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ISSN 3061-8142 (Electronic)
ISSN 0484-7903 (Print)

2006, Number 2

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Rev Mex Anest 2006; 29 (2)

Hypertension induced by pneumoperitoneum and its treatment with dexmedetomidine

Núñez-Bacarreza JJ, Pórtela-Ortiz JM, Magro-Ibáñez E, García-Hernández L, Cabrera-Jardines R, Alarcón-Rodríguez J

Language: Spanish
References: 8
Page: 70-73
PDF size: 84.01 Kb.


ABSTRACT

Introduction: During laparoscopic surgery, CO2-induced pneumoperitoneum may cause hypertension (CO2-HT), which should not be mistaken for an inadequate anesthetic plane. If a monitor for hypnotic depth is not used, the usual reaction is giving more anesthetic, whereas the right intervention should be the use of a vasodilator. Dexmedetomidine is an alpha-2-adrenergic agonist with a wide range of pharmacological properties; it has a short half-life and a quick onset. Dexmedetomidine provides sedation and reduces blood pressure, heart rate, and plasmatic levels of catecholamines without causing respiratory depression or a decrease in cardiac output. Objectives: To determine the incidence of hypertension associated to pneumoperitoneum during laparoscopic surgery in the supramesocolic region, and the effectiveness of dexmedetomidine to control it. Methods: One hundred patients undergoing supramesocolic laparoscopic surgery, ASA I-II, ages 18 to 65, were studied prospectively for intraoperative hypertension and treated with dexmedetomidine. Anesthetic management and monitoring were standardized. Results: Thirty four percent of patients developed CO2-HT. Statistical analysis revealed a correlation between body mass index and development of hypertension. In 97% of cases, hypertension control was achieved with the loading dose of dexmedetomidine. Conclusions: Hypertension associated to pneumoperitoneum is common, even in patients with an adequate hypnotic plane. Dexmedetomidine is a useful drug to control this type of hypertension.


REFERENCES

  1. Joris J, Noirot D, Legrand M, et al. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993;76:1067.

  2. Joris J, Lamy M. Neuroendocrine changes during pneumoperitoneum for laparoscopic cholecystectomy. Br J Anaesth 1993;70:A33.

  3. Kamibayashi, Takahik, Maze, Mervyn. Clinical uses of a2-Adrenergic agonists. Anesth 2000;93:1345-1351.

  4. McCallum JB, Boban N, Hogan Q, Schmeling WT, Kampine JP, Bosnjak ZJ. The mechanism of a2-adrenergic inhibition of sympathetic ganglionic transmission. Anesth Analg 1998;87:503-10.

  5. Hogue, Charles W, Talke, Pekka. Autonomic nervous system responses during sedative infusions of dexmedetomidine. Anesthesiology 2002;97:592-599.

  6. Kalkman CJ, Drummond JC. Monitors of Depth of Anesthesia, Quo Vadis? Anesthesiology 2002;96:784-786.

  7. Dix P, Howell S. Survey of cancellation rate of hypertensive patients undergoing anaesthesia and elective surgery. Br J Anaesth 2001;86:789-793.

  8. Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth 2000;85:91-108.




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