Evaluation of dexmedetomidine anesthesia-related temperature changes: preliminary retrospective observational study
Avaliação de alterações de temperatura relacionadas à anestesia com dexmedetomidina: estudo observacional retrospectivo preliminar
Felipe Aparecido Ferreira da Cruz; Luiz Fernando dos Reis Falcão; José Luiz Gomes do Amaral; Helga Cristina Almeida da Silva
Abstract
Introduction and objective
Dexmedetomidine is a potent adrenergic alpha-2 agonist, and analgesic, sedative, anxiolytic and sympatholytic. Given there have been reports of dexmedetomidine associated temperature changes, in which these events have been associated with complications, our objective was to describe both temperature increase and decrease, during the intra and postoperative period (initial 24 hours), and factors associated, in patients who received dexmedetomidine for anesthesia/sedation in the surgical suite.
Method
Retrospective observational study, analyzing charts of patients ≥ 18 years submitted to anesthesia/sedation with dexmedetomidine, between 1/1/2017 and 31/12/2017. Upper temperature threshold was considered ≥ 37.8 °C, and lower, < 35 °C. The association with dexmedetomidine was assessed by the OMS/UMC causality system and by the Naranjo algorithm.
Results
The sample included 42 patients who received dexmedetomidine and whose temperature data were available, with predominance of men 26 (62%), 49.4/16.5 years old (mean/standard deviation), and weight 65/35.8 kg. None of the patients presented intraoperative temperature equal to or above 37.8 °C or below 35 °C. During the postoperative period, one patient presented an increase ≥ 37.8 °C (2.4%) and three, temperature decrease < 35 °C (7%). Surgery/anesthesia time and exposure time to dexmedetomidine were not appropriate linear predictors of maximum temperature. Older age (p < 0.01), longer exposure to dexmedetomidine (p < 0.05) and shorter surgery time (p < 0.01) were significant linear predictors for lower minimum temperature.
Conclusions
Increase ≥ 37.8 °C/decrease < 35 °C of temperature possibly associated with dexmedetomidine did not occur in the intraoperative period and had a low frequency during the postoperative period.
Abbreviations
MHmalignant hyperthermiaUMCUppsala Monitoring CentreICUIntensive Care UnitWHOWorld Health Organization
Keywords
Resumo
Justificativa e objetivo: Dexmedetomidina é potente agonista alfa-2 adrenérgico com ação analgésica, sedativa, ansiolítica e simpatolítica. Como há relatos de alteração da temperatura associada à dexmedetomidina, eventos esses associados a complicações, nosso objetivo foi descrever variação de temperatura, tanto aumento como diminuição, intra e pós-operatória (primeiras 24 horas), e fatores associados em pacientes que receberam dexmedetomidina para anestesia/sedação em centro cirúrgico. Método: Estudo observacional retrospectivo, com análise de prontuários de pacientes ≥ 18 anos submetidos a anestesia/sedação com dexmedetomidina, entre 1/1/2017 e 31/12/2017. Considerou-se como limite o aumento de temperatura ≥ 37,8ºC e diminuição da temperatura < 35ºC. A associação à dexmedetomidina foi avaliada pelo teste de causalidade OMS/UMC e pela escala Naranjo. Resultados: A amostra incluiu 42 pacientes que usaram dexmedetomidina cujos dados de temperatura estavam disponíveis, com predomínio de homens (26(62%)) de 49,4/16,5 anos (média/desvio padrão) e peso de 65/35,8 kg. Nenhum paciente apresentou temperatura intraoperatória maior ou igual a 37,8ºC ou menor que 35ºC. No pós-operatório, um paciente apresentou aumento ≥ 37,8ºC (2,4%) e três, diminuição da temperatura < 35ºC (7%). Tempo de cirurgia/anestesia e tempo de exposição à dexmedetomidina não foram bons preditores lineares da temperatura máxima. Idade mais avançada (p < 0,01), maior tempo de exposição à dexmedetomidina (p < 0,05) e menor tempo de cirurgia (p < 0,01) foram previsores lineares significantes para temperatura mínima mais baixa. Conclusões: Aumento ≥ 37,8ºC /diminuição < 35ºC da temperatura possivelmente associadas à dexmedetomidina não ocorreram no intraoperatório e tiveram baixa frequência no pós- -operatório.
Palavras-chave
References
1 N.R. Villela, P.N. Junior Dexmedetomidine in anesthesiology Rev Bras Anestesiol, 53 (2003), pp. 97-113
2 B.D. Krüger, J. Kurmann, N. Corti, et al. Dexmedetomidine-associated hyperthermia: a series of 9 cases and a review of the literature Anesth Analg, 125 (2017), pp. 1898-1906
3 A. Harding, A. Heine, A. Gerlach Dexmedetomidine induced hyperthermia Crit Care Med, 41 (2013), p. A340
4 T. Okabe, S. Takeda, S. Akada, et al. Postoperative intensive care unit drug fever caused by dexmedetomidine Anesth Analg, 108 (2009), pp. 1589-1591
5 L.B. Straw, C.R. Dodson, D.S. Schrift Dexmedetomidine — induced fever and delirium: a case report J Clin Pharm Ther, 43 (2018), pp. 430-433
6 M. Shukry, Z.V. Guruli, U. Ramadhyani Case report: suspected malignant hyperthermia in a child with laminin a2 (merosin) deficiency in the absence of a triggering agent Paediatr Anesth, 16 (2006), pp. 462-465
7 A.C. Faust, S.E. Sutton Dexmedetomidine — associated fever in the intensive care unit Ther Adv Drug Saf, 6 (2015), pp. 234-237
8 J.C. Finkel, Z.M.N. Quezado Hypothermia-induced bradycardia in a neonate receiving dexmedetomidine J Clin Anesth, 19 (2007), pp. 290-292
9 P. Talke, F. Tayefeh, D.I. Sessler, et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds Anesthesiology, 87 (1997), pp. 835-841
10 C.G. Lopes, R.R. Nunes Temperatura corporal e anestesia J.T. Manica (Ed.), Anestesiologia: Princípios e Técnicas (4th ed.), Artmed, Porto Alegre, RS (2018), pp. 554-562
11 E. Dewhirst, A. Naguib, J.D. Tobias Dexmedetomidine as part of balanced anesthesia care in children with malignant hyperthermia risk and egg allergy J Pediatr Pharmacol Ther, 16 (2011), pp. 113-117
12 A. Naguib, C. McKee, A. Phillips, et al. Dexmedetomidine as the primary anesthetic agent during cardiac surgery in an infant with a family history of malignant hyperthermia Saudi J Anaesth, 5 (2011), pp. 426-429
13 S.R. Lewis, A. Nicholson, A.F. Smith, et al. Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia Cochrane Database of Sys Rev, 8 (2015), Article CD011107
14 W.M. Abdelmageed, W.M. Al Taher Intramuscular dexmedetomidine for prevention of shivering after general anesthesia in patients undergoing arthroscopic anterior cruciate ligament reconstruction Ain-Shams J Anesthesiol, 07 (2014), pp. 156-162
15 S. Karaman, I. Gunusen, M.A. Ceylan, et al. Dexmedetomidine infusion prevents postoperative shivering in patients undergoing gynecologic laparoscopic surgery Turk J Med Sci, 43 (2013), pp. 232-237
16 Y.S. Kim, Y.I. Kim, K.H. Seo, et al. Optimal dose of prophylactic dexmedetomidine for preventing postoperative shivering Int J Med Sci, 10 (2013), pp. 1327-1332
17 C. Bicer, A. Esmaoglu, A. Akin, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering Eur J Anaesthesiol, 23 (2006), pp. 149-153
18 E.G. Elvan, B. Oc, S. Uzun, et al. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy Eur J Anaesthesiol, 25 (2008), pp. 357-364
19 F. Tan, X. Gan, Y. Deng, et al. Intraoperative dexmedetomidine attenuates postoperative systemic inflammatory response syndrome in patients who underwent percutaneous nephrolithotomy: a retrospective cohort study Ther Clin Risk Manag, 14 (2018), pp. 287-293
20 F. Marquez-Grados, E. Vettorato, F. Corletto Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study J Vet Sci, 21 (2020), p. e8
21 G.R. Browning, D. Eshar, H. Beaufrere Comparison of dexmedetomidine-ketamine-midazolam and isoflurane for anesthesia of black-tailed prairie dogs (Cynomys ludovicianus) J Am Assoc Lab Anim Sci, 58 (2019), pp. 50-57
22 D.I. Sessler Temperature monitoring and perioperative thermoregulation Anesthesiology, 109 (2008), pp. 318-338
23 L.F.E. Santana, M.S. Rodrigues, M.P.A. Silva, et al. Fever of unknown origin in special groups Rev Assoc Med Bras, 65 (2019), pp. 1308-1313
24 I.R. Edwards, C. Biriell Harmonisation in pharmacovigilance Drug Saf, 10 (1994), pp. 93-102
25 C.A. Naranjo, U. Busto, E.M. Sellers, et al. A method for estimating the probability of adverse drug reactions Clin Pharmacol Ther, 30 (1981), pp. 239-245
26 S.M. Jakob, E. Ruokonen, R.M. Grounds, et al. Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials JAMA, 307 (2012), pp. 1151-1160
27 K. Grayson, A.E. Tobin, T.K. Lim, et al. Dexmedetomidine-associated hyperthermia: a retrospective cohort study of intensive care unit admissions between 2009 and 2016 Anaesth Intensive Care, 45 (2017), pp. 727-736
28 N. Patel, C.E. Smith, A.C. Pinchak, et al. Comparison of esophageal, tympanic, and forehead skin temperatures in adult patients J Clin Anesth, 8 (1996), pp. 462-468
29 Ribeiro MLB, Silva HB. Resolução do Conselho Federal de Medicina nᵒ 2.174, de 14 de dezembro de 2017. Dispõe sobre a prática do ato anestésico e revoga a Resolução CFM nº 1.802/2006. Diário Oficial da União. Publicado em 27/02/2018. Edição 39. Seção 1. Página 75-76-84. Disponível em https://www.sbahq.org/wp-content/uploads/2018/03/RESOLUC%CC%A7A%CC%83O-2_174-de-14-de-dezembro-de-2017-Dia%CC%81rio-Oficial-da-Unia%CC%83o-Imprensa-Nacional.pdf [último acesso: 06/04/2020].
30 D.C. Carretiero, F.E. Santiago, A.C. Motzko-Soares, et al. Temperature and toxic Tau in Alzheirmer’s disease: new insights Temperature, 2 (2015), pp. 491-498
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email