Aug 2026· Journal of Clinical and Diagnostic Research· 0 citations
Abstract
Introduction: Agents used for induction of anaesthesia often cause vasodilation and suppression of the sympathetic nervous system, leading to a drop in blood pressure. Additionally, laryngoscopy and endotracheal intubation can cause hypertension and tachycardia. So, maintaining haemodynamic stability during induction, intubation and maintenance of anaesthesia is important. Induction of anaesthesia needs sufficient depth of anaesthesia while preventing haemodynamic derangement.
Aim: To study the haemodynamic effects of dexmedetomidine when used as an adjuvant to propofol as compared to propofol as a sole agent in the induction of General Anaesthesia (GA) in patients undergoing elective surgeries under GA.
Materials and Methods: This double-blinded randomised clinical study was conducted at the Department of Anaesthesiology, SUT Academy of Medical Sciences, Trivandrum, Kerala, India, from October 2025 to April 2026. A total of 38 patients were enrolled and randomly assigned to two groups. Group A patients were induced with propofol and vecuronium as muscle relaxants, and in Group B patients were initially given dexmedetomidine before induction with propofol and vecuronium. Heart Rate (HR), Non Invasive Blood Pressure (NIBP) Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Oxygen Saturation (SpO2 ) were recorded in each group at pre op, before induction, one minute, five minutes, 10 minutes and 15 minutes post induction. An Independent t-test was used to compare quantitative parameters, Chi-square test for categorical variables and a Mann-Whitney U Test for comparing ordinal parameters.
Results: A total of 38 patients assessed showed no significant demographic differences. Post induction tachycardia (group A-91.11±5.78; group B-79.00±13.25) was significant in group A. There was significant hypotension (MAP, DBP) post induction in group A {MAP 5 min post induction (group A-84.1±11.0, group B-93.1±9.6), DBP 5 min post induction (group A-70.6±9.8; group B-77.8±10)}. Group A required a significantly higher mean dose of propofol (134.2±25.2 mg) compared to group B (101.1±18.8 mg).
Conclusion: Dexmedetomidine as an adjuvant to propofol provides better haemodynamic stability than propofol alone during induction of GA. The total propofol requirement is also significantly lower in the patients when induced along with Dexmedetomidine.
Background:Electroconvulsive therapy (ECT) is widely used in the management of severe psychiatric disorders and is associated with significant hemodynamic fluctuations. Attenuation of this hyperdynamic response is essential to improve patient safety. Dexmedetomidine and remifentanil are commonly used adjuncts to anaesthesia for this purpose.
Aim:To compare the effects of intravenous dexmedetomidine and remifentanil as adjuncts to anaesthesia on hemodynamic parameters, depth of anaesthesia, seizure duration, and recovery characteristics in patients undergoing ECT.
Materials and Methods:
This prospective, randomized, single-blinded study included 20 patients (ASA I/II) aged 18–70 years undergoing ECT. Patients were divided into two groups: Group D received dexmedetomidine (1 µg/kg IV over 10 minutes), and Group R received remifentanil (1 µg/kg IV prior to induction). Standard anaesthesia with propofol and succinylcholine was administered. Hemodynamic parameters (HR, SBP, DBP), oxygen saturation, and bispectral index (BIS) were recorded at predefined intervals. Sedation was assessed using the Ramsay Sedation Scale. Statistical analysis was performed using paired t-test and Mann–Whitney U test.
Results:Dexmedetomidine showed significantly better attenuation of heart rate (p = 0.03) and systolic blood pressure (p = 0.04) compared to remifentanil. BIS values were more stable in the dexmedetomidine group (p = 0.02). Sedation scores were significantly higher in Group D during the early recovery period (p = 0.04). There was no significant difference in diastolic blood pressure, oxygen saturation, or seizure duration between the groups.
Conclusion:Dexmedetomidine provides superior hemodynamic stability, better sedation, and more controlled depth of anaesthesia compared to remifentanil in patients undergoing ECT, without affecting seizure duration. It may be considered a preferable adjunct in ECT anaesthesia, particularly in patients at cardiovascular risk.
Dr. Uday Gollamudi, Dr. Pravallika Rallapalli, D. Meena et al.· Adolescência e Saúde· 0 citations
Background:Epidural anaesthesia is widely used for lower limb orthopaedic surgeries because of its ability to provide effective intraoperative anaesthesia and prolonged postoperative analgesia. Addition of adjuvants such as dexmedetomidine, clonidine, and fentanyl toepidural local anaesthetics improves block characteristics and haemodynamic stability. This study was conducted to compare the effects of dexmedetomidine, clonidine, and fentanyl on intraoperative haemodynamics when used as adjuvants to epidural ropivacaine.Methodology:This randomized prospective comparative study was conducted in the Department of Anaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, from February 2025 to November 2025. A total of 45 ASA grade I and II patients aged 20–60 years undergoing lower limb orthopaedic surgeries under epidural anaesthesia were randomly divided into three groups of 15 each. Group A received ropivacaine with dexmedetomidine, Group B received ropivacaine with clonidine, and Group C received ropivacaine with fentanyl. Intraoperative haemodynamic parameters, onset and duration of sensory and motor blockade, analgesia, and adverse effects were assessed.Results:A statistically significant fall in systolic, diastolic, and mean arterial pressure was observed in Groups B and C from 15 to 120 minutes after epidural block (p<0.05). Dexmedetomidine demonstrated better haemodynamic stability compared to clonidine and fentanyl groups. All three groups provided effective anaesthesia and satisfactory analgesia with manageable adverse effects.Conclusion:Dexmedetomidine, clonidine, and fentanyl are effective epidural adjuvants in lower limb orthopaedic surgeries. Dexmedetomidine showed superior haemodynamic stability and prolonged analgesic effect with minimal adverse effects.
Dr. Sreekala, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Background: Surgical stress induces haemodynamic instability and stress-related hyperglycaemia, which may adversely affect perioperative outcomes. Alpha-2 adrenergic agonists such as dexmedetomidine and clonidine are used as anaesthetic adjuvants to attenuate this response. Patient State Index (PSI) monitoring allows objective assessment of the depth of anaesthesia and precise titration of anaesthetic agents. Methods: This prospective randomised comparative study included 62 adult patients (18–60 years), ASA physical status I–II, undergoing elective thoracoabdominal surgeries under general anaesthesia. Patients were randomly allocated to receive dexmedetomidine (1 μg/kg loading dose followed by 0.5 μg/kg/h infusion) or clonidine (1 μg/kg loading dose followed by 0.5 μg/kg/h infusion). Anaesthesia was maintained with desflurane and titrated to maintain PSI values between 25 and 50. Results: PSI values remained within the recommended range in both groups with no significant intergroup difference (p > 0.05). Dexmedetomidine provided significantly lower heart rate and more stable mean arterial pressure compared to clonidine (p < 0.05). Blood glucose levels were comparable between groups except at 30 minutes after induction. Conclusion: Dexmedetomidine offers superior haemodynamic stability and may be preferred when cardiovascular stability is desired.
Background:Emergence agitation (EA) is a common and distressing complication following sevoflurane anaesthesia in paediatric patients, characterized by non-purposeful restlessness, crying, and disorientation. Dexmedetomidine, a highly selective α2-agonist, is frequently utilized to prevent EA. However, the optimal administration method, rapid intravenous bolus versus continuous intraoperative infusion, remains debated regarding the balance of efficacy and hemodynamic stability.Aims and Objectives:To systematically compare the clinical effectiveness, postoperative recovery profile, and perioperative hemodynamic stability of a rapid bolus versus a continuous low-dose infusion of dexmedetomidine (0.3 μg/kg) in preventing emergence agitation in children undergoing elective abdominal and genitourinary surgeries under sevoflurane anaesthesia.Materials and Methods:This prospective, randomized, double-blind, comparative study enrolled 80 paediatric patients (ASA physical status I–II, aged 2–12 years) randomly allocated into two equal groups (n=40). Group B received IV dexmedetomidine 0.3 μg/kg as a bolus over 10 minutes; Group I received a continuous infusion at 0.3 μg/kg/hour. Intraoperative Heart Rate and MAP were continuously monitored. Postoperative emergence agitation and pain were assessed using the PAED scale and Observational Pain Scores (OPS) in the PACU.Results:Both techniques provided comparable hemodynamic stability. A transient, statistically significant decrease in MAP (p=0.015) was noted at 10 minutes post dexmedetomidine administration in group B, accompanied by a mild, non significant reduction in heart rate (p=0.184); all values remained within 20% of pre-induction baselines without requiring intervention. Group B demonstrated superior early analgesia (OPSon PACU arrival: 1.8 ± 1.2 vs 4.6 ± 1.8; p<0.001). Extubation times (6.2 ± 1.1 vs 6.5 ± 1.4 min; p=0.284) and emergence times (8.1 ± 1.5 vs 8.4 ± 1.8 min; p=0.418) were highly comparable.Conclusion:A 0.3 μg/kg bolus of dexmedetomidine is hemodynamicallysafe and clinically superior to an equivalent continuous infusion. It provides good early postoperative analgesia and effectively mitigates sevoflurane-induced emergence agitation without extending recovery or extubation times.
Sardar Bhagat Singh, Manmohan Jindal, Namrata Jain et al.· Asian Journal of Medical Res...· 0 citations
Background:Functional Endoscopic Sinus Surgery (FESS) requires a clear and bloodless surgical field for optimal visualization and prevention of intraoperative complications. Controlled hypotension is commonly employed during FESS to reduce blood loss and improve surgical conditions. Dexmedetomidine and Propofol are widely used agents for controlled hypotensive anesthesia. The present study was conducted to compare the efficacy of dexmedetomidine and propofol infusion in achieving controlled hypotension during FESS.Methodology:This prospective randomized comparative study was conducted in the Department of Anaesthesiology at Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 100 patients aged between 18 and 40 years belonging to ASA Grade I and II undergoing elective FESS were included in the study. Patients were randomly allocated into two groups of 50 each. Group D received dexmedetomidine infusion at 0.4–0.8 μg/kg/hr, while Group P received propofol infusion at 75–100 μg/kg/min following induction of general anesthesia. Intraoperative pulse rate, mean arterial pressure, blood loss, quality of surgical field, sedation score, and complications were assessed and compared between the two groupsResults:Baseline demographic and hemodynamic parameters were comparable between the groups. Intraoperative pulse rate and mean arterial pressure were significantly lower in the dexmedetomidine group at various time intervals compared with the propofol group (p<0.05). Quality of surgical field and mean blood loss were comparable in both groups. Postoperative Ramsay sedation scores at 30 minutes were significantly higher in the propofol group (p=0.023). No major complications were observed in either group.Conclusion:Both dexmedetomidine and propofol were effective and safe agents for controlled hypotension during FESS. Dexmedetomidine provided superior intraoperative hemodynamic stability with comparable surgical field quality and blood loss, making it a useful alternative to propofol for hypotensive anesthesia in endoscopic sinus surgery.
Dr. Balakrishnan, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids.
Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery.
Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and sideeffects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant.
Results: The mean age was 38.43±8.31 years in GroupRF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension.
Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.
Akansha Singhal, Karuna Taksande· Journal of Clinical and Diag...· 0 citations