Bolus Dose Of Dexmedetomidine Research Articles

Comparison of intravenous ketamine hydrochloride plus dexmedetomidine hydrochloride and ketamine hydrochloride plus midazolam hydrochloride in procedural sedation for short surgical procedures: A prospective randomized double-blind study

Background: The growing popularity of ambulatory anesthesia has led to the development of newer drug regimens and combinations. We decided to compare the effects of ketamine plus dexmedetomidine versus ketamine plus midazolam in procedural sedation. Aims and Objectives: The present study aimed to compare the effects of ketamine plus dexmedetomidine versus ketamine plus midazolam on the adequacy of anesthesia, level of sedation and analgesia, hemodynamic and respiratory parameters, recovery time, and post-operative side effects in short surgical procedures. Materials and Methods: Hundred adult patients were randomized into two groups: Group KD: A bolus dose of Dexmedetomidine 1 mcg/kg in 100 ml NS over 10 min and Group KM: A bolus dose of Midazolam 0.05 mg/kg in 100 ml NS over 10 min. Both groups received bolus dose of Ketamine 1 mg/kg at the start of the procedure. Level of sedation, adequacy of anesthetic technique, hemodynamic parameters, time for rescue analgesia, post-operative recovery time, and complications was measured. Results: In Group KD 7 (14%) patients and in Group KM 13 (26%) patients had inadequate anesthesia. A significant reduction in pulse rate (P<0.001) was observed in Group KD as compared to Group KM. MAP between the two study groups showed a statistically significant reduction in Group KD as compared to Group KM (P<0.05). Time for first rescue analgesia was delayed in Group KD (70.20±14.35) compared to that of Group KM (49±4.73) (P=0.000). Four (8%) patients in Group KD and 11 (22%) patients in Group KM had post-operative nausea and vomiting. Conclusion: Dexmedetomidine-ketamine combination is a good and safe alternative agent for procedural sedation in patients undergoing short surgical procedures.

Anesthetic Stability of Propofol, Dexmedetomidine, and Isoflurane by Measuring Bispectral Index (BIS) and Hemodynamic Indices: A Comparative Study

BackgroundHemodynamic changes and anesthetic awareness occurring during surgery under general anesthesia is a great concern for both surgeon and anesthesiologist. Maintenance of the adequate depth of anesthesia throughout the intraoperative period is important in maintaining hemodynamic stability, preventing intraoperative awareness, and avoiding postoperative recall.AimThis study aims to predict the anesthetic stability of propofol, dexmedetomidine, and isoflurane by measuring bispectral index (BIS) and hemodynamic indices.Materials and methodsThis is a prospective comparative study. Sixty patients of either sex, aged 18-60 years, with American Society of Anesthesiologist (ASA) physical status classification I and II, undergoing elective surgical procedures requiring general anesthesia were allocated into three groups of 20 each. Patients in each group were administered standard general anesthesia with routine hemodynamic monitoring along with BIS, and values were recorded at baseline and thereafter at every five-minute interval for the duration of surgery. Anesthesia was maintained in Group P using a bolus dose of propofol 1 milligram.kg-1 for 10 minutes followed by propofol infusion 50-75 microgram.kg-1.minute-1, Group D with a bolus dose of dexmedetomidine 1 microgram.kg-1 for 10 minutes followed by infusion 0.2-0.7 microgram.kg-1.hour-1, and Group I with isoflurane at 1 minimum alveolar concentration (MAC) for 10 minutes and then maintained between 0.5 MAC and 1.5 MAC until the duration of surgery. To maintain the surgical plane of anesthesia, the BIS score was monitored between 40 and 65. The quantitative variables were expressed as mean±SD and compared between groups using Student’s unpaired t-test. Data analysis was done using SPSS Statistics for Windows version 20.0 (IBM Corp., Armonk, NY, USA). A p-value of <0.05 was considered statistically significant.ResultsDuring intergroup comparison among study drugs, the mean BIS values were statistically significant among the groups (p<0.05). Hemodynamic indices were significantly better maintained in the dexmedetomidine group as compared to the isoflurane and propofol groups throughout the intraoperative period (p<0.05).ConclusionDexmedetomidine is better than propofol and isoflurane in maintaining the BIS score and hemodynamic parameters during the intraoperative period.

Anesthetic management of a patient with Takotsubo syndrome undergoing hip fracture repair

Introduction: Takotsubo syndrome (TTS) is a type of acute reversible left ventricular dysfunction in the form of acute catecholaminergic myocardial stunning in the absence of occlusive coronary artery, with considerable patient morbidity and mortality1. The optimal anesthetic management of patients with TTS remains unclear. We would like to share our experience with a patient with TTS presenting for hip fracture repair. Methods: An 80-year old female complained of dyspnea and retrosternal chest pain after subcapital hip fracture. Her diagnostic workup revealed elevated markers of myocardial necrosis and pathologic findings from transthoracic echocardiogram. Left ventriculography imaging along with an unremarkable coronariography was suggestive of TTS. After the initial control of acute myocardial crisis, the patient was scheduled for hip fracture repair, under spinal anesthesia. Having obtained patient’s informed consent, we performed an ultrasound guided fascia iliaca compartment block (FICB) (30 mL ropivacaine 0.5%/8 mg dexamethasone). Twenty minutes after the FICB, the patient was placed in the lateral decubitus position and 3 mL levobupivacaine 0.5% were injected intrathecally. A bolus dose of dexmedetomidine 1 mcg/kg followed by a continuous intravenous infusion at a rate of 0.5 mcg/kg/hour was initiated 10 min before lumbar puncture. The infusion was reduced to 0.25 mcg/kg/hour 30 min later due to a drop in systolic blood pressure 40% below baseline, until the end of surgery. Results: No complications occurred in the postoperative period. The patient walked on the second day and one week later she was discharged from hospital. Conclusion: To our knowledge, there are no reports of intraoperative dexmetomidine administration in TTS patients. Avoidance of adrenergic agonists and initiation of antiadrenergic therapy is suggestive by the pathogenesis of the syndrome [1]. Our main goal was the control of stress response [2, 3], performing FICB to facilitate perioperative analgesia and administering dexmetomidine, an agent with sedative, anxiolytic and analgesic properties.

Intravenous dexmedetomidine sedation for magnetoencephalography: A retrospective study.

Magnetoencephalography (MEG) plays a preponderant role in the preoperative assessment of patients with drug-resistant epilepsy (DRE). However, the magnetoencephalography of patients with drug-resistant epilepsy can be difficult without sedation and/or general anesthesia. Our objective is to describe our experience with intravenous dexmedetomidine as sedation for magnetoencephalography and its effect, if any, on the ability to recognize epileptic spikes. In this retrospective study, we reviewed the records of 89 children who presented for Magnetoencephalography/electroencephalography (EEG) scans between August of 2008 and May of 2015. Data analyzed included demographics and the frequency of epileptic spikes. Sedated magnetoencephalography recordings were compared to nonsedated video-electroencephalography (vEEG) recordings in the same patients to determine the impact of dexmedetomidine. Spike frequency between magnetoencephalography with sedation and video-electroencephalography without sedation was compared in 85 patients. Magnetoencephalography and video-electroencephalography were considered clinically concordant in 80 patients (94.1%) and discordant in 5 patients (5.9%), all with less spikes during Magnetoencephalography. The median (range) bolus dose of dexmedetomidine was 2 (1-2) mcg/kg. The median (range) infusion rate of dexmedetomidine was 2 (0.5-4) mcg/kg/h. All patients experienced reductions in heart rate after administration of dexmedetomidine; these reductions were statistically, but not clinically, significant. Our results suggest that dexmedetomidine-based protocol provides reliable sedation in children undergoing MEG scanning because of the high success rate, limited interictal artifacts, and minimal impacts on spike frequency.

The Effect of Midazolam and Dexmedetomidine Sedation on Block Characteristic Following Spinal Bupivacaine: A Randomized Comparative Study.

Background:Dexmedetomidine is widely used as an adjunct to general as well as regional anesthesia.Aims:This study was conducted to compare and evaluate the synergistic effect of single intravenous (i.v.) bolus dose of dexmedetomidine with midazolam on spinal block duration, analgesia, and sedation in patients undergoing infra-umbilical surgeries.Settings and Design:Prospective, randomized, comparative, and double-blinded study.Materials and Methods:One hundred patients between 18 and 60 years of age of American Society of Anesthesiologists physical status I and II posted for elective infra-umbilical surgery under subarachnoid block were randomly divided into two groups (Group D and Group M). Patients of Group D received i.v. dexmedetomidine 0.5 μg.kg−1 and of Group M received i.v. midazolam 0.05 mg.kg−1 as premedication 5 min before spinal anesthesia over 10 min. Vital parameters, Ramsay sedation score, level of sensory and motor block, recovery time for sensory blockade, postoperative numerical rating scale, time of requirement of the first dose of postoperative rescue analgesic, and duration of analgesia were recorded and analyzed.Statistical Analysis:Chi-square test, t-test, and analysis of variance test were applied to analyze data using SPSS package for Windows.Results and Conclusion:Premedication with single i.v. dexmedetomidine prolonged the duration and increased the maximum upper level of only sensory component of spinal anesthesia (6.42 ± 3.21 vs. 4.8 ± 1.21 thoracic segments higher than with midazolam sedation). This property can be beneficial in preventing undesirable prolongation of motor block and facilitating early ambulation in shorter duration of infra-umbilical surgeries. In addition, dexmedetomidine slowed the regression of sensory block and increased the time of the first request of analgesic.

Attenuation of hemodynamic response to laryngoscopy and tracheal intubation in adult patients with a single intravenous bolus dose of dexmedetomidine - A prospective, randomized, double-blind, controlled clinical study

Background: Performing laryngoscopy and endotracheal intubation evokes a reflex circulatory response, which results in an increase in the blood pressure and heart rate (HR) and causes arrhythmia due to increased outflow from the sympatho-adrenal axis. Aim and Objective: The aim of this study was to evaluate the efficacy of a single bolus dose of 0.6 mg/kg body weight dexmedetomidine, a centrally acting α-2 agonist, through intravenous route, in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation. Materials and Methods: It was a randomized, prospective, two fold-blinded, and placebo-controlled clinical study. After obtaining Ethical Committee clearance, 100 adult patients in the age group of 18–50 years were enrolled. Blood pressure of the patients enrolled was within the normal range and they were posted for various elective surgeries. Categorization was performed with the American Society of Anaesthesiologists and Mallampatti as Class I and II Grade I and II, respectively. The patients were randomly distributed into two groups, Group A and Group B. Group A included 50 patients (n = 50) and was treated with 1 ml/kg of normal saline intravenously for about 10 min and 10 min before the induction. Group B included 50 patients (n = 50) and was treated with dexmedetomidine 1 ml/kg (0.6 μg/kg body weight), which was further diluted in 100 ml ordinary saline and given intravenously, for about 10 min and 10 min before the induction. After premedication, anesthesia was induced with injection thiopentone 5 mg/kg body weight and was given until the loss of eyelash reflex. Dose of thiopentone required was noted. It was followed by injection succinylcholine 1.5 mg/kg body weight. HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were the various parameters for analysis and recorded at regular time intervals. Results: Initiation of laryngoscopy and intubation resulted in significant rise in the HR (36.14 bpm), SBP (29.22 mmHg), DBP (20.30 mmHg), and MAP (14.46 mmHg) in patients who were grouped under Group A. In Group B (dexmedetomidine), mean of HR, SBP, DBP, and MAP decreased by 2.86 bpm, 17.66 mmHg, 1.54 mmHg, and 4.98 mmHg, respectively, when compared to basal values which is statistically highly significant (P < 0.0001). Conclusion: Dexmedetomidine, at the dose of 0.6 μg/kg body weight when given intravenously 10 min before induction was noted to efficiently reduce the hemodynamic response to laryngoscopy and tracheal intubation.

Sedation of mechanically ventilated patients in intensive care units: Dexemedetomidine versus ketofol

Background Patients in the ICUs are usually provided with sedation and analgesia to avoid pain and anxiety, facilitate invasive maneuvers, decrease stress and oxygen utilization, and facilitate mechanical ventilation. The Association of Critical Care Medicine recommends the use of nonbenzodiazepine drugs such as propofol and dexmedetomidine in sedating the intensive care patients to improve outcomes. Usual sedation protocols should be changed by incorporating propofol, dexmedetomidine, or drug combinations to reach arousal targets and decreasing benzodiazepine use. Objectives The study was conducted to compare between the sedative effect of dexmedetomidine versus ketamine–propofol combination (ketofol) in ICU patients on mechanical ventilation. Patients and methods A total of 90 patients who needed sedation for postoperative mechanical ventilation and monitoring in ICUs were randomly allocated into two groups: ketofol group, where sedation of the patients was done with ketofol at a loading dose of 500 μg/kg of ketamine and propofol mixture 1 : 1 (ketamine 8 mg/ml and propofol 8 mg/ml), followed by continuous infusion at 8–10 μg/kg/min, and dexmedetomidine group, where patients were sedated with an initial bolus dose of dexmedetomidine of 2 µg/kg intravenous infused over 10 min followed by infusion rate of 0.3–0.5 µg/kg/h. Patients’ hemodynamics, Ramsay sedation scale, and total analgesic requirement were recorded. Results Mean blood pressure and heart rate were statistically significantly lower in dexmedetomidine group than in ketofol group. Ramsay sedation score was clinically efficient in both groups but statistically higher in dexmedetomidine group than ketofol group. Dexmedetomidine group showed faster recovery time and less analgesic requirement than ketofol group. Conclusion Dexmedetomidine is an effective sedative drug for ICU patients, with more hemodynamic stability, less analgesic requirement, and rapid recovery time than ketofol.

Discharge Readiness after Propofol with or without Dexmedetomidine for Colonoscopy

Enhanced recovery protocols employ various approaches to minimize detrimental side effects of anesthetizing agents. The authors tested the hypothesis that adding low-dose dexmedetomidine to propofol for anesthesia in ambulatory colonoscopies, compared with propofol alone, would lower the propofol requirement, improve the intra-procedure hemodynamic state, and not increase time-to-discharge. In this noninferiority, double-blind, randomized controlled trial, patients having colonoscopies received total IV anesthesia either with propofol and placebo (n = 50), or propofol and a bolus dose of dexmedetomidine, 0.3 μg/kg (n = 51). Additional propofol was administered to maintain a Bispectral Index score of 60. Following the procedure, readiness for discharge was assessed regularly using the Modified Post Anesthetic Discharge Scoring System until discharge criteria were met. The primary outcome was the percentage of patients meeting discharge criteria within 30 min from procedure end-time. Twenty-six of 51 (51%) patients receiving propofol-dexmedetomidine were ready for discharge by 30 min from procedure end time, compared with 44 of 50 (88%) receiving propofol (P < 0.001). Propofol consumption was lower in subjects receiving propofol-dexmedetomidine (140 μg · kg(-1) · min(-1)) compared to those receiving propofol (180 μg · kg(-1) · min(-1)) with P = 0.011. The lowest mean arterial pressure decreased further from baseline in those receiving propofol-dexmedetomidine (-30%; mean decrease -30 ±10.5 mmHg) compared to propofol (-21%; mean decrease, -22 ± 14.2 mmHg) with P = 0.003. There was no difference in incidence of bradycardia, with sustained bradycardia occurring in 3 of 51 (6%) patients receiving propofol-dexmedetomidine compared to 1 of 50 (2%) patients receiving propofol (P = 0.62). No apnea episodes requiring positive-pressure ventilation occurred in either group. For anesthesia in ambulatory colonoscopy, combining low-dose dexmedetomidine with propofol delayed discharge readiness and provoked hypotension compared to propofol alone.

Dexmedetomidine reduces sevoflurane EC50 for supraglottic airway device insertion in spontaneously breathing morbidly obese patients.

Purpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC50 for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients.Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40–57 kg/m2 who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ETsev) was adjusted to a target value as to the modified Dixon’s up-and-down method. Patients’ response to SAD insertion was classified as “movement” or “no movement”. The average of the midpoints of all crossover points was defined as calculated sevoflurane EC50 for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC50) and 95% (EC95) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD.Results: The calculated sevoflurane EC50 for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p<0.001). By the probit regression analysis, EC50 and EC95 of sevoflurane for successful SAD insertion were 1.59% (95% CI, 1.22–1.90%) and 2.15% (95% CI, 1.86–3.84%) in group D, respectively, and 2.81% (95% CI, 2.35–3.29%) and 3.32% (3.02–6.74%) in group S.Conclusion: When sevoflurane inhalational induction is performed in spontaneous breathing morbidly obese patients, intravenous DEX can reduce sevoflurane EC50 for successful SAD insertion by about 40%.Chinese Clinical Trial Registry: No. ChiCTR1800016868

Dexmedetomidine infusion for prevention of emergence agitation in patients undergoing percutaneous nephrolithotomy under sevoflurane anesthesia

Introduction Percutaneous nephrolithotomy (PCNL) under general anesthesia is more susceptible for developing emergence agitation (EA). Aim This randomized double-blinded, prospective, comparative, clinical study was aimed to evaluate dexmedetomidine efficacy for EA prevention in patients undergoing PCNL. Patients and methods A total of 44 patients with American Society of Anesthesiologists grades I–II aged between 21 and 70 years, experiencing an elective PCNL under general anesthesia, were included in the study. Patients were randomly allocated to one of two groups: group C and group D. Placebo was given to group C, whereas a bolus dose of dexmedetomidine 1.0 µg/kg was given to group D patients, followed by 0.4 µg/kg/h after anesthesia induction. Adjustment was made to end-tidal sevoflurane to keep bispectral index at 45–55. Sevoflurane and the study drug were stopped when surgical dressing was applied. Evaluation of EA was made from extubation until the patients was transferred to postanesthesia care unit. EA incidence was the primary outcome, whereas sevoflurane requirement, hemodynamic stability, and recovery from anesthesia were the secondary outcomes. Results There was a significant reduction of EA incidence (group C 54.5%; group D 9.1%) with dexmedetomidine infusion to 90.9% (P=0.0001). There was also significant lowering of the end-tidal sevoflurane concentration and an average 38.87% reduction in required concentration in group D, in contrast to group C (P&lt;0.001). There was significantly higher average mean arterial blood pressure and heart rate in group C compared with group D (P&lt;0.001). There is significantly lesser time to extubation, lesser time to achieve bispectral index 90, and lesser time in reacting to verbal command in group C when compared with group D (P&lt;0.0001). Conclusion The EA incidence and sevoflurane requirement among patients experiencing PCNL are significantly decreased by dexmedetomidine infusion. Moreover, dexmedetomidine was associated with delayed extubation time, residual sedation, and prolonged postanesthesia care unit stay.

Dexmedetomidine as Bolus or Low-dose Infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients.

Background:This study was designed to compare the prevention of emergence agitation (EA) of sevoflurane anesthesia by an intraoperative bolus or low-dose infusion of dexmedetomidine in pediatric patients undergoing lower abdominal surgeries.Materials and Methods:Forty-eight patients, aged 2–12 years, undergoing lower abdominal surgeries with sevoflurane anesthesia were enrolled in this study. Patients were randomly assigned to receive either intravenous bolus over 10 min. 0.4 μg/kg dexmedetomidine (Group I, n = 24) or low-dose infusion 0.4 μg/kg/h of dexmedetomidine (Group II, n = 24) after intubation. Heart rate and mean arterial pressure were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, and Ramsay sedation scores (RSS) were recorded on arrival to the postanesthesia care unit and at 5, 10, 15, 30, 45, 60 min thereafter. Extubation time, emergence time, and time to reach Aldrete score ≥9 were recorded.Results:OPS and PAED scores and percentage of patients with OPS ≥4 or PAED scale ≥10 were significantly higher in Group II as compared to Group I. RSS score, extubation time, emergence time, and time to reach Aldrete score ≥9 did not show any significant difference.Conclusion:Both bolus or low-dose infusion of dexmedetomidine was effective for the prevention of EA with sevoflurane anesthesia, but bolus dose of dexmedetomidine was more effective.

Comparison of Intravenous Bolus and Infusion of Dexmedetomidine on Characteristics of Subarachnoid Block.

Aims:Dexmedetomidine is very dynamic drug, used for analgesia, sedation, blunting the laryngoscopic responses and as adjuvants in regional anesthesia. Studies have shown that intravenous (iv) dexmedetomidine given during spinal anesthesia increases the quality of subarachnoid block (SAB). In this study, we compare the two iv regimen of dexmedetomidine on analgesic effect of spinal anesthesia. One is bolus dose of dexmedetomidine and other is infusion during the surgery, both given after induction of spinal anesthesia.Subjects and Methods:Sixty American Society of Anesthesiologists I and II patients scheduled to undergo surgeries under SAB were randomly allocated into two groups namely B and I. After SAB with 3.0 ml of bupivacaine 0.5% heavy, Group B received 0.5 μg/kg of dexmedetomidine bolus over 15 min, Group I received 0.5 μg/kg/h of dexmedetomidine infusion until the end of surgery.Statistical Analysis Used:All parametric data were statistically analyzed using Student's t-test and nonparametric data analyzed using Chi-square test and Fischer exact test as appropriate. P < 0.05 was considered as statistically significant. Statistical analysis was performed using the SPSS.Results:Time to reach desired level T10 was quick in Group B compared to Group I. Regression of sensory and motor was prolonged in Group I compared to Group B. Total duration of analgesia was significantly prolonged in Group I 230.39 ± 16.20 compared to Group B 196.01 ± 14.32 and the difference is statistically significant (P = 0.0001). Both groups had Ramsay sedation score of 3 which lasted for 45 min in Group B while it was maintained in Group I. Side effects profile of both groups was comparable with few incidence of bradycardia and hypotension in both groups requiring treatment.Conclusions:We conclude that the continuous infusion of dexmedetomidine after SAB results in prolonged analgesia than just a bolus dose. Therefore, we suggest use of the maintenance dose of iv dexmedetomidine after SAB for prolonging the duration and achieving adequate sedation

Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room

To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups. As an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

Clinical evaluation of combination of dexmedetomidine and midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia.

BackgroundDexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported to decreases heart rate in a dose-dependent manner. In the present study, we compared the bolus dose of midazolam and bolus loaded dexmedetomidine over 10 min to determine additional sedation methods.MethodsA total of 100 patients who were classified as American Society of Anesthesiologists physical status I–II undergoing spinal anesthesia were randomly divided into two groups. In the combination of midazolam and dexmedetomidine group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 μg/kg/h dexmedetomidine was infused. In the dexmedetomidine group (group D), 1 μg/kg bolus dose of dexmedetomidine was infused over 10 min, and then 0.5 μg/kg/h dexmedetomidine was infused continuously.ResultsAt 10 min, the sedation depth of the two groups was approximately the same. In both groups, the bispectral index (BIS) was within the optimal range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Both patient and surgeon satisfaction with sedation did not differ between groups. At 10 min, heart rate (beats/min) was significantly lower (P < .01) in group D and mean blood pressure (mm Hg) was significantly lower (P < .01) in group MD. The prevalence of bradycardia (P = .714), hypotension (P = .089), and hypoxia (P = .495) did not differ statistically between the two groups.ConclusionsMidazolam bolus and dexmedetomidine continuous infusion may be a useful additional sedation method for patients who have severe bradycardia.

Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery

ABSTRACT The stress response to an intense painful surgical stimulus is characterized by activation of the sympathetic nervous system and an increased secretion of the stress hormones. The ability of the alpha agonist dexmedetomidine (DEX) to decrease heart rate (HR) and arterial blood pressure in perioperative period was tested. One hundred and thirty two patients undergoing craniotomy for supratentorial tumor were randomly distributed to receive either saline (B group) or DEX (A group). The placebo group received saline, whereas the treatment group (A group) received a single bolus dose of DEX (1μg/kg) intravenously over 10 minutes before induction of anesthesia. Hemodynamic parameters, such as HR and arterial blood pressure were measured. Both the groups were comparable with respect to age, sex, American Society for Anesthesiologist grade, and duration of surgery. The arterial blood pressure and HR were found to be lower in the DEX group when compared with the placebo group. How to cite this article Vaishnav S, Shetty A, Sarkar M. Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery. Res Inno in Anesth 2017;2(1):14-17.

Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol

BackgroundThe field of cochlear implantation has been expanding rapidly and it has been hailed as one of the greatest advances in otology. The technique of anesthesia plays a crucial role in success of cochlear implant surgery as the anesthesiologist has to produce conditions which facilitate surgery by inducing bloodless operative field.Study objectiveTo determine the efficacy of dexmedetomidine versus esmolol usage as an adjunct to induce controlled hypotension in children undergoing cochlear implant surgery.DesignClinical trial study.SettingOperating room in a university hospital.Patients70 children aged 2–4 years scheduled for cochlear implant surgery under general anesthesia. Patients were randomly allocated according to drugs used into two equal groups (35 patients in each group). Interventions: Group (D): The patients in this group received a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by continuous infusion 0.2–0.5 ug/kg/h after induction of anesthesia but before surgery. Group (E): The patients in this group received a bolus dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion 100–300 ug/kg/min after induction of anesthesia but before surgery.MeasurementsHeart rate, Mean Arterial blood Pressure, Quality of surgical field, operative time, adverse events.Main resultsThe quality of surgical field was comparable between both groups in all times of measurements. The time to first analgesic request was statistically significant longer in group (D) than in group (E) and the total tramadol consumption was statistically significant less in group (D) than in group (E).ConclusionsIn our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

Use of dexmedetomidine for fast-track anesthesia in noncomplex pediatric cardiac surgery

Introduction Fast-track anesthesia technique is now an important aspect for reducing or eliminating the adverse effects of prolonged postoperative ventilation together with reducing ICU and hospital length of stay. This study was conducted to evaluate the effect of using dexmedetomidine as an adjuvant drug for fast-track technique in pediatric cardiac surgery. Patients and methods Sixty patients of both sexes with ages ranging from 1 to 12 years indicated for correction of noncomplex congenital heart diseases with cardiopulmonary bypass (CPB) were included in this study. After standard inhalational induction using sevoflurane for all patients, they were randomly classified into two groups of 30 each. In the dexmedetomidine group (group D), the patients received an initial bolus dose of dexmedetomidine (0.4 mg/kg) over 10 min, followed by continuous infusion of 0.5 mg/kg/h until the end of CPB. In the propofol group (group P) the patients received an initial bolus dose of propofol (2 mg/kg) over 30 s, followed by infusion at rate of 0.5 mg/kg/min until the end of CPB. Results There were significant differences between the two groups ( P Conclusion Dexmedetomidine helps in fast-track anesthesia in pediatric cardiac surgery and has many desirable effects that encourage its use in the perioperative period.

Effects of dexmedetomidine on sevoflurane requirement for 50% excellent tracheal intubation in children: a randomized, double‐blind comparison

We investigated the effects of two dexmedetomidine bolus and infusion combinations on the amount of sevoflurane required to produce 50% excellent tracheal intubation conditions (ED50 TI). In a prospective, double-blinded parallel, randomized manner, 60 children (ASA I or II, age 3-8years) undergoing elective surgery were allocated to one of three groups: saline only (group D0 ), a bolus dose of 1.0μg·kg(-1) dexmedetomidine followed by a continuous infusion of 0.5μg·kg(-1) ·h(-1) (group D1 ), or a bolus dose of 2.0μg·kg(-1) dexmedetomidine followed by a continuous infusion of 1.0μg·kg(-1) ·h(-1) (group D2 ). Each bolus dose of dexmedetomidine was infused over 10min, after which a dexmedetomidine infusion and 5% sevoflurane were immediately begun, with sevoflurane subsequently adjusted to target specific values determined according to Dixon's up-and-down method. After the target concentration of sevoflurane was maintained stable for 15min, laryngoscopy and tracheal intubation were performed. Intubation was considered excellent only if all subcomponents of the intubation score were rated excellent. Patient enrollment continued until there were six pairs of consecutive patients in which not excellent tracheal intubation conditions were followed by excellent conditions. The ED50 TI of sevoflurane in group D2 (1.41±0.07%) was significantly lower than in group D1 (2.36±0.16%; P<0.001), the latter being significantly lower than in group D0 (3.52±0.21%; P<0.001). Dexmedetomidine infusion produced a dose-dependent decrease in the ED50 TI of sevoflurane in children.

The Efficacy of Etomidate-Fentanyl versus Dexmedetomidine-Ketamine for Procedural Sedation and Analgesia during Upper Endoscopy and Biopsy: A Prospective, Randomized Study

Objective: To assess the effectiveness of a combination of etomidate-fentanyl versus dexmedetomidineketamine for Procedural Sedation and Analgesia (PSA) in patients undergoing upper endoscopy and biopsy. Patients and methods: This is a prospective randomized observer-blinded study. This study was carried out in Tanta university hospital on 100 patients of both sexes; ASA physical status I and II, age range from 20-60 years undergone upper endoscopy and biopsy. All patients were randomly divided into two groups (each group 50 patients) Group E (etofen): patients received an initial IV bolus dose of etomidate 0.15 mg/kg + fentanyl 1 mcg/kg IV, followed by etomidate infusion at 0.01-0.03 mg/kg/min. Group D (dexmedetomidine-ketamine): patients received an initial IV bolus dose of dexmedetomidine (1 μg/kg) +ketamine (1 mg/kg) followed by dexmedetomidine infusion (0.5-1 μg/kg/hr) with supplemental bolus doses of ketamine (0.5 mg/kg) as needed. Sedation started and adjusted according to bispectral index level (BIS) range 60-80. Patients were then observed by an anesthesiologist who was blinded about sedative/analgesic received. The primary outcomes were onset, level and time of sedation and the secondary outcomes were recovery time, Length of recovery room (RR) stay (min), duration of hospital stay, VAS score, hemodynamic changes (HR, MBP, SPO2, RR), surgeon satisfaction, side effects, and patient satisfaction. Results: There was significant rapid onset of sedation in group E as compared to group D, Sedation level by BIS, showed significant increase (P<0.05) in group E in comparison with group D. Recovery time, Length of recovery room (RR) stay (min) and Length of hospital stay (hr) showed significant decrease (P<0.05) in group E in comparison with group D. Conclusion: The etomidate/fentanyl combination provides an effective and safe procedural sedation and analgesia for upper endoscope and biopsy. Etomidate/Fentanyl combination provides shorter sedation times and lighter sedation level (but enough for the procedure) when compared to the dexmedetomidine/ketamine combination.

Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study

Background:It has been postulated that Multiple sclerosis (MS) stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as The “Liberation Procedure”. Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure.Aims:To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure.Settings and design:A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC) who will receive dexmedetomidine as an anesthetic agent.Methods:A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2–0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, “How would you rate your experience with the sedation you have received during surgery?” using a seven-point Likert-like verbal rating scale.Statistical analysis:Repeated measurements were analyzed by repeated measures ANOVA for HR and BP.Results:Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant.Conclusions:Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.