ДЕКСМЕДЕТОМИДИН КАК КОМПОНЕНТ АНЕСТЕЗИИИ ПЕРСПЕКТИВНАЯ ОСНОВА СХЕМБЕЗОПИОИДНОЙ АНАЛЬГЕЗИИ


Цитировать

Полный текст

Аннотация

Обзор посвящен применению селективного агониста α-2-адренорецепторов дексмедетомидина в качестве компонента схем мультимодальной анестезии и послеоперационной анальгезии. Представлены данные, свидетельствующие о том, что в/в инфузия дексмедетомидина, начатая за 15-20 мин до индукции общей анестезии, позволяет существенно снизить дозы в/в гипнотиков и МАК ингаляционных анестетиков, а также дозы опиоидных анальгетиков во время операции. Интраоперационная инфузия дексмедетомидина удлиняет время первого требования анальгетиков после операции, снижает среднюю интенсивность боли в ранний послеоперационный период, а также потребность в назначении опиоидных анальгетиков.

Об авторах

Алексей Михайлович Овечкин

ФГАОУ ВО «Первый московский государственный медицинский университет им. И.М. Сеченова»

Email: ovechkin_alexei@mail.ru
доктор медицинских наук, профессор кафедры анестезиологии и реаниматологии ФГАОУ ВО «Первый московский государственный медицинский университет им. И.М. Сеченова», 119991, Москва 119991, Москва

М. Е Политов

ФГАОУ ВО «Первый московский государственный медицинский университет им. И.М. Сеченова»

119991, Москва

Е. Л Буланова

ФГАОУ ВО «Первый московский государственный медицинский университет им. И.М. Сеченова»

119991, Москва

Список литературы

  1. Волков П.А., Чурадзе Б.Т., Севалкин С.А., Волкова Ю.Н., Гурьянов В.А. Дексмедетомидин как составляющая анестезиологического компонента общей анестезии при лапароскопических операциях. Анестезиология и реаниматология. 2015; 60 (1): 4-7
  2. Le Bot A., Michelet D., Hilly J., Maesani M., Dilly M., Brasher C. et al. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies. Minerva Anestesiol. 2015; 81: 1105-17.
  3. Davy A., Fessler J., Fischler M., Le Guen M. Dexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery. Minerva Anestesiologica. 2017; 83 (12): 1294-308.
  4. Piao G., Wu J. Systematic assessment of dexmedetomidine as an anesthetic agent: a meta-analysis of randomized controlled trials. Arch. Med. Sci. 2014; 10 (1): 19-24.
  5. Arain S., Ruehlow R., Uhrich T., Ebert T. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth. Analg. 2004; 98:153-8.
  6. Grosu I., Lavand’homme P. Use of dexmedetomidine for pain control. F1000 Med. Rep. 2010; 2: 90.
  7. Kimura M., Saito S., Obata H. Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord. Neurosci. Lett. 2012; 529: 70-4.
  8. Mizrak A., Ganidagli S., Cengiz M., Oner U., Saricicek V. The effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements. J. Clin. Monit. Comput. 2013; 27: 329-34.
  9. Patel C., Engineer S., Shah B., 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: 542-46.
  10. Harsoor S., Rani D., Roopa M., Lathashree S., Sudheesh K., Nethra S. Anesthetic sparing effect of intraoperative lignocaine or dexmedetomidine infusion on sevoflurane during general anesthesia. Middle East J. Anaesthesiol. 2015; 23: 301-7.
  11. Mariappan R., Ashokkumar H., Kuppuswamy B. Comparing the effects of oral clonidine premedication with intraoperative dexmedetomidine infusion on anesthetic requirement and recovery from anesthesia in patients undergoing major spine surgery. J. Neurosurg. Anesthesiol. 2014; 26: 192-7.
  12. Le Guen M., Liu N., Tounou F., Auge M., Tuil O., Chazot T. et al. 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.
  13. Wu X., Hang L., Chen Y., Wang H., Shao D., 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. 2015; 184: 805-11.
  14. Li Y., Ge D., Li J., Qi B. Sex differences in the morphine-sparing effects of intraoperative dexmedetomidine in patient-controlled analgesia following general anesthesia: A consort-prospective, randomized, controlled clinical trial. Medicine (Baltimore). 2016; 95:e3619.
  15. Ziemann-Gimmel P., Goldfarb A., Koppman J., Marema R. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br. J. Anaesth. 2014; 112: 906-11.
  16. Hwang W., Lee J., Park J., Joo J. Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: a randomized controlled study. BMC Anesthesiol. 2015; 15: 21.
  17. Эпштейн С.Л., Азарова Т.М., Сторожев В.Ю., Вдовин В.В., Саблин И.А.,Романов Б.В., Мартынов А.Н. Общая анестезия без опиоидов в хирургии морбидного ожирения. Зачем и как? Регионарная анестезия и лечение острой боли. 2016; 10 (1): 47-54.
  18. Баландин В.В., Горобец Е.С. Безопиоидная анестезия, анальгезия и седация в хирургии опухолей головы и шеи. Анестезиология и реаниматология, 2015; 60 (6): 39-42.
  19. Баландин В.В., Горобец Е.С. Безопиоидная анестезия/ анальгезия и седация у онкологического больного с длительной наркотической зависимостью в анамнезе. Регионарная анестезия и лечение острой боли. 2014; 8 (2): 54-7.
  20. Grewal A. Dexmedetomidine: new avenues. J. Anaesthesiol. Clin. Pharmacol. 2011; 27(3): 297-302.
  21. Liang F., Liu M., Fu X., Zhou X., Chen P., Han F. Dexmedetomidine attenuates neuropathic pain in chronic constriction injury by suppressing NR2B, NF-kB, and iNOS activation. Saudi Pharm. J. 2017; 25 (4): 649-54.
  22. Liu L., Ji F., Liang J., He H., Fu Y., Cao M. Inhibition by dexmedetomidine of the activation of spinal dorsal horn glias and the intracellular ERK signaling pathway induced by nerve injury. Brain Res. 2012; 1427: 1-9.
  23. Khasar S., Green P., Chou B., Levine J. Peripheral nociceptive effects of alpha 2-adrenergic receptor agonists in the rat. Neuroscience. 1995; 66(2): 427-32.
  24. Sadjak A., Wintersteiger R., Zakel D. et al. [Peripheral analgesic effect of intra-articularly applied clonidine]. Schmerz. 2006; 20 (4): 293-294, 296-299. German [with English abstract].
  25. Tang C., Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. J. Pain Research. 2017; 10: 1899-904.
  26. Lee C., Kim Y., Kim J. Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia. Korean J. Anesthesiol. 2013; 64 (4): 301-7.
  27. Cai X., Zhang P., Lu S. et al. Effects of intraoperative dexmedetomidine on postoperative pain in highly nicotine-dependent patients after thoracic surgery: a prospective, randomized, controlled trial. Medicine (Baltimore). 2016; 95 (22): e3814.
  28. Cheung C., Qiu Q., Ying A., Choi S., Law W., Irwin M. The effects of intra-operative dexmedetomidine on postoperative pain, side-effects and recovery in colorectal surgery. Anaesthesia. 2014; 69: 1214-21.
  29. Ge D., Qi B., Tang G., Li J. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal colectomy: A consort-prospective, randomized, controlled clinical trial. Medicine (Baltimore). 2015; 94: e1727.
  30. Xu S., Li Y., Wang S., Hu S., Ju X., Xiao J. Effects of intravenous lidocaine, dexmedetomidine and their combination on the postoperative pain and recovery of bowel function in patients undergoing abdominal hysterectomy. Minerva Anestesiol. 2017; 83: 685-94.
  31. Kim S., Oh Y., Park B., Sim J., Choi Y. Effects of single-dose dexmedetomidine on the quality of recovery after modified radical mastectomy: a randomised controlled trial. Minerva Anestesiol. 2013; 79: 1248-58.
  32. Lee M., Ko J., Kim E., Cheung M., Choi Y., Choi E. The effects of intravenous dexmedetomidine on spinal anesthesia: comparision of different dose of dexmedetomidine. Korean J. Anesthesiol. 2014; 67 (4): 252-7.
  33. Abdallah F., Abrishami A., Brull R. The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis. Anesth. Analg. 2013; 117 (1): 271-8.
  34. Abdallah F., Dwyer T., Chan V. et al. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triple-masked, placebocontrolled trial. Anesthesiology. 2016; 124 (3): 683-95.
  35. Wang X., Liu W., Xu Z., Wang F., Zhang C., Wang B. et al. Effect of dexmedetomidine alone for intravenous patient-controlled analgesia after gynecological laparoscopic surgery: A consort-prospective, randomized, controlled trial. Medicine (Baltimore). 2016; 95: e3639.
  36. Peng K., Liu H., Wu S., Cheng H., Ji F. Effects of combining dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: A systematic review and meta-analysis. Clin. J. Pain. 2015; 31: 1097-104.
  37. Schnabel A., Meyer-Friebem C., Reichl S., Zahn P., Pogatzki-Zahn P. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain. 2013; 154: 1140-9.
  38. Jessen Lundorf L., Korvenius Nedergaard H., Moller A. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database Syst. Rev. 2016; 2:CD010358.
  39. Zhao J-N., Kong M., Qi B., Ge D-J. Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients. Medicine. 2016; 95: 33-8.
  40. Лубнин А.Ю., Куликов А.С., Кобяков Г.Л., Гаврилов А.Г. Краниотомия в сознании. Анестезиология и реаниматология. 2012; 57 (4): 28-37
  41. Lee C., Kim M. Effects of preanesthetic dexmedetomidine on hemodynamic responses to endotracheal intubation in elderly patients undergoing treatment for hypertension: a randomized, double-blinded trial. Korean J. Anesthesiol. 2017; 70: 39-45.
  42. Kang S.-H., Kim Y.-S., Hong T.-H., Chae M.-S., Cho M.-L., Her Y.-M and Lee J. Effects of dexmedetomidine on inflammatory responses in patients undergoing laparoscopic cholecystectomy. Acta Anaesth. Scand. 2013; 57 (4): 480-7.
  43. Maes M., Lin A., Kenis G., Egyed B., Bosmans E. The effects of noradrenaline and alpha-2 adrenoreceptor agents on the production of monocytic products. Psychiatry Res. 2000; 96: 245-53.
  44. Szelenyi J., Kiss J., Vizi E. Differential involvement of sympathetic nervous system and immune system in the modulation of TNF-alpha production by alpha2- and betaadrenoreceptors in mice. J. Neuroimmunol. 2000; 103: 34-40.
  45. Sanders R., Xu J., Shu Y., Januszewski A., Halder S., Fidalgo A., Sun P., Hossain M., Ma D., Maze M. Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology. 2009; 110: 1077-85.
  46. Hotchkiss R., Nicholson D. Apoptosis and caspases regulate death and inflammation in sepsis. Nat. Rev. Immunol. 2006; 6: 813-22.
  47. Weatherby K., Zwilling B., Lafuse W. Resistance of macrophages to Mycobacterium avium is induced by alpha2- adrenergic stimulation. Infect. Immun. 2003; 71: 22-9.
  48. Gets J., Monroy F. Effects of alpha- and beta-adrenergic agonists on Toxoplasma gondii infection in murine macrophages. J. Parasitol. 2005; 91: 193-5.
  49. Tracey K. Physiology and immunology of the cholinergic anti-inflammatory pathway. J. Clin. Invest. 2007; 117: 289-96.
  50. Nance D., Sanders V. Autonomic innervations and regulation of the immune system (1987-2007). Brain Behav. Immun. 2007; 21: 736-45.
  51. Li B., Li Y., Tian S., Wang H., Wu H., Zhang A. et al. Antiinflammatory effects of perioperative dexmedetomidine administered as an adjunct to general anesthesia: A metaanalysis. Sci.Rep. 2015; 5: 12342.
  52. Chen W., Liu B., Zhang F., Xue P., Cui R., Lei W. The effects of dexmedetomidine on post-operative cognitive dysfunction and inflammatory factors in senile patients. Int. J. Clin. Exp. Med. 2015; 8: 4601-05.
  53. Li Y., He R., Chen S, Qu Y. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp. Ther. Med. 2015; 10: 1635-42.
  54. Wang Y., Xu X., Liu H., Ji F. Effects of dexmedetomidine on patients undergoing radical gastrectomy. J. Surg. Res. 2015; 194:147-53.
  55. Kim H., Lee Y., Jeon Y., Hwang J., Lim Y., Park J et al.The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection: A double-blind randomised study. Eur. J. Anaesthesiol. 2015; 32: 596-601.
  56. Kim S., Kim J., Lee J., Song B., Koo B. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br. J. Anaesth. 2013; 111: 222-8.
  57. Ge D., Qi B., Tang G., Li J. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal hysterectomy: A double-blind, randomized clinical trial. Sci. Rep. 2016; 6:21514.
  58. Lee S., Lee C., Lee J., Kim N., Lee H., Oh Y. Intraoperative dexmedetomidine improves the quality of recovery and postoperative pulmonary function in patients undergoing video-assisted thoracoscopic surgery: A CONSORT-Prospective, Randomized, Controlled Trial. Medicine (Baltimore). 2016; 95:e2854.
  59. Li B., Wang H., Wu H., Gao C. Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU sedation: a meta-analysis. Medicine (Baltimore). 2015; 94:e597.
  60. Zhou C., Zhu Y., liu Z., Ruan l. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis. J. Int. Med. Res. 2016; 44: 1182-90.
  61. Bharati S., Pal A., Biswas C., Biswas R. Incidence of cardiac arrest increases with the indiscriminate use of dexmedetomidine: a case series and review of published case reports. Acta Anaesthesiol.Taiwan. 2011; 49: 165-7.
  62. Klinger R., White W., Hale B., Habib A., Bennett-Guerrero E. Hemodynamic impact of dexmedetomidine administration in 15,656 noncardiac surgical cases. J. Clin. Anesth. 2012; 24: 212-20.
  63. Biccard B., Goga S., De Beurs J. Dexmedetomidine and cardiac protection for non-cardiac surgery: a meta-analysis of randomised controlled trials. Anaesthesia. 2008; 63: 4-14.
  64. Ji F., Li Z., Nguyen H., Young N., Shi P., Fleming N. et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. 2013; 127: 1576-84.

© ООО "Эко-Вектор", 2018


 


Данный сайт использует cookie-файлы

Продолжая использовать наш сайт, вы даете согласие на обработку файлов cookie, которые обеспечивают правильную работу сайта.

О куки-файлах