Abstract
Alpha-2 sympatho-mimetic drugs are used to prevent adverse peri-operative reactions. The aim of this study was to compare premedication with dexmedetomidine against other currently used agents.
After ethic committee approval and patients' consent, premedication with atropine 0.5 mg and one of the following agents was administered in a randomised and blind fashion to the deltoid muscle 15 min before induction to anaesthesia: dexmedetomidine 1.0 pg . kg-1 + ketamine 0.5 mg . kg-1 + fentanyl 1.0 ug . kg-1 (group DexKeFNT), pethidine 1.5 mg . kg-1 (group Dolsin), dexmedetomidine 1.0 pg . kg-1 + morphine 0.05 mg . kg-1 (group DexMor) and morphine 0.05 mg . kg1 (group Morfin). Induction and maintenance of anaesthesia were standardised.
Parameters of the vital functions, side-effects and time to request for the first dose of analgesics after surgery were examined and processed by Kruskal-Wallis, chi-squared and Fisher tests. Total 61 patients scheduled for laparoscopic cholecystectomy were enrolled in the trial.
Capnoperitoneum-induced hypertension and peri-operative fentanyl consumption were the most frequent in Dolsin group (68.7%, p < 0.001 vs. all others; and 165-111ug vs. 13-15ug in DexMor, 25-42ug In Morfin and 31.5-53.8ug in DexKeFNT group, respectively). Amnesia was present in 92.9% in DexKeFNT (p < 0.001 vs. all others) and longer postoperative analgesia was found in both the dexmedetomidine groups, p < 0.01 (DexMor 3.7-1.0 h, Morfin 0.7-1.1 h, Dolsin 0.9- 1.1 h, DexKeFNT 2.3-1.0 h).
Conclusion: The combination of dexmedetomidine, ketamine, fentanyl and atropine suppresses the adverse haemodynamic effects of the capnoperitoneum, decreases fentanyl consumption and prolongs postoperative analgesia without side-effects.