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Volume 12 Issue 3 ( July-September ) 2023

Original Articles

Effect of dexmedetomidine infusion on Sevoflurane requirement during general anesthesia in various surgical procedures: A prospective observational study based on entropy monitoring.
Dr. Summiya Jan, Dr.Rayees Najib, Dr. Hina Bashir

Background and Aims: Dexmede to midine is an alpha 2- adrenergic receptor agonist drug with analgesic, sedative, anxiolytic, sympatholytic, anaesthetic-sparing and hemodynamic-stabilizing properties used in perioperative anaesthesia care and has been shown to blunt the stress response to surgery as an adjuvant to general anaesthesia. The drug is claimed to decrease the requirement of inhalational anaesthetic agents thereby reducing the untoward effects of high concentrations of volatile anaesthetics on the body. Hence a study was designed toevaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for various surgical procedures on Sevoflurane requirement. Methods: About 100 patients scheduled for various surgical procedures under general anesthesia were divided into group 1 and group 2 of 50 patients each. Group 1 received a loading dose of Dexmedetomidine IV infusion before inducing the patient at the rate of 1 μg/kg over 10 mins diluted in 100 mL normal saline, followed by maintenance rate of 0.5μg/kg/hr, till the end of surgery. Group 2 received the conventional anaesthesia without dexmedetomidine infusion. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane on the basis of entropy level keeping it between40 and60. The dial concentration and MAC of Sevoflurane was noted during anaesthesia in both the groups and the data wasanalyzed using students t test, chi square test and Fisher Exact test as applicable. Results: Mean hourlySevoflurane requirement in Group 1 was 11.29 ± 1.18 mL, compared to 15.53 ±1.25 mL in Group 2 and during 2nd hour mean Sevoflurane consumption in group 1 was 8.47± 1.32 ml and in group 2 was 10.75±1.38 mland was statistically significant (P < 0.01).Therefore, the total Sevoflurane volume required by dexmedetomidine group was significantly less when compared to the group where conventional anaesthesia was given. The study found that mean duration of surgery in Group 1 was 98.6±16.17 mins and in Group 2 it was 96.3±19.19 mins which was statistically insignificant and hence comparable(P=0.5). In peri-operativeperiod, the mean heart rate and MAP were significantly lower in Group 1, when compared to Group 2 which was statistically significant(P< 0.01). Patients in Group 1 were bettersedated and post-operative pain score was better in Group 1 compared to Group 2. Conclusion: In traoperative use of Dexmedetomidine infusion as an adjuvant decreases the amount of sevoflurane requirement as compared to conventional general anaesthesia under entropy guided monitoring, without any adverse haemodynamic effects. It also provides additional postoperative analgesia as indicated by VAS score.

 
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