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      Effects of Dexmedetomidine Infusion During Sevoflurane Anesthesia on Otoacoustic Emissions

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          Abstract

          Background and Objectives

          Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs).

          Subjects and Methods

          This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups.

          Results

          In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies ( p<0.05).

          Conclusions

          Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

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          Most cited references28

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          alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role.

          Sohrab Z. Khan, Jonathan Jones, Mhairi C. Ferguson (1999)
          Clonidine has proved to be a clinically useful adjunct in clinical anaesthetic practice as well as in chronic pain therapy because it has both anaesthetic and analgesic-sparing activity. The more selective alpha-2 adrenoceptor agonists, dexmedetomidine and mivazerol, may also have a role in providing haemodynamic stability in patients who are at risk of peri-operative ischaemia. The side-effects of hypotension and bradycardia have limited the routine use of alpha-2 adrenoceptor agonists. Investigations into the molecular pharmacology of alpha-2 adrenoceptors have elucidated their role in the control of wakefulness, blood pressure and antinociception. We discuss the pharmacology of alpha-2 adrenoceptors and their therapeutic role in this review. The alpha-2 adrenoceptor agonists are agonists at imidazoline receptors which are involved in central blood pressure control. Selective imidazoline agonists are now available for clinical use as antihypertensive agents and their pharmacology is discussed.
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            Cerebral autoregulation and anesthesia.

            Wilbur Lam, Armagan Dagal (2009)
            This review will examine the recent literature on anesthesia and monitoring techniques in relation to cerebral autoregulation. We will discuss the effect of physiologic and pharmacological factors on cerebral autoregulation alongside its clinical relevance with the help of new evidence. Intravenous anesthesia, such as combination of propofol and remifentanil, provides best preservation of autoregulation. Among inhaled agents sevoflurane appears to preserve autoregulation at all doses, whereas with other agents autoregulation is impaired in a dose-related manner. Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with neurologic disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.
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              Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans.

              Pekka Talke, Michelle Lobo, Ronald Brown (2003)
              alpha(2)-Adrenoceptors mediate both sympatholytic and vasoconstrictive hemodynamic effects. The goal of this study was to profile the peripheral vasoconstrictive effects of a selective alpha(2)-adrenoceptor agonist in isolation from the sympatholytic effects it also induces. The authors administered increasing plasma target concentrations of dexmedetomidine (0.075, 0.15, 0.3, and 0.6 ng/mL) or saline placebo to healthy young volunteers in whom the sympatholytic effects of the drug were attenuated in one of two ways: general anesthesia (propofol-alfentanil-nitrous oxide) or axillary brachial plexus block. Measurements were made of finger blood volume (an indicator of vasoconstriction) by photoplethysmographic determination of light transmitted through a finger (LTF) and hemodynamic variables. Measurements made before and during the four steps of infusion were compared by repeated-measures ANOVA. In anesthetized volunteers, all concentrations of dexmedetomidine increased LTF (vasoconstriction) and systolic blood pressure (P < 0.001 for both), whereas placebo did not. In awake volunteers, all concentrations decreased systolic blood pressure (P < 0.001). Concentrations of 0.15, 0.3, and 0.6 ng/mL decreased LTF (vasodilation) in the neurally intact hand; in contrast, the same concentrations increased LTF (vasoconstriction) in the sympathectomized hand (P < 0.001 for both). The results of this study are the first to characterize the lower end of the dose-response curve for vasoconstriction induced by dexmedetomidine. By denervating the vascular bed of interest or by decreasing sympathetic nervous system activity, the authors were able to observe vasoconstriction induced by a systemically administered alpha(2)-agonist with minimal interference from the sympatholytic effects of the drug.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Audiol Otol
                Journal ID (iso-abbrev): J Audiol Otol
                Journal ID (publisher-id): JAO
                Title: Journal of Audiology & Otology
                Publisher: The Korean Audiological Society and Korean Otological Society
                ISSN (Print): 2384-1621
                ISSN (Electronic): 2384-1710
                Publication date (Print): April 2019
                Publication date (Electronic): 13 March 2019
                Volume: 23
                Issue: 2
                Pages: 89-95
                Affiliations
                [1 ]Department of Otolaryngology, Erciyes University Faculty of Medicine, Kayseri, Turkey
                [2 ]Department of Anesthesia, Erciyes University Faculty of Medicine, Kayseri, Turkey
                Author notes
                Address for correspondence Mehmet İlhan Şahin, MD Department of Otolaryngology, Erciyes University Faculty of Medicine, Erciyes Üniversitesi Tıp Fakültesi Gevher Nesibe Hastanesi KBB AD Talas Yolu, Melikgazi, Kayseri 38039, Turkey Tel +90 352 207 6666 (ext 21457) Fax +90 352 207 6600 E-mail misahin@ 123456erciyes.edu.tr
                Article
                Publisher ID: jao-2018-00311
                DOI: 10.7874/jao.2018.00311
                PMC ID: 6468276
                PubMed ID: 30857385
                SO-VID: 90efea4c-3e14-4bd8-9456-7d0e63eef9d9
                Copyright © Copyright © 2019 The Korean Audiological Society and Korean Otological Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 August 2018
                Date revision received : 24 September 2018
                Date accepted : 28 October 2018
                Categories
                Subject: Original Article

                Keywords: dexmedetomidine,adrenergic alpha-2 receptor agonists,otoacoustic emissions,sevoflurane,inhalational anesthetics
                Data availability:
                Keywords: dexmedetomidine, adrenergic alpha-2 receptor agonists, otoacoustic emissions, sevoflurane, inhalational anesthetics

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