Application of dexmedetomidine with total intravenous anesthesia on perioperative period of carotid endarterectomy

Objective To evaluate the safety and efficacy of dexmedetomidine in patients undergoing carotid endarterectomy (CEA), and to explore its mechanism in cerebral protection. Methods Forty patients undergoing CEA were divided into 2 groups: dexmedetomidine group (Group D, N = 20) and control group (Group S, N = 20), respectively receiving dexmedetomidine intravenous infusion (0.40 μg/kg) and the same dose of normal saline. Total intravenous anesthesia (TIVA) was applied in both 2 groups. Mean arterial pressure (MAP) and heart rate (HR) of each patient were recorded at T0 (before administration), T1 (before tracheal intubation), T2 (1 min after intubation), T3 (carotid explosing), T4 (before extubation) and T5 (1 min after extubation) respectively. Total amount of propofol and remifentanil, and patients' recovery conditions after anesthesia were also recorded. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured and compared before and after operation between 2 groups. Results In Group D, MAP and HR decreased significantly at T1-5 compared with T0 (P < 0.05, for all); in group S, HR and MAP increased at the same condition (P < 0.05, for all). Total amount of propofol and remifentanil in Group D was lower than that in Group S (P < 0.05, for all). And the patients' recovery conditions in Group D after anesthesia was better than that in Group S (P < 0.05, for all). TNF-α and IL-6 increased after anesthesia compared with that before anesthesia in 2 groups, however, it was higher in Group S than in Group D (P < 0.05, for all). Conclusions Dexmedetomidine can provide stable hemodynamic condition during anesthesia in patients undergoing CEA, and improve both the outcome of operation and recovery. With good safety and efficacy, it can provide brain protection by reducing the level of TNF-α and IL-6. doi：10.3969/j.issn.1672-6731.2014.02.004