Journal of Anesthesia

, Volume 33, Issue 2, pp 266–272 | Cite as

Low-dose dexmedetomidine provides hemodynamics stabilization during emergence and recovery from general anesthesia in patients undergoing carotid endarterectomy: a randomized double-blind, placebo-controlled trial

  • Shogo TsujikawaEmail author
  • Kazutoshi Ikeshita
Original Article



Carotid artery stenosis is a major risk factor for ischemic stroke. Carotid endarterectomy protects patients with severe atherosclerotic carotid artery stenosis against stroke. In such patients, arterial blood pressure is often difficult to control and perioperative hemodynamic instability is associated with high morbidity and mortality after carotid endarterectomy. We performed a randomized double-blind placebo-control trial to evaluate the effects of low-dose dexmedetomidine on hemodynamic stability during the emergence and the recovery phases of general anesthesia in patients undergoing carotid endarterectomy.


Forty-seven patients (68–84 years) were randomly assigned to receive either dexmedetomidine (DEX group) or 0.9% saline (control group). Infusion of dexmedetomidine 1.0 µg/kg/hr for 1 h, followed by 0.2 µg/kg/hr or the same dose of saline was started after carotid artery declamping in the DEX and in the control group, respectively. At the end of surgery, nicardipine was used to maintain systolic arterial pressure within 20% of preoperative values. We compared the maximum dose of nicardipine, time to extubation, plasma catecholamine levels, arterial blood gases, the Richmond Agitation Sedation Scales, visual analogue scale (VAS) in the postanesthesia care unit, and adverse events within 30-days between the control and Dex groups.


The baseline clinical characteristics were similar in the two groups. The maximum dose of nicardipine (p = 0.021), plasma norepinephrine level (p = 0.033), sedation score and VAS were significantly lower in the Dex group than the control group. There were no differences between the two groups regarding time to extubation, arterial blood gases, and adverse events.


Low-dose dexmedetomidine improves hemodynamic stability during emergence and recovery from general anesthesia in patients receiving carotid endarterectomy.

Trial registry number



Dexmedetomidine Carotid endarterectomy Hemodynamics 



The authors are grateful to all the pharmacists and nurses who contributed to data collection. Supported, in part, by a grant from Clinical Research Fund at Yao Tokushukai General Hospital.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no conflict of interest.


  1. 1.
    International Carotid Stenting Study investigators, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010; 375:985–97.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Stoneham MD, Thompson JP. Arterial pressure management and carotid endarterectomy. Br J Anaesth. 2009;102:442–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14:13–21.CrossRefGoogle Scholar
  4. 4.
    Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, Heard S, Cheung A, Son SL, Kallio A. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834–9.CrossRefGoogle Scholar
  5. 5.
    Guler G, Akin A, Tosun Z, Eskitascoqlu E, Mizrak A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand. 2005;49:1088–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, Skrivanek G, Macaluso A, Shah M, Provost DA. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008;106:1741–8.CrossRefPubMedGoogle Scholar
  7. 7.
    McCutcheon CA, Orme RM, Scott DA, Davies MJ, McGlade DP. A comparison of dexmedetomidine versus conventional therapy for sedation and hemodynamic control during carotid endarterectomy performed under regional anesthesia. Anesth Analg. 2006;102:668–75.CrossRefPubMedGoogle Scholar
  8. 8.
    Bekker AY, Basile J, Gold M, Riles T, Adelman M, Cuff G, Mathew JP, Goldberg JD. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol. 2004;16:126–35.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong JH, Findlay JM, Suarez-Almaor ME. Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications. Neurosurgery. 1997;41:35–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Scheinman M, Ascher E, Hingorani A, Yorkovich W, Gade P. Hemodynamic instability following carotid endarterectomy does not affect early discharge. Cardiovasc Surg. 1998;6:470–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Bond R, Narayan SK, Rothwell PM, Warlow CP, European Carotid Surgery Trialists’ Collaborative Group. Clinical and radiographic risk factors for operative stroke and death in the European carotid surgery trial. Eur J Vasc Endovasc Surg. 2002;23:108–16.CrossRefPubMedGoogle Scholar
  12. 12.
    Kawamata T, Okada Y, Kawashima A, Yoneyama T, Yamaguchi K, Ono Y, Hori T. Postcarotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation. Neurosurgery. 2009;64:447–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Abou-Chebl A, Yadav JS, Reginelli JP, Bajzer C, Bhatt D, Krieger DW. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol. 2004;43:1596–601.CrossRefPubMedGoogle Scholar
  14. 14.
    Alborch E, Salom JB, Torregorsa G. Calcium channels in cerebral arteries. Pharmacol Ther. 1995;68:1–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Peacock WF, Varon J, Baumann BM, Borczuk P, Cannon CM, Chandra A, Cline DM, Diercks D, Hiestand B, Hsu A, Jois-Bilowich P, Kaminski B, Levy P, Nowak RM, Schrock JW. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Crit Care. 2011;15:R157.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Dorman T, Thompson DA, Breslow MJ, Lipsett PA, Rosenfeld BA. Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy. J Clin Anesth. 2001;13:16–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Wijeysundera DN, Naik JS, Beattie WS. Alpha–2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003;114:742–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Matsumoto M, Zornow MH, Rabin BC, Maze M. The alpha 2 adrenergic agonist, dexmedetomidine, selectively attenuates ischemia—induced increases in striatal norepinephrine concentrations. Brain Res. 1993;627:325–9.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyYao Tokushukai General HospitalYao CityJapan

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