Combination of Dexmedetomidine and Tramadol in Patient-Controlled Intravenous Analgesia Strengthens Sedative Effect in Pregnancy-Induced Hypertension.

Shu-Yao Zhang,Chengcheng Xu,Meini Chen,Hai-Yan Li,Xia-Lan Zhang,Qiuzhen Zhang,Yun Chen,Hui Zhao,Dong-Hua Yang,Chengkuan Zhao

doi:10.3389/fphar.2021.739749

Abstract

Objective: The aim of the present study is to explore the combination of dexmedetomidine (DXM) and tramadol (TMD) on sedative effect in patients with pregnancy-induced hypertension (PIH). Methods: A total of 356 patients with pregnancy-induced hypertension (PIH) were randomly divided into three groups: DXM, TMD and DXM + TMD groups. These patients were treated with different doses of DXM, TMD or combination of DXM and TMD by a patient-controlled intravenous injection device. The scores of static pain and dynamic pain, sedation degree, and adverse reaction were recorded. The plasma levels of inflammatory mediators IL-10 and C-reactive protein (CRP), and the serum level of p-p38-MAPK were evaluated. Results: It was found that administration with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg result in stronger sedative effect than single administration with DXM or TMD. The mean arterial pressure (MAP) and heart rate (HR) of patients with PIH were decreased with the combinational treatment of DXM and TMD. Interestingly, the PIH patients injected with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg showed stronger sedative effect. In addition, the plasma level of level of IL-10 was increased and CRP decreased. The serum level of p-p38/MAPK was decreased. Conclusion: Taken together, our study indicates that combination of DXM and TMD effectively lowers blood pressure and reduces inflammation through increasing the level of IL-10, reducing CRP and inhibiting p-p38/MAPK in patients with PIH. This study suggests that the combination of DXM and TMD could be an anesthetic choice in the management of PIH.

Highlights

Pregnancy-induced hypertension (PIH) refers to a state where diastolic blood pressure is higher than 90 mmHg, or in the situation where systolic blood pressure is higher than 140 mmHg when tested in not less than 2 times with the duration of not less than 4 h each time (Veerbeek et al, 2015)
There was no difference in age, body weight, body mass index (BMI) and average gestational weeks of patients among these three groups (Table 1)
These results showed that the mean arterial pressure (MAP) and heart rate (HR) were decreased by administration of DXM and TMD

Summary

Introduction

Pregnancy-induced hypertension (PIH) refers to a state where diastolic blood pressure is higher than 90 mmHg, or in the situation where systolic blood pressure is higher than 140 mmHg when tested in not less than 2 times with the duration of not less than 4 h each time (Veerbeek et al, 2015). Dexmedetomidine (DXM) has been reported to have a positive role in helping control blood pressure as well as uterine bleeding in the process of cesarean section in patients with PIH (Li et al, 2016a; Hariharan, 2017; Kong et al, 2018). DXM could inhibit blood pressure and heart rate of patients during tracheal intubation (Luthra et al, 2017). DXM administration effectively maintains the hemodynamic stability in patients receiving cesarean section who undergo general anesthesia and does not cause adverse effects to the newborns (Yu et al, 2015). TMD injection suppressed systolic arterial blood pressure in rabbits (Egger et al, 2009). Administration of TMD contributes to efficient analgesia after surgery in cesarean section patients with general anesthesia (Demirel et al, 2014)

Methods

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Discussion

Conclusion