responses and increase the plasma concentration of catecholamines [2]. Although these hemodynamic responses including tachycardia and hypertension are transient, they can be harmful to patients with hypertension, myocardial ischemia, or cerebrovascular disease [3, 4]. The supplement of an inhaled anesthetic agent during anesthetic induction and intubation using a nondepolarizing muscle relaxant is a normal practice at our hospital. However, we observe that this practice is found ineffective to attenuate the hemodynamic responses to intubation and rescue treatment is frequently required. Therefore, some measures should be added in order to optimize this condition. Several drugs have been used to attenuate the hemodynamic responses to laryngoscopy and DLT intubation. Dexmedetomidine, a highly selective α2 receptor agonist, produces sedative, analgesic, and central sympatholytic effects. It reduces norepinephrine release at the neuroeffector junction, inhibits neurotransmission of sympathetic
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