Document Detail


Deep sedation with dexmedetomidine in a porcine model does not compromise the viability of free microvascular flap as depicted by microdialysis and tissue oxygen tension.
MedLine Citation:
PMID:  17717221     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Deep sedation is often necessary after major reconstructive plastic surgery in the face and neck regions to prevent sudden spontaneous movements capable of inflicting mechanical injury to the transplanted musculocutaneous flap(s). An adequate positioning may help to optimize oxygenation and perfusion of the transplanted tissues. We hypothesized that dexmedetomidine, a central alpha2-agonist and otherwise potentially ideal postoperative sedative drug, may induce vasoconstriction in denervated flaps, and thus increase the risk of tissue deterioration. METHODS: Two symmetrical myocutaneous flaps were raised on each side of the upper abdomen in 12 anesthetized pigs. The sympathetic nerve fibers were stripped from the arteries in one of the flaps (denervated flap), while nerve fibers were kept untouched in the other (innervated flap). After simulation of ischemia and reperfusion periods, the animals were randomized to deep postoperative sedation with either propofol (n = 6) or dexmedetomidine (n = 6). Flap tissue metabolism was monitored by microdialysis and tissue-oxygen partial pressure. Glucose, lactate, and pyruvate concentrations were analyzed from the dialysate every 30 min for 4 h. RESULTS: Mean arterial blood pressure was higher in the dexmedetomidine group (P = 0.036). Flap tissue metabolism remained stable throughout the experiment as measured by lactate-pyruvate and lactate-glucose ratios (median ranges 14.3-24.5 for lactate-pyruvate and 0.3-0.6 for lactate-glucose) and by tissue-oxygen partial pressure, and no differences were found between groups. CONCLUSIONS: Our data suggest that dexmedetomidine, even if used for deep sedation, does not have deleterious effects on local perfusion or tissue metabolism in denervated musculocutaneous flaps.
Authors:
Silvia Nunes; Leena Berg; L-P Raittinen; Heikki Ahonen; Jussi Laranne; Leena Lindgren; Iikka Parviainen; Esko Ruokonen; Jyrki Tenhunen
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  105     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-24     Completed Date:  2007-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  666-72     Citation Subset:  AIM; IM    
Affiliation:
Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland.
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Pressure / drug effects
Cardiac Output / drug effects
Cell Survival / drug effects
Central Venous Pressure / drug effects
Consciousness / drug effects*
Dexmedetomidine / pharmacology*
Female
Glucose / metabolism
Hypnotics and Sedatives / pharmacology*
Lactic Acid / metabolism
Microcirculation / drug effects,  metabolism
Microdialysis*
Models, Animal
Oxygen / metabolism*
Partial Pressure
Propofol / pharmacology*
Pyruvic Acid / metabolism
Rectus Abdominis / blood supply,  drug effects*,  innervation,  metabolism,  pathology
Surgical Flaps / blood supply*,  pathology
Sus scrofa
Sympathectomy
Time Factors
Vascular Resistance / drug effects
Chemical
Reg. No./Substance:
0/Hypnotics and Sedatives; 113775-47-6/Dexmedetomidine; 127-17-3/Pyruvic Acid; 2078-54-8/Propofol; 50-21-5/Lactic Acid; 50-99-7/Glucose; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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