Skip to main content
Top
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease

Authors: Ahmed Hasanin, Kareem Taha, Bassant Abdelhamid, Ayman Abougabal, Mohamed Elsayad, Amira Refaie, Sarah Amin, Shaimaa Wahba, Heba Omar, Mohamed Maher Kamel, Yaser Abdelwahab, Shereen M. Amin

Published in: BMC Anesthesiology | Issue 1/2018

Login to get access

Abstract

Background

Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

Methods

Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate.

Results

Dexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion.

Conclusion

A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

Trial registration

clinicaltrials.​gov: NCT02843698 on 20 July 2016.
Literature
1.
go back to reference Groeben H, Mitzner W, Brown RH. Effects of the alpha2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs. Anesthesiology. 2004;100:359–63.CrossRefPubMed Groeben H, Mitzner W, Brown RH. Effects of the alpha2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs. Anesthesiology. 2004;100:359–63.CrossRefPubMed
2.
go back to reference Unal Y, Pampal HK, Arslan M, Demirel CB, Alkan M. The effects of dexmedetomidine on pulmonary artery pressure in experiment. Bratisl Lek ListyBratisl Lek Listy. 2014;115:272–4. Unal Y, Pampal HK, Arslan M, Demirel CB, Alkan M. The effects of dexmedetomidine on pulmonary artery pressure in experiment. Bratisl Lek ListyBratisl Lek Listy. 2014;115:272–4.
3.
go back to reference Lee SH, Kim N, Lee CY, Ban MG, Oh YJ. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery. Eur J Anaesthesiol. 2016;33:1–8.CrossRef Lee SH, Kim N, Lee CY, Ban MG, Oh YJ. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery. Eur J Anaesthesiol. 2016;33:1–8.CrossRef
4.
go back to reference Heil LBB, Santos CL, Santos RS, et al. The effects of short-term Propofol and Dexmedetomidine on lung mechanics, histology, and biological markers in experimental obesity. Anesth Analg. 2016;122:1015–23.CrossRefPubMed Heil LBB, Santos CL, Santos RS, et al. The effects of short-term Propofol and Dexmedetomidine on lung mechanics, histology, and biological markers in experimental obesity. Anesth Analg. 2016;122:1015–23.CrossRefPubMed
6.
go back to reference De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol. 2015;29:119–28.CrossRef De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol. 2015;29:119–28.CrossRef
7.
go back to reference Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol. 2015;15:56.CrossRefPubMedPubMedCentral Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol. 2015;15:56.CrossRefPubMedPubMedCentral
8.
go back to reference Hardman JG, Aitkenhead AR. Estimating alveolar dead space from the arterial to end-tidal CO (2) gradient: a modeling analysis. Anesth Analg. 2003;97:1846–51.CrossRefPubMed Hardman JG, Aitkenhead AR. Estimating alveolar dead space from the arterial to end-tidal CO (2) gradient: a modeling analysis. Anesth Analg. 2003;97:1846–51.CrossRefPubMed
9.
go back to reference Kobelt P, Burke K, Renker P. Evaluation of a standardized sedation assessment for opioid Administration in the Post Anesthesia Care Unit. Pain Manag Nurs. 2014;15:672–81.CrossRefPubMed Kobelt P, Burke K, Renker P. Evaluation of a standardized sedation assessment for opioid Administration in the Post Anesthesia Care Unit. Pain Manag Nurs. 2014;15:672–81.CrossRefPubMed
10.
go back to reference Xia R, Yin H, Xia Z, Mao Q, Chen G, Xu W. Effect of intravenous infusion of dexmedetomidine combined with inhalation of isoflurane on arterial oxygenation and intrapulmonary shunt during single-lung ventilation. Cell Biochem Biophys. 2013;67:1547–50.CrossRefPubMed Xia R, Yin H, Xia Z, Mao Q, Chen G, Xu W. Effect of intravenous infusion of dexmedetomidine combined with inhalation of isoflurane on arterial oxygenation and intrapulmonary shunt during single-lung ventilation. Cell Biochem Biophys. 2013;67:1547–50.CrossRefPubMed
11.
go back to reference Xia R, Xu J, Yin H, et al. Intravenous infusion of Dexmedetomidine combined isoflurane inhalation reduces oxidative stress and potentiates hypoxia pulmonary vasoconstriction during one-lung ventilation in patients. Mediat Inflamm. 2015;2015:238041.CrossRef Xia R, Xu J, Yin H, et al. Intravenous infusion of Dexmedetomidine combined isoflurane inhalation reduces oxidative stress and potentiates hypoxia pulmonary vasoconstriction during one-lung ventilation in patients. Mediat Inflamm. 2015;2015:238041.CrossRef
12.
go back to reference Huang S-Q, Zhang J, Zhang X-X, et al. Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials. Chin Med J. 2017;130:1707.CrossRefPubMedPubMedCentral Huang S-Q, Zhang J, Zhang X-X, et al. Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials. Chin Med J. 2017;130:1707.CrossRefPubMedPubMedCentral
13.
go back to reference Zhang W, Zhang S, Li B, Sun M, Zhang J. Paravertebral dexmedetomidine as an adjuvant to ropivacaine protects against independent lung injury during one-lung ventilation: a preliminary randomized clinical trial. BMC Anesthesiol. 2018;18:67.CrossRefPubMedPubMedCentral Zhang W, Zhang S, Li B, Sun M, Zhang J. Paravertebral dexmedetomidine as an adjuvant to ropivacaine protects against independent lung injury during one-lung ventilation: a preliminary randomized clinical trial. BMC Anesthesiol. 2018;18:67.CrossRefPubMedPubMedCentral
14.
go back to reference Meng L, Li L, Lu S, et al. The protective effect of dexmedetomidine on LPS-induced acute lung injury through the HMGB1-mediated TLR4/NF-κB and PI3K/Akt/mTOR pathways. Mol Immunol. 2018;94:7–17.CrossRefPubMed Meng L, Li L, Lu S, et al. The protective effect of dexmedetomidine on LPS-induced acute lung injury through the HMGB1-mediated TLR4/NF-κB and PI3K/Akt/mTOR pathways. Mol Immunol. 2018;94:7–17.CrossRefPubMed
15.
go back to reference Conti G, Ranieri VM, Costa R, et al. Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study. Crit Care. 2016;20:206.CrossRefPubMedPubMedCentral Conti G, Ranieri VM, Costa R, et al. Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study. Crit Care. 2016;20:206.CrossRefPubMedPubMedCentral
16.
go back to reference Reade MC, Eastwood GM, Bellomo R, et al. Effect of Dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. JAMA. 2016;315:1460–8.CrossRefPubMed Reade MC, Eastwood GM, Bellomo R, et al. Effect of Dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. JAMA. 2016;315:1460–8.CrossRefPubMed
17.
go back to reference Grant MJC, Schneider JB, Asaro LA, et al. Dexmedetomidine use in critically ill children with acute respiratory failure. Pediatr Crit Care Med. 2016;17:1131–41.CrossRefPubMedPubMedCentral Grant MJC, Schneider JB, Asaro LA, et al. Dexmedetomidine use in critically ill children with acute respiratory failure. Pediatr Crit Care Med. 2016;17:1131–41.CrossRefPubMedPubMedCentral
18.
go back to reference Gu H, Bai J, Liu J. Effects of dexmedetomidine versus propofol on SPO2 in children with tetralogy of fallot during anesthesia. Int J Clin Exp Med. 2015;8:22550–6.PubMedPubMedCentral Gu H, Bai J, Liu J. Effects of dexmedetomidine versus propofol on SPO2 in children with tetralogy of fallot during anesthesia. Int J Clin Exp Med. 2015;8:22550–6.PubMedPubMedCentral
19.
20.
go back to reference Defresne AA, Hans GA, Goffin PJ, et al. Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study. Br J Anaesth. 2014;113:501–7.CrossRefPubMed Defresne AA, Hans GA, Goffin PJ, et al. Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study. Br J Anaesth. 2014;113:501–7.CrossRefPubMed
Metadata
Title
Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease
Authors
Ahmed Hasanin
Kareem Taha
Bassant Abdelhamid
Ayman Abougabal
Mohamed Elsayad
Amira Refaie
Sarah Amin
Shaimaa Wahba
Heba Omar
Mohamed Maher Kamel
Yaser Abdelwahab
Shereen M. Amin
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0572-y

Other articles of this Issue 1/2018

BMC Anesthesiology 1/2018 Go to the issue