Administration Of Dexmedetomidine Research Articles

Effect of dexmedetomidine infusion on characteristics of spinal anesthesia with hyperbaric bupivacaine: A randomized controlled trial

Dexmedetomidine is a highly selective and potent α2 agonist having both sedative and analgesic properties. This study was aimed to assess the effects of intravenous dexmedetomidine on sensory, motor, haemodynamic parameters and sedation during subarachnoid block (SAB) with 0.5% hyperbaric bupivacaine. Sixty patients undergoing infraumbilical and lower limb surgeries were allocated into 2 groups, group D (n=30) received dexmedetomidine infusion at the rate of 0.5 µg/kg/h over an hour prior to SAB and continued till the end of surgery whereas patients in group C (n=30) received similar volume of normal saline infusion for the same duration. Onset of sensory block was 63.77 ± 7.42 s in group D compared with 126.2 ± 12.83s in group C. Two segment regression time was 177.03 ± 11.64 min in group D and 85.67 ± 10.32 min in group C and analgesia duration was 287.67 ± 14.84 min in group D and 149 ± 13.16 min in group C. Onset of motor block was 3.95 ± 0.65 min in group D and 4.5 ± 0.62 min in group C. Motor blockade duration was prolonged in group D compared with group C. There was significant difference between the groups in respect to block characteristics. Administration of intravenous dexmedetomidine during SAB hastens the onset and prolongs the duration of sensory and motor block. It also provides conscious sedation and additional analgesia.

Perioperative variables associated with emergence delirium in children following strabismus surgery: A five-year retrospective single-center cohort study

ABSTRACT Background Emergence Delirium (ED) is common among children. Several factors have been linked to ED related to patient characteristics, anesthesia, or the type of surgery. Strabismus surgery has been associated with the development of ED. The aim of this study was to determine the perioperative variables associated with ED after strabismus surgery in children. Methodology A retrospective cohort study of children who underwent strabismus surgery from January 2018 to December 2022 was conducted. Data on factors leading to ED, including patient characteristics, preoperative anxiety, postoperative pain, surgery-related characteristics anesthesia-related characteristics, were analyzed. Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results Three-hundred-and-thirty-six children were included in the analysis. Fourteen percent of patients developed ED. Predictors of ED were age, multiple muscle surgery, binocular surgery. Midazolam premedication, intraoperative dexmedetomidine and fentanyl were associated with lower incidence of ED. On multivariable analysis, younger age (Odds Ratio (OR) = 1.05; p = 0.039), multiple muscle correction (OR = 1.91; p = 0.041), binocular surgery (OR = 1.85; p = 0.021) midazolam premedication (OR = 2.02; p = 0.007), intraoperative fentanyl administration (OR = 1.88; p = 0.031), and intraoperative dexmedetomidine administration (OR = 1.32; p < 0.001), were independent predictors of ED. Conclusion In this study, younger age, multiple muscle surgery, and binocular surgery were the main non-modifiable factors associated with ED in children following strabismus surgery. Administration of midazolam, dexmedetomidine, or fentanyl were associated with lower incidence of ED. Patients at higher risk for ED could be selected for prophylaxis against ED using these medications to prevent ED after strabismus correction surgery in children.

Dexmedetomidine use during orthotopic liver transplantation surgery on early allograft dysfunction: A randomized controlled trial.

Previous studies have shown a protective effect of dexmedetomidine use in kidney transplantation. In contrast, it is not known whether intraoperative administration of dexmedetomidine can reduce early allograft dysfunction incidence following liver transplantation. To investigate the effect of dexmedetomidine use during surgery on early allograft dysfunction following orthotopic liver transplantation (OLT). This is a single-center, double-blinded, placebo-controlled randomized clinical trial. 330 adult patients undergoing orthotopic liver transplantation were enrolled from Jan 14th, 2019 to May 22nd, 2022. Patients received dexmedetomidine or normal saline during surgery. 1 year follow-ups were recorded. Patients were randomized to two groups receiving either dexmedetomidine or normal saline intraoperatively. For patients in the dexmedetomidine group, a loading dose (1μg/kg over 10 min) of dexmedetomidine was given after induction of anesthesia followed by a continuous infusion (0.5μg/kg /h) until the end of surgery. For patients in the normal saline group, an equal volume loading dose of 0.9% saline was given after the induction of anesthesia followed by an equal volume continuous infusion until the end of surgery. The primary outcome was early allograft dysfunction. Secondary outcomes included primary graft non-function, acute kidney injury and acute lung injury/ acute respiratory distress syndrome. Of 330 patients included in the intention-to-treat analysis, 165 were in the dexmedetomidine group (mean [SD] age, 49 [10] years; 117 [70.9%] men), and 165 were in the normal saline group (mean SD age, 49 [9] years; 118 [74%] men). 39 (24.4%) patients in the dexmedetomidine group and 31 (19.4%) in normal saline group developed early allograft dysfunction and the difference was statistically insignificant (P=0.28). Secondary outcomes including primary graft non-function and acute kidney injury was similar between the two groups. Intraoperative administration of dexmedetomidine did not reduce early allograft dysfunction rate after orthotopic liver transplantation.

Effects of Dexmedetomidine Added to Ropivacaine in Ultrasound-Guided Continuous Pericapsular Nerve Group Block Among Elderly Patients Undergoing Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a highly effective intervention for addressing hip joint issues, yet managing perioperative pain remains a significant challenge. In this study, we aimed to investigate the impact of supplementing ropivacaine with dexmedetomidine in ultrasound-guided continuous pericapsular nerve group block (PENGB) among elderly patients undergoing THA. We conducted a retrospective analysis involving 112 elderly patients who underwent THA. These patients were divided into two groups: the Control group, receiving ropivacaine alone, and the DEX group, receiving ropivacaine combined with dexmedetomidine. We evaluated various parameters including hemodynamic data, postoperative pain levels assessed using the Visual Analog Scale, cognitive status measured with the Montreal Cognitive Assessment, and serum markers (S100β and GFAP). Our findings revealed that the DEX group exhibited improved stability in blood pressure and oxygen saturation following surgery. Moreover, patients in the DEX group reported significantly lower levels of pain at 6 and 12 hours postsurgery, with a prolonged duration of pain relief. Furthermore, dexmedetomidine administration was associated with preserved cognitive function during the early postoperative period. Analysis of serum markers suggested potential cognitive protection conferred by the addition of dexmedetomidine. Overall, our study underscores the multifaceted benefits of incorporating dexmedetomidine into ropivacaine-based PENGB for elderly THA patients.

Efficacy and Safety of Dexmedetomidine Compared to Other Needle-Free Pharmacological Sedation Methods in Pediatric Patients Undergoing Imaging Procedures.

Pediatric patients often require sedation during magnetic resonance imaging (MRI) and computed tomography (CT) to ensure stillness and minimize stress. This meta-analysis compared the effectiveness and safety of 3 sedative agents-dexmedetomidine, midazolam, and chloral hydrate-for pediatric MRI/CT sedation. Six studies with a total of 633 patients were included in the analysis. Quality assessment revealed varying levels of bias risk. Dexmedetomidine exhibited a significantly higher successful sedation rate compared to midazolam (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.29-0.64]), but no statistically significant difference compared to chloral hydrate (RR = 0.94, 95% CI [0.60-1.45]). Chloral hydrate also showed a higher successful sedation rate compared to midazolam (RR = 0.46, 95% CI [0.25-0.83]). The onset of sedation time did not significantly differ between the 3 agents. The dexmedetomidine group had a significantly higher incidence of bradycardia compared to the chloral hydrate group (RR = 0.17, 95% CI [0.05-0.59]), but no significant difference compared to the midazolam group (RR = 0.29, 95% CI [0.06-1.26]). No statistically significant differences were observed in the incidence of nausea and vomiting between the 3 groups. Dexmedetomidine demonstrates effectiveness in pediatric MRI/CT sedation, offering advantages over midazolam and similar efficacy to chloral hydrate. Careful cardiovascular monitoring is essential during administration, particularly in patients with congenital heart disease. Sublingual and intranasal administration of dexmedetomidine is a viable option with high bioavailability. This meta-analysis contributes valuable insights into refining sedation protocols for pediatric imaging procedures, emphasizing efficacy and safety considerations.

Use of orally administered dexmedetomidine to induce emesis in cats.

This case series describes the use of orally administered dexmedetomidine at a dose of 20 µg/kg to induce emesis in six cats. Emesis was successfully induced in 5/6 cats, with each of the cats vomiting once. The reasons for inducing vomiting included known or suspected ingestion of lilies, onions, acetaminophen (paracetamol) or acetylsalicylic acid. Four of the five cats in which emesis induction was successful did not develop any clinical signs of toxicity associated with the toxin ingested; the fifth cat developed clinicopathological changes consistent with acetaminophen toxicity. All six cats exhibited moderate to profound sedation, as expected, but no other adverse effects were documented. Induction of emesis in cats is notoriously difficult. This case series describes a novel route of administration of dexmedetomidine, a commonly available medication, with a high success rate observed for inducing emesis in this group of cats.

Dexmedetomidine improves mitophagy and pyroptosis through the ALKBH5/FUNDC1 axis during epidural-related maternal fever

PurposeEpidural analgesia has emerged as a commonly used method for relieving labor pain. However, epidural-related maternal fever (ERMF) is characterized by a high occurrence rate and can have detrimental consequences for the well-being of both the mother and the fetus. This study aimed to investigate the functional role and underlying mechanism of dexmedetomidine (DEX) in ERMF. Materials and methodsRopivacaine (ROP)-induced human umbilical vein endothelial cells (HUVECs) were treated with DEX and/or transfected with ALKBH5 or FUNDC1 overexpression plasmid. qPCR and Western blot were adopted for mitophagy and pyroptosis marker protein detection. Autophagosomes were observed through electron microscopy, Caspase-1/PI double-positive cells were determined using flow cytometry. Inflammation-related factors were quantified using ELISA. The N6-methyladenosine (m6A) modification of FUNDC1 mRNA was examined using methylated RNA immunoprecipitation (MeRIP) and the binding between ALKBH5 and FUNDC1 mRNA was confirmed by RNA immunoprecipitation (RIP). ResultsIn ROP-induced HUVECs, there was a significant upregulation in ALKBH5 and FUNDC1, resulting in a notable increase in inflammation, pyroptosis, and mitophagy. The administration of DEX demonstrated the ability to alleviate ROP-induced pyroptosis and promote protective mitophagy. Interestingly, DEX treatment significantly reduced the interaction between ALKBH5 and FUNDC1 mRNA, while simultaneously increasing the m6A level of FUNDC1 mRNA in ROP-treated cells. Moreover, the overexpression of FUNDC1 partially reversed the effects of ALKBH5 overexpression on mitophagy and pyroptosis in HUVECs. ConclusionsDEX can promote mitophagy and inhibit pyroptosis through the ALKBH5/FUNDC1 axis in ERMF, indicating its potential as a therapeutic strategy for clinical ERMF treatment.

The dual effects of dexmedetomidine on intestinal barrier and intestinal motility during sepsis

BackgroundSepsis, characterized by dysregulated host responses to infection, remains a critical global health concern, with high morbidity and mortality rates. The gastrointestinal tract assumes a pivotal role in sepsis due to its dual functionality as a protective barrier against injurious agents and as a regulator of motility. Dexmedetomidine, an α2-adrenergic agonist commonly employed in critical care settings, exhibits promise in influencing the maintenance of intestinal barrier integrity during sepsis. However, its impact on intestinal motility, a crucial component of intestinal function, remains incompletely understood. MethodsIn this study, we investigated dexmedetomidine’s multifaceted effects on intestinal barrier function and motility during sepsis using both in vitro and in vivo models. Sepsis was induced in Sprague-Dawley rats via cecal ligation and puncture. Rats were treated with dexmedetomidine post-cecal ligation and puncture, and various parameters were assessed to elucidate dexmedetomidine's impact. ResultsOur findings revealed a dichotomous influence of dexmedetomidine on intestinal physiology. In septic rats, dexmedetomidine administration resulted in improved intestinal barrier integrity, as evidenced by reduced mucosal hyper-permeability and morphological alterations. However, a contrasting effect was observed on intestinal motility, as dexmedetomidine treatment inhibited both the frequency and amplitude of contractions in isolated intestinal strips and decreased the distance of ink migration in vivo. Additionally, dexmedetomidine suppressed the secretion of pro-motility hormones while having no influence on hormones that inhibit intestinal peristalsis. ConclusionThe study revealed that during sepsis, dexmedetomidine exhibited protective effects on barrier integrity, although concurrently it hindered intestinal motility, partly attributed to its modulation of pro-motility hormone secretion. These findings underscore the necessity of a comprehensive understanding of dexmedetomidine’s impact on multiple facets of gastrointestinal physiology in sepsis management, offering potential implications for therapeutic strategies and patient care.

The effect of dexmedetomidine on the postoperative recovery of patients with severe traumatic brain injury undergoing craniotomy treatment: a retrospective study

BackgroundTraumatic brain injury (TBI) has been a worldwide problem for neurosurgeons. Patients with severe TBI may undergo craniotomy. These patients often require sedation after craniotomy. Dexmedetomidine (DEX) has been used in patients receiving anesthesia and in intensive care units. Not much is known about the postoperative effect of DEX in patients with severe TBIs undergoing craniotomy. The purpose of this study was to explore the effects of postoperative DEX administration on severe TBI patients who underwent craniotomy.MethodsPatients who underwent craniectomy for severe TBI at our hospital between January 2019 and February 2022 were included in this study. The patients were admitted to the intensive care unit (ICU) after surgery to receive sedative medication. The patients were then divided into DEX and control groups. We analyzed the sedation, hemodynamics, and other conditions of the patients (hypoxemia, duration of ventilation during endotracheal intubation, whether tracheotomy was performed, and the duration in the ICU) during their ICU stay. Other conditions, such as delirium after the patients were transferred to the general ward, were also analyzed.ResultsA total of 122 patients were included in this study. Among them, 53 patients received DEX, and the remaining 69 did not. The incidence of delirium in the general ward in the DEX group was significantly lower than that in the control group (P < 0.05). The incidence of bradycardia in the control group was significantly lower than that in the DEX group (P < 0.05). Other data from the DEX group and the control group (hypotension, hypoxemia, etc.) were not significantly different (P > 0.05).ConclusionThe use of DEX in the ICU can effectively reduce the incidence of delirium in patients who return to the general ward after craniotomy. DEX had no adverse effect on the prognosis of patients other than causing bradycardia.

Updated ESAIC guidelines on postoperative delirium in adults

The updated ESAIC guideline on postoperative delirium (POD) comprises a total of 13 recommendations, including five with the recommendation grade "strong": 1.)The assessment of preoperative POD risk factors, 2.)the optimisation of the preoperative condition, 3.)the discussion of prevention strategies, 4)the implementation of a non-pharmacological multicomponent intervention in patients at risk of POD and 5.)the risk-benefit assessment of the prophylactic administration of dexmedetomidine. The latter applies in particular due to the partly contradictory data situation and different areas of application (cardiac surgery versus non-cardiac surgery patients). Index-based EEG monitoring of the depth of anaesthesia is also recommended, whereby other parameters such as burst suppression and density spectral array should also be included. If non-pharmacological measures fail, POD should be treated with haloperidol. In contrast, the use of benzodiazepines is not recommended.

Intravenous infusion of dexmedetomidine during the surgery to prevent postoperative delirium and postoperative cognitive dysfunction undergoing non-cardiac surgery: a meta-analysis of randomized controlled trials.

Dexmedetomidine plays a pivotal role in mitigating postoperative delirium and cognitive dysfunction while enhancing the overall quality of life among surgical patients. Nevertheless, the influence of dexmedetomidine on such complications in various anaesthesia techniques remains inadequately explored. As such, in the present study, a meta-analysis was conducted to comprehensively evaluate its effects on postoperative delirium and cognitive dysfunction. A number of databases were searched for randomised controlled trials comparing intravenous dexmedetomidine to other interventions in preventing postoperative delirium and cognitive dysfunction in non-cardiac and non-neurosurgical patients. These databases included PubMed, Embase, and Cochrane Library. Statistical analysis and graphing were performed using Review Manager, STATA, the second version of the Cochrane risk-of-bias tool for randomised controlled trials, and GRADE profiler. This meta-analysis comprised a total of 24 randomised controlled trials, including 20 trials assessing postoperative delirium and 6 trials assessing postoperative cognitive dysfunction. Across these 24 studies, a statistically significant positive association was observed between intravenous administration of dexmedetomidine and a reduced incidence of postoperative delirium (RR: 0.55; 95% CI 0.47 to 0.64,p < 0.00001, I2 = 2%) and postoperative cognitive dysfunction (RR: 0.60; 95% CI 0.38 to 0.96,p = 0.03, I2 = 60%). Subgroup analysis did not reveal a significant difference in the incidence of postoperative delirium between the general anaesthesia and non-general anaesthesia groups, but a significant difference was observed in the incidence of postoperative cognitive dysfunction. Nonetheless, when the data were pooled, it was evident that the utilisation of dexmedetomidine was associated with an increased incidence of hypotension (RR: 1.42; 95% CI 1.08 to 1.86,p = 0.01, I2 = 0%) and bradycardia (RR: 1.66; 95% CI 1.23 to 2.26,p = 0.001, I2 = 0%) compared with other interventions. However, there was no significantly higher occurrence of hypertension in the DEX groups (RR = 1.35, 95% CI 0.81-2.24, p = 0.25,I2 = 0%). Compared with other interventions, intravenous dexmedetomidine infusion during non-cardiac and non-neurosurgical procedures may significantly reduce the risk of postoperative delirium and cognitive dysfunction. The results of subgroup analysis reveal a consistent preventive effect on postoperative delirium in both general and non-general anaesthesia groups. Meanwhile, continuous infusion during general anaesthesia was more effective in reducing the risk of cognitive dysfunction. Despite such findings, hypotension and bradycardia were more frequent in patients who received dexmedetomidine during surgery.

Exploring the impact of dexmedetomidine on short-term outcomes in critically ill sepsis-associated encephalopathy patients.

Dexmedetomidine has demonstrated potential in preclinical medical research as a protective agent against inflammatory injuries and a provider of neuroprotective benefits. However, its effect on the short-term prognosis of patients with sepsis-associated encephalopathy remains unclear. This study aims to explore the underlying value of dexmedetomidine in these patients. This study enrolled patients with sepsis-associated encephalopathy from the Medical Information Mart for Intensive Care (MIMIC)-IV database, and they were divided into two groups based on dexmedetomidine therapy during hospitalization. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to balance the inter-group baseline differences. Kaplan-Meier (KM) curves with log-rank test and subgroup analysis were also employed. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality, intensive care unit (ICU) stay time, hospital stay time, and the incidence of ventilator-associated pneumonia (VAP). After PSM, 1,075 pairs of patients were matched. In contrast to the non-dexmedetomidine cohort, the dexmedetomidine cohort did not exhibit a shortened ICU [4.65 (3.16, 8.55) vs. 6.14 (3.66, 11.04), p<0.001] and hospital stay duration [10.04 (6.55, 15.93) vs. 12.76 (7.92, 19.95), p<0.001], and there was an elevated incidence of VAP [90 (8.4%) vs. 135 (12.6%), p=0.002]. The log-rank test for the KM curves of dexmedetomidine use and 28-day mortality was statistically significant (p<0.001). The results showed that dexmedetomidine was associated with improved 28-day mortality [hazard ratio (HR) 0.46, 95% confidence interval (CI) 0.35-0.61, p<0.001] and in-hospital mortality (HR 0.50, 95% CI 0.37-0.67, p<0.001) after adjusting for various confounders. In the following subgroup analysis, dexmedetomidine infusion was associated with decreased 28-day mortality in most subgroups. Dexmedetomidine administration was significantly associated with reduced short-term mortality among patients with sepsis-associated encephalopathy in the ICU. However, it also prolonged ICU and hospital stays and increased the incidence of VAP.

Dexmedetomidine Effects on Surgical Stress Hormones

Background: Increased levels of cortisol and catecholamines are the reaction to tissue damage due to surgical trauma. Dexmedetomidine inhibits the synthesis of these two hormones.Objective: This study aimed to prove that dexmedetomidine reduces the endocrine response to surgical stress.Method: 40 patients who underwent Total Knee or Hip Replacement surgery with regional anesthesia were involved in the Double-Blind Randomized Controlled Trial Pre-Test – Post-Test Design, which was divided into two research groups: the therapy group and the control group. Changes in the body's response to stress during surgery were compared by assessing blood cortisol levels, heart rates (HRs), and mean arterial pressures (MAPs). The Beck Depression Inventory (BDI) was used to evaluate the level of depression. The numeric rating scale is used to evaluate perioperative pain, while the Ramsay scale is used to measure the level of sedation. Data analysis was carried out using the Statistical Program for Social Sciences (SPSS).Results: The cortisol levels of the therapy group compared to the control group (p = 0.016) decreased significantly immediately after surgery. Hemodynamic changes in the study, the heart rate (p=0.001), and mean arterial pressure (p=0.000) were significantly lower than the control group.Conclusion: Administration of dexmedetomidine during the surgical period reduces stress hormone responses. These results indicate that dexmedetomidine administration is good to apply, especially in TKR/THR.

Effect of dexmedetomidine on the incidence of postoperative acute kidney injury in living donor liver transplantation recipients: A randomized controlled trial.

Acute kidney injury (AKI) is one of the most common complications after living-donor liver transplantation (LDLT) that has great impact on recipient and graft outcomes. Dexmedetomidine is reported to decrease the incidence of AKI. In the current study, we investigated whether intraoperative dexmedetomidine infusion would reduce the AKI following LDLT. In total, 205 adult patients undergoing elective LDLT were randomly assigned to the dexmedetomidine group (n=103) or the control group (n=102). Dexmedetomidine group received continuous dexmedetomidine infusion at a rate of 0.4mcgּ/kg/hr after the anesthesia induction until 2 hours after graft reperfusion. The primary outcome was to compare the incidence of AKI. Secondary outcomes included serial lactate levels during surgery, chronic kidney disease, major adverse cardiovascular events, early allograft dysfunction, graft failure, overall mortality, duration of mechanical ventilation, ICU and hospital length of stay. Intraoperative hemodynamic parameters were also collected. Of 205 recipients, 42.4% (n=87) developed AKI. The incidence of AKI was lower in the dexmedetomidine group (35.0%, n=36/103) compared with the control (50.0%, n=51/102) ( P =0.042). There were significantly lower lactate levels in the dexmedetomidine group after reperfusion (4.39 [3.99-4.8] vs 5.02 [4.62-5.42], P =0.031) until the end of surgery (4.23 [3.73-4.73] vs 5.35 [4.84-5.85], P =0.002). There were no significant differences in the other secondary outcomes besides lactate. Also, intraoperative mean blood pressure, cardiac output, and systemic vascular resistance did not show any difference. Our study suggests that intraoperative dexmedetomidine administration was associated with significantly decreased AKI incidence and lower intraoperative serum lactate levels in LDLT recipients, without untoward hemodynamic effects.

The Effect of a Subsequent Dose of Dexmedetomidine or Other Sedatives following an Initial Dose of Dexmedetomidine on Electrolytes, Acid-Base Balance, Creatinine, Glucose, and Cardiac Troponin I in Cats: Part II.

The administered dose of dexmedetomidine may occasionally fail to produce the anticipated sedative effects. Therefore, a subsequent dose or administration of another sedative may enhance sedation; however, patient safety may be affected. The safety of seven different drugs administered at the following time point after an insufficient dose of dexmedetomidine was evaluated in a crossover, blind, experimental study that included six healthy adult cats. All cats received an initial dose of dexmedetomidine and a subsequent dose of either dexmedetomidine (Group DD), NS 0.9% (DC), tramadol (DT), butorphanol (DBT), buprenorphine (DBP), ketamine (DK), or midazolam (DM). Animal safety was assessed using repeated blood gas analysis and measurement of electrolytes, glucose, cardiac troponin I, and creatinine to evaluate cardiac, respiratory, and renal function. The median values of creatinine, cardiac troponin I, pH, partial pressure of carbon dioxide, potassium, and sodium did not change significantly throughout the study. Heart rate was significantly decreased in all groups after administration of the drug combinations, except for in the DK group. Respiratory rate decreased significantly after administration of the initial dose of dexmedetomidine and in the DBP and DM groups. The partial pressure of oxygen, although normal, decreased significantly after the administration of dexmedetomidine, whereas the median concentration of glucose increased significantly following the administration of dexmedetomidine. The results of our study suggest that the drug combinations used did not alter the blood parameters above normal limits, while cardiac and renal function were not compromised. Therefore, a safe level of sedation was achieved. However, the administration of dexmedetomidine reduced the partial pressure of oxygen; thus, oxygen supplementation during sedation may be advantageous. Additionally, the increase in glucose concentration indicates that dexmedetomidine should not be used in cats with hyperglycaemia, whereas the decrease in haematocrit suggests that dexmedetomidine is not recommended in anaemic cats.

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial.

Background One-lung ventilation (OLV) is a common ventilation technique used during thoracic surgery. It can cause serious complications in children, and hypoxic pulmonary vasoconstriction (HPV) is a protective mechanism against the resulting hypoxia.Dexmedetomidine does not affect HPV, so we will investigate its impact on the partial pressure of oxygen in arterial blood (PaO2) and pulmonary shunt fraction (Qs/Qt). Methods Children who underwent OLV were divided into two equal groups. The Dex group received 0.4 μg/kg/h of dexmedetomidine intravenously. The placebo group received normal saline. Two blood samples were taken to analyze arterial and central venous blood gasses during four time periods: T1, 10 minutes after anesthesia; T2, 10 minutes after OLV; T3, 60 minutes after OLV; and T4, 20 minutes after the end of OLV. Heart rate, mean arterial pressure (MAP), PaO2, Qs/Qt, and peak inspiratory pressure (PIP) values were recordedat these time points. Results Regarding heart rate, the Dex group remained relatively stable, whereas the placebo group showed a slight increase in T3 and T4. Concerning MAP, theDex group had a reduction at T1 compared with the placebo group and remained similar for other points. PaO2 decreased with OLV. However, the Dex group consistently maintained higher PaO2 values than the placebo, especially in T3 and T4. Concerning Qs/Qt, the Dex group maintained lower time values than the placebo group at OLV. Regarding PIP, the Dex group had significantly lower T2 and T3 than the placebo group. Conclusion Administration ofdexmedetomidine inchildren with OLV improves PaO2 and reduces pulmonary shunt fraction (Qs/Qt), thereby improving oxygen transport. It reduces the maximum PIP values, thereby reducing pressure-related complications.

Comparison of bolus dose administration of propofol and dexmedetomidine for incidence of emergence delirium in pediatric patients undergoing surgery with general anesthesia: A randomized, double-blind trial

Abstract Background and Aims: Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Material and Methods: Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. Results: The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. Conclusion: In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.

Antinociceptive and Cardiorespiratory Effects of a Single Dose of Dexmedetomidine in Laboratory Mice Subjected to Craniotomy under General Anaesthesia with Isoflurane and Carprofen or Meloxicam.

Pain refinement represents an important aspect of animal welfare in laboratory animals. Refining analgesia regimens in mice undergoing craniotomy has been sparsely investigated. Here, we sought to investigate the effect of dexmedetomidine in combination with other analgesic drugs on intraoperative anti-nociceptive effects and cardiorespiratory stability. All mice were anaesthetised with isoflurane and received local lidocaine infiltration at the surgical site. Mice were randomised into treatment groups consisting of either carprofen 5 mg kg-1 or meloxicam 5 mg kg-1 with or without dexmedetomidine 0.1 mg kg-1 administered subcutaneously. Intra-anaesthetic heart rates, breathing rates, isoflurane requirements, and arterial oxygen saturations were continuously monitored. We found that administration of dexmedetomidine significantly improved heart and breathing rate stability during two of four noxious stimuli (skin incision and whisker stimulation) compared to non-dexmedetomidine-treated mice and lowered isoflurane requirements throughout anaesthesia by 5-6%. No significant differences were found between carprofen and meloxicam. These results demonstrate that dexmedetomidine reduces nociception and provides intra-anaesthetic haemodynamic and respiratory stability in mice. In conclusion, the addition of dexmedetomidine to anaesthetic regimes for craniotomy offers a refinement over current practice for laboratory mice.

Impact of Dexmedetomidine on Postoperative Nausea and Vomiting in Opiate-Addicted Patients Undergoing Elective Laparoscopic Cholecystectomy: A Randomized, Placebo-Controlled Clinical Trial

Background: Postoperative Nausea and Vomiting (PONV) is one of the most common complications of general anesthesia, moreover opioid addiction increases the risk of PONV. Hence, this study evaluates the effect of administering dexmedetomidine infusion as an intraoperative analgesic on PONV in opium-addicted patients who underwent elective laparoscopic cholecystectomy.&#x0D; Methods: In a randomized clinical trial, 100 opium-addicted patients who were candidates for elective laparoscopic cholecystectomy surgery under general anesthesia were studied in two groups of 50 participants. The intervention group received dexmedetomidine infusion 10 min after induction of anesthesia until the end of surgery. The placebo group received normal saline at the same time. The rate of PONV was compared between the two groups.&#x0D; Results: Both groups had no significant difference in terms of hemodynamic parameters during surgery, including pulse rate, systolic and diastolic blood pressure, and duration of anesthesia. In the dexmedetomidine group, patients had less PONV than the control group, and this difference was significant (p=0.0164).&#x0D; Conclusion: Dexmedetomidine administration during laparoscopic surgery can reduce PONV, especially in patients addicted to opium.&#x0D;

Effect of intravenous dexmedetomidine as an adjuvant to brachial plexus block in upper limb orthopedic surgeries – A systemic review and meta-analysis

Brachial plexus block for upper limb orthopedic surgeries has been widely used for surgical anesthesia and post operative analgesia. Various adjuvants are used to prolong the duration of the nerve block. Systemic dexmedetomidine as an adjuvant to local anesthetics has been shown to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in its efficacy. Hence, an updated meta-analysis was planned to assess the efficacy and safety of systemic dexmedetomidine as an adjuvant to local anesthetics in brachial plexus nerve block (BPNB). Objective of the study is to assess the duration of analgesia in patients undergoing upper limb orthopaedic procedures with BPNB and intravenous dexmedetomidine as an adjuvant. Data sources were PubMed, Cochrane, and Google Scholar were systematically searched till July 2023. The meta-analysis included all published studies that investigated the effect of systemic dexmedetomidine on duration of analgesia following BPNB. The data extraction was guided by a predetermined checklist. Analysis was done Using RevMan_5 software, the mean difference for duration of analgesia between the two groups and odds ratio was calculated from the selected studies. The fixed-effects model was used to compare the difference in the duration of analgesia between the two groups. The outcome was prolonged duration of analgesia in patients undergoing upper limb orthopedic procedure where intravenous dexmedetomidine was used as an adjuvant to peripheral nerve blocks. Our meta-analysis currently generates the evidence that intravenous dexmedetomidine administration offers advantages over other drugs in terms of prolonged duration of analgesia.