100 persons were included in the study, 20 subjects as controls, 40 patients in group D (Dexmedetomidine) and 40 patients in group F (Fentanyl) with no significant difference between the 3 groups regarding age, sex and body mass index (Table 1)
Table 1: Characteristics of all studied groups:
P value
|
Group F 40
|
Group D 40
|
Control 20
|
Parameter
|
40
|
40
|
20
|
No
|
0.5a
|
54.7±5.4
|
53.9±5.4
|
55.5±5
|
Age (M±SD)
|
0.9b
|
13(32.5%)
27(67.5%)
|
28(70%)
12(30%)
|
14 (70%)
6 (30%)
|
Sex male
female
|
0.7a
|
27.2±1.6
|
27.2±1.7
|
26.9±2
|
BMI(M±SD)
|
aby Anova test b by chi-square test
By using paired t test to compare the initial measurements of group D (T0) with different interval T1, T2 and T3 of the same 40 cases, there were significant difference in pulse, SBP, DBP and blood sugar between T0 and each of T1 and T2 but no difference between T0 and T3. FT4, FT3, cortisol, GH, ACTH, Norepinephrine and lactic acid there were significant difference between T0 and each T1, T2 and T3 While, insulin was significant different in T2, T3 compared to T0and GH was significant at T0 with T2. By comparing T1 and T2 there were significant increase in most of parameters in T2 comparing to T1 except in ACTH and SBP significant decrease in T2 comparing to T1. By comparing to T1 and T3 there were significant increase in all of parameters in T3 comparing to T1 except GH showed insignificant increase. By comparing T2 and T3 there were significant increase in T3 comparing T2 in SBP, ACTH and lactic acid and significant decrease in pulse, DBP, blood sugar, FT3, GH and cortisol but no significant changes in serum insulin, FT4 and norepinephrine Table (2)
Table 2: Hemodynamic and biochemical changes in Group D patients in the different periods of operation
P6 a
|
P5 a
|
P4 a
|
P3 a
|
P2 a
|
P1 a
|
T3
|
T2
|
T1
|
T0
|
Parameter
(M±SD)
|
<0.001
|
<0.001
|
<0.001
|
0.3
|
<0.001
|
<0.001
|
87.5±7.6
|
95.6±6.8
|
69.4±5.2
|
88.5±7.3
|
Pulse (M±SD)
|
<0.001
|
<0.001
|
<0.035
|
0.4
|
<0.001
|
<0.001
|
129±2
|
114±16.1
|
119.8±4.7
|
128.7±2.6
|
SBP (M±SD)
|
0.006
|
<0.001
|
<0.001
|
0.5
|
0.017
|
<0.001
|
81.7±3.9
|
84.8±5.7
|
69.5±4.4
|
82.2±4.6
|
DBP (M±SD)
|
0.02
|
<0.001
|
<0.001
|
0.2
|
0.004
|
<0.001
|
101±4.9
|
104.3±7.4
|
86.7±8.4
|
99.5±6
|
Blood Sugar(M±SD)
|
0.8
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.08
|
16.8±2.9
|
16.6±2.7
|
10.4±2.5
|
11.6±3.4
|
Serum Insulin(M±SD
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.039
|
4.2±0.4
|
4.8±0.7
|
2.8±0.7
|
3.3±1.2
|
F T3 (M±SD)
|
0.4
|
<0.001
|
<0.001
|
0.006
|
0.02
|
<0.001
|
2.1±0.3
|
2.1±0.6
|
1.2±0.3
|
1.8±0.5
|
FT4 (M±SD)
|
0.001
|
0.48
|
0.004
|
0.8
|
0.01
|
0.4
|
6.5±0.7
|
7±0.8
|
6.3±1.0
|
6.5±1.1
|
GH (M±SD)
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
414.5±53.2
|
474.6±64.5
|
282.8±39.5
|
347±42.1
|
Cortisol (M±SD
|
<0.001
|
0.003
|
<0.001
|
0.001
|
<0.001
|
<0.001
|
63.2±7.7
|
39.6±6.9
|
58.5±8.1
|
70.1±7.7
|
ACTH (M±SD)
|
0.7
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
7.2±1.14
|
7.3±1.4
|
2.3±0.5
|
4.1±1.4
|
Norepinephrine
(M±SD)
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
10.3±0.3
|
9.3±0.3
|
7.8±0.5
|
7.2±0.3
|
Lactic acid
M±SD
|
a Paired t test P1 between T0 and T1 P2 between T0 and T2
P3 between T0 and T3 P4 between T1 and T2 P5 between T1 and T3
P6 between T2 and T3
By using post hoc Tukey test of Anova; there were significant difference in pulse, SBP, DBP, FT4 , cortisol, ACTH, norepinephrine, and lactic acid between control and each of group D and F initial measurements There were no significant differences in insulin between control and each of group D and F at T0 and FT3in control compared to D group at T0. While, there were no significant difference in these parameters between group D and F except in norepinephrine and blood sugar as they were higher in group D (Table 3).
Table 3: Hemodynamic and biochemical changes between Control, D group and F group at T0.
P3 a
|
P2 a
|
P1 a
|
P value a
|
F group
(40)
|
D group (40)
|
Control 20
|
|
0.5
|
<0.001
|
<0.001
|
<0.001
|
89.5±6.8
|
88.5±7.3
|
72.5±5.8
|
Pulse (M±SD)
|
0.9
|
<0.001
|
<0.001
|
<0.001
|
128.6±2.4
|
128.7±2.6
|
124.4±4.5
|
SBP (M±SD)
|
0.9
|
<0.001
|
<0.001
|
<0.001
|
81.9±4.07
|
82.2±4.6
|
76.4±6
|
DBP (M±SD)
|
0.02
|
0.8
|
0.02
|
0.009
|
94.9±9.8
|
99.5±6
|
93.7±6.3
|
Blood Sugar(M±SD)
|
0.99
|
0.94
|
0.94
|
0.9
|
11.6±3.5
|
11.6±3.4
|
11.9±4.6
|
Serum Insulin(M±SD
|
0.06
|
0.01
|
0.4
|
0.014
|
3.8±1.0
|
3.3±1.2
|
3.0±0.9
|
F T3 (M±SD)
|
0.5
|
<0.001
|
<0.001
|
<0.001
|
1.7±0.5
|
1.8±0.5
|
1.1±0.3
|
FT4 (M±SD)
|
0.8
|
<0.001
|
<0.001
|
<0.001
|
6.5±1.1
|
6.5±1.1
|
5±1.2
|
GH (M±SD)
|
0.5
|
<0.001
|
<0.001
|
<0.001
|
340.8±44.7
|
347±42.1
|
216.2±20.5
|
Cortisol (M±SD
|
0.09
|
<0.001
|
<0.001
|
<0.001
|
73±7.6
|
70.1±7.7
|
53.8±9.8
|
ACTH (M±SD)
|
0.001
|
<0.001
|
<0.001
|
<0.001
|
3.2±0.7
|
4.1±1.4
|
1.2±0.6
|
Norepinephrine (M±SD)
|
0.07
|
<0.001
|
<0.001
|
<0.001
|
6.9±0.5
|
7.2±0.3
|
5.1±0.3
|
Lactic acid (M±SD)
|
aby Anova test Tukey test
P1 between control and group D
P2 between control and group F
P3 between group D and group F
By using paired t test to compare the initial measurements of group F with T1, T2 and T3 of the same 40 cases, there were significant difference in pulse, SBP and DBP between T0 and each of T1 and T2 but no difference between T0 and T3. Blood sugar, FT3, cortisol, ACTH, Norepinephrine and lactic acid there were significant difference between T0 and each T1, T2 and T3. Serum insulin and GH were significantly increase in T2 and T3 compared to T0. By comparing T1 and T2 there were significant increase in all of parameters in T2 comparing to T1 except in ACTH significant decrease in T2 comparing to T1. By comparing T1 and T3 there were significant increase in all of parameters in T3 comparing to T1 except GH. By comparing T2 and T3 there were significant increase in in T3 comparing to, T2 in ACTH and lactic acid and significant decrease in pulse, SBP, DBP, FT3, GH and cortisol but no significant changes in serum insulin, blood sugar, FT4 and NP Table (4)
Table 4: Hemodynamic and biochemical changes in group F patient in different periods of operation
P6a
|
P5a
|
P4a
|
P3a
|
P2a
|
P1a
|
T3
|
T2
|
T1
|
T0
|
Parameter
|
<0.001
|
<0.001
|
<0.001
|
0.8
|
<0.001
|
<0.001
|
89.8±7.5
|
99.5±6.3
|
71.4±5.4
|
89.5±6.8
|
Pulse (M±SD)
|
0.029
|
<0.001
|
<0.001
|
0.1
|
<0.001
|
<0.001
|
129.4±2.1
|
130.6±2.6
|
120.1±5.2
|
128.6±2.4
|
SBP (M±SD)
|
<0.001
|
<0.001
|
<0.001
|
0.2
|
<0.001
|
<0.001
|
82.7±4.1
|
89.3±5.7
|
71.5±4.4
|
81.9±4.07
|
DBP (M±SD)
|
0.443
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
103.8±5.6
|
105±6.7
|
88.3±7.3
|
94.9±9.8
|
Blood Sugar (M±SD)
|
0.41
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.7
|
17.7±2.9
|
18.2±2.6
|
11.4±3
|
11.6±3.5
|
Serum Insulin (M±S
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.007
|
4.8±0.8
|
5.5±0.9
|
3.3±0.6
|
3.8±1.0
|
F T3 (M±SD)
|
0.3
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.06
|
2.3±0.4
|
2.4±0.7
|
1.5±0.4
|
1.7±0.5
|
FT4 (M±SD)
|
<0.001
|
0.41
|
<0.001
|
0.04
|
<0.001
|
0.4
|
6.9±0.5
|
7.6±0.9
|
6.7±1.1
|
6.5±1.1
|
GH (M±SD)
|
0.016
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
483.6±66
|
510.2±55.7
|
303.5±34.3
|
340.8±44.7
|
Cortisol (M±SD
|
<0.001
|
0.004
|
<0.001
|
<0.001
|
<0.001
|
0.001
|
62.6±7.4
|
41.5±6.4
|
66.2±8.5
|
73±7.6
|
ACTH (M±SD)
|
0.5
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
0.02
|
8±1.2
|
7.7±1.4
|
2.8±0.59
|
3.2±0.7
|
Norepinephrine (M±SD)
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
<0.001
|
10.9±0.3
|
10.2±0.2
|
8.2±0.3
|
6.9±0.5
|
Lactic acid
M±SD
|
a Paired t test
P1 between T0 and T1
P2 between T0 and T2
P3 between T0 and T3
P4 between T1 and T2
P5 between T1 and T3
P6 between T2 and T3
By using an independent t test to compare groups D and F. There was a significant increase in initial measurements of norepinephrine and blood sugar in group D compared to group F. At T1 measurements, there was a significant increase in FT3, FT4, cortisol, ACTH, norepinephrine, and lactic acid in group F compared to group D.
At T2 measurements, there was a significant increase in pulse, SBP, DBP, FT3, GH, cortisol, insulin, and lactic acid in group F compared to group D.
At T3 measurements, there was a significant increase in FT3, FT4, cortisol, GH, norepinephrine, and lactic acid in group F compared to group D (Table 5)
Table 5: A comparison between groups D and F regarding different parameters and operation time:
P4
|
F
T3
|
D
T3
|
P3
|
F
T2
|
D
T2
|
P2
|
F
T1
|
D
T1
|
P1
|
F
T0
|
D
T0
|
Parameter
|
0.2
|
89.8±7.5
|
87.5±7.6
|
0.01
|
99.5±6.3
|
95.6±6.8
|
0.1
|
71.4±5.4
|
69.4±5.2
|
0.5
|
89.5±6.8
|
88.5±7.3
|
Pulse
M±SD
|
0.3
|
129.4±2.1
|
129±2
|
<0.001
|
130.6±2.6
|
114±16.1
|
0.7
|
120.1±5.2
|
119.8±4.7
|
0.9
|
128.6±2.4
|
128.7±2.6
|
SBP
M±SD
|
0.2
|
82.7±4.1
|
81.7±3.9
|
0.001
|
89.3±5.7
|
84.8±5.7
|
0.05
|
71.5±4.4
|
69.5±4.4
|
0.9
|
81.9±4.07
|
82.2±4.6
|
DBP
M±SD
|
0.02
|
103.8±5.6
|
101±4.9
|
0.6
|
105±6.7
|
104.3±7.4
|
0.3
|
88.3±7.3
|
86.7±8.4
|
0.02
|
94.9±9.8
|
99.5±6
|
B.Sugar
M±SD
|
0.1
|
17.7±2.9
|
16.8±2.9
|
0.01
|
18.2±2.6
|
16.6±2.7
|
0.1
|
11.4±3
|
10.4±2.5
|
0.9
|
11.6±3.5
|
11.6±3.4
|
S.Insulin
M±SD
|
<0.001
|
4.8±0.8
|
4.2±0.4
|
0.001
|
5.5±0.9
|
4.8±0.7
|
0.002
|
3.3±0.6
|
2.8±0.7
|
0.06
|
3.8±1.0
|
3.3±1.2
|
F T3
M±SD
|
0.008
|
2.3±0.4
|
2.1±0.3
|
0.07
|
2.4±0.7
|
2.1±0.6
|
0.006
|
1.5±0.4
|
1.2±0.3
|
0.5
|
1.7±0.5
|
1.8±0.5
|
FT4
M±SD
|
0.008
|
6.9±0.5
|
6.5±0.7
|
0.003
|
7.6±0.9
|
7±0.8
|
0.1
|
6.7±1.1
|
6.3±1.0
|
0.8
|
6.5±1.1
|
6.5±1.1
|
GH
M±SD
|
<0.001
|
483.6±66
|
414.5±53.2
|
0.01
|
510.2±55.7
|
474.6±64.5
|
0.01
|
303.5±34.3
|
282.8±39.5
|
0.5
|
340.8±44.7
|
347±42.1
|
Cortisol
M±SD
|
0.5
|
62.6±7.4
|
63.2±7.7
|
0.2
|
41.5±6.4
|
39.6±6.9
|
<0.001
|
66.2±8.5
|
58.5±8.1
|
0.09
|
73±7.6
|
70.1±7.7
|
ACTH
M±SD
|
0.004
|
8±1.2
|
7.2±1.14
|
0.1
|
7.7±1.4
|
7.3±1.4
|
<0.001
|
2.8±0.59
|
2.3±0.5
|
0.001
|
3.2±0.7
|
4.1±1.4
|
Norepinephrine
M±SD
|
<0.001
|
10.9±0.3
|
10.3±0.3
|
<0.001
|
10.2±0.2
|
9.3±0.3
|
<0.001
|
8.2±0.3
|
7.8±0.5
|
0.07
|
6.9±0.5
|
7.2±0.3
|
Lactic acid
M±SD
|
P value by independent t test P value in red color is significant
By comparing the Ramsy scale at arrival and after 10 minutes, there was no significant difference in group D, but in group F, there was a significant decrease in the Ramsy score after 10 minutes compared to at arrival.
However, by comparison between the Ramsy scale in groups D and F, there was a significant decrease in the Ramsy score in group F compared to group D at both arrival and after 10 minutes (Table 6).
Table 6: Ramsy scale in groups D and F at arrival and after 10 minutes
P value by independent t test
|
Group F
|
Group D
|
|
0.001
|
2.2±0.4
|
2.6±0.49
|
At arrival (M±SD)
|
<0.001
|
1.4±0.4
|
2.1±0.3
|
After 10 minutes (M±SD)
|
|
<0.001
|
0.2
|
P value by paired t test
|
P<0.05 is considered significant in red color
Correlation:
At T0 measurements in group D, there was a positive correlation between lactic acid and both blood glucose and GH, between insulin and both free T4 and ACTH, and between cortisol and both ACTH and NP. However, a negative correlation was recorded between ACTH and both GH and Np and between cortisol and free T4 (Figure 1)
At T1 measurements in group D, there was a moderate positive correlation between blood glucose and each of insulin, Np, cortisol, GH, and lactic. There is a mild positive relationship between insulin and cortisol. Negative correlation between ACTH and each of blood glucose and insulin, Np FT3 (Figure 2)
At T2 measurements in group D, there was a positive correlation between insulin and blood sugar, as well as between GH and cortisol, Np, and each of cortisol and GH. There is a negative correlation between lactic acid and each of FT3 and Np, blood sugar, and each of cortisol and FT4. Insulin and each of FT4 and ACTH (Figure 3)
At T3 measurements in group D, there was a positive correlation between lactic acid and each of FT3 and ACTH. Also, ACTH and FT3. Cortisol, FT3, and insulin. Negative correlation between GH and blood sugar (Figure 4)
In group F, there was a positive correlation between lactic acid and each of the blood glucose, Np, and GH, as well as between ACTH and both FT4 and insulin, and between insulin and FT4. There is a negative correlation between ACTH and blood sugar, Np and cortisol, and insulin and GH (Figure 5)
In group F, there was a mild positive correlation between blood glucose and each of FT3 and cortisol. Also, between GH and each of FT4 and Np. Negative correlation between NP, ACTH, and FT4 (Figure 6)
In group F, there was a positive correlation between GH and each of FT3, cortisol, and lactic acid, as well as between cortisol and each of Np, GH, and ACTH. Negative correlation between ACTH and insulin and cortisol and FT4 (Figure 7)
In group F, there was a positive correlation between insulin and each of Np and FT4. There is a negative correlation between GH and blood sugar, FT3 and lactic acid, and Np and each of FT4 and ACTH (Figure 8)