Journal of Clinical Monitoring and Computing

, Volume 30, Issue 4, pp 429–435 | Cite as

The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia

  • Hee Yeon Park
  • Jong Yeop Kim
  • Sang Hyun Cho
  • Dongchul Lee
  • Hyun Jeong Kwak
Original Research


The purpose of this study was to evaluate the effects of low-dose dexmedetomidine on hemodynamics and anesthetic requirements during propofol and remifentanil anesthesia for laparoscopic cholecystectomy. Thirty adult patients were randomly allocated to receive dexmedetomidine infusion of 0.3 μg/kg/h (dexmedetomidine group, n = 15) or comparable volumes of saline infusion (control group, n = 15). Target controlled infusion of propofol and remifentanil was used for anesthetic induction and maintenance, and adjusted in order to maintain a bispectral index of 40–55 and hemodynamic stability. We measured hemodynamics and recorded total and mean infused dosages of propofol and remifentanil. For anesthesia induction and maintenance, mean infused doses of propofol (121 ± 27 vs. 144 ± 29 μg/kg/min, P = 0.04) and remifentanil (118 ± 27 vs. 150 ± 36 ng/kg/min, P = 0.01) were lower in the dexmedetomidine group than in the control group, respectively. The dexmedetomidine group required 16 % less propofol and 23 % less remifentanil. During anesthetic induction and maintenance, the dexmedetomidine group required fewer total doses of propofol (9.6 ± 2.3 vs. 12.4 ± 3.3 mg/kg, P = 0.01) and remifentanil (9.6 ± 3.4 vs. 12.7 ± 2.6 μg/kg, P = 0.01). The change in mean arterial pressure over time differed between the groups (P < 0.05). Significantly lower mean arterial pressure was observed in the dexmedetomidine group than in the control group at immediately and 5 min after pneumoperitoneum. The time to extubation after completion of drug administration did not differ between the groups (P = 0.25). This study demonstrated that a low-dose dexmedetomidine infusion of 0.3 μg/kg/h reduced propofol and remifentanil requirements as well as hemodynamic change by pneumoperitoneum without delayed recovery during propofol-remifentanil anesthesia for laparoscopic cholecystectomy.


Anesthetic requirement Dexmedetomidine Hemodynamics Propofol Remifentanil 


Compliance with Ethical Standards

Conflict of interest

No conflicts of interest, financial of otherwise, are declared by the authors.


  1. 1.
    Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth. 1999;83:372–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Ngwenyama NE, Anderson J, Hoernschemeyer DG, Tobias JD. Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents. Paediatr Anaesth. 2008;18:1190–5.PubMedGoogle Scholar
  3. 3.
    Dutta S, Karol MD, Cohen T, Jones RM, Mant T. Effects of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Sci. 2001;90:172–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: a study with entropy analysis. Indian J Anaesth. 2012;56:542–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Le Guen M, Liu N, Tounou F, Augé M, Tuil O, Chazot T, Dardelle D, Laloë PA, Bonnet F, Sessler DI, Fischler M. Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia: a double-blind, placebo-controlled trial. Anesth Analg. 2014;118:946–55.CrossRefPubMedGoogle Scholar
  6. 6.
    Kang SH, Kim YS, Hong TH, Chae MS, Cho ML, Her YM, Lee J. Effects of dexmedetomidine on inflammatory responses in patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2013;57:480–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Park JK, Cheong SH, Lee KM, Lim SH, Lee JH, Cho K, Kim MH, Kim HT. Does dexmedetomidine reduce postoperative pain after laparoscopic cholecystectomy with multimodal analgesia? Korean J Anesthesiol. 2012;63:436–40.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bulow NM, Barbosa NV, Rocha JB. Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic videolaparoscopic surgery. J Clin Anesth. 2007;19:280–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Ohtani N, Kida K, Shoji K, Yasui Y, Masaki E. Recovery profiles from dexmedetomidine as a general anesthetic adjuvant in patients undergoing lower abdominal surgery. Anesth Analg. 2008;107:1871–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Iwakiri H, Oda Y, Asada A, Ozaki M. The efficacy of continuous infusion of low dose dexmedetomidine for postoperative patients recovering in general wards. Eur J Anaesthesiol. 2012;29:251–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Schnider TW, Minto CF, Shafer SL, Gambus PL, Andressen C, Goodale DB, Youngs EJ. The influence of age on propofol pharmacodynamics. Anesthesiology. 1999;90:1502–16.CrossRefPubMedGoogle Scholar
  12. 12.
    Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, Billard V, Hoke JF, Moore KH, Hermann DJ, Muir KT, Mandema JW, Shafer SL. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil: I. Model Dev Anesthesiol. 1997;86:10–23.CrossRefGoogle Scholar
  13. 13.
    Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgegic agent. Proceedings (Bayl Univ Med Cent). 2001;14:13–21.PubMedCentralGoogle Scholar
  14. 14.
    Kang WS, Kim SY, Son JC, Kim JD, Muhammad HB, Kim SH, Yoon TG, Kim TY. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol. 2012;62:113–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Liolios A, Guerit JM, Scholtes JL, Raftopoulos C, Hantson P. Propofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult. Anesth Analg. 2005;100:1804–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Burow BK, Johnson ME, Packer DL. Metabolic acidosis associated with propofol in the absence of other causative factors. Anesthesiology. 2004;101:239–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Fourcade O, Simon MF, Litt L, Samii K, Chap H. Propofol inhibits human platelet aggregation induced by proinflammatory lipid mediators. Anesth Analg. 2004;99:393–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Manne GR, Upadhyay MR, Swadia V. Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Indian J Anaesth. 2014;58:726–31.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30:1537–41.PubMedGoogle Scholar
  20. 20.
    Wu X, Hang LH, Chen YF, Wang H, Shao DH, Chen Z. Remifentanil requirements for preventing motor response to skin incision in healthy women anesthetized with combinations of propofol and dexmedetomidine titrated to similar Bispectral Index (BIS) values. Ir J Med Sci. 2014. doi: 10.1007/s11845-014-1176-2.
  21. 21.
    Angst MS, Ramaswamy B, Davies MF, Maze M. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology. 2004;101:744–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans—II: hemodynamic changes. Anesthesiology. 1992;77:1134–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Joshi GP, Hein HA, Mascarenhas WL, Ramsay MA, Bayer O, Klotz P. Continuous transesophageal echo-Doppler assessment of hemodynamic function during laparoscopic cholecystectomy. J Clin Anesth. 2005;17:117–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Kanwer DB, Kaman L, Nedounsejiane M, Medhi B, Verma GR, Bala I. Comparative study of low-pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy: a randomised controlled trial. Trop Gastroenterol. 2009;30:171–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012;62:118–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Dyck JB, Maze M, Haack C, Azarnoff DL, Vuorilehto L, Shafer SL. Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology. 1993;78:821–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Hee Yeon Park
    • 1
  • Jong Yeop Kim
    • 2
  • Sang Hyun Cho
    • 2
  • Dongchul Lee
    • 1
  • Hyun Jeong Kwak
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineGachon University, Gil Medical CenterIncheonRepublic of Korea
  2. 2.Department of Anesthesiology and Pain MedicineAjou University School of MedicineSuwonRepublic of Korea

Personalised recommendations