Combination Of Dexmedetomidine Research Articles

A randomised, prospective, double blind study of intraperitoneal instillation of 0.25% bupivacaine with clonidine versus 0.25% bupivacaine with dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the standard and most accepted technique for Cholecystectomies due to lesser postop pain and short recovery time.The origin of abdominal and shoulder pain after laparoscopic procedures has led to the use of intra peritoneal instillation of local anaesthetic agent to reduce postoperative pain. To assess the efficacy and quality of postoperative analgesia between the study groups using Visual Analogue Scale (VAS) score at various time intervals along with side effects if any.: 60 patients belonging to ASA 1 and 11 categories posted for Laparoscopic Cholecystectomy were given General Anaesthesia. After completion of surgery, before removing the trocar, anaesthetic study solution was sprayed on the surface of liver, gall bladder bed, right sub-diaphragmatic space, and port sites in Trendelenburg position. Volume and dilution of two drugs were same in both groups. Bupivacaine (0.25%) 50 mL; Dexmedetomidine (1 µg/kg) (BD) or Clonidine (1 µg/kg) (BC) was used. VAS score, Heart rate and BP measured at various time intervals and the time of first rescue analgesia noted.: VAS of BD group was 5.27 ± 0.64 to 3.70 ± 0.837 from 1 hour to 6 hour post extubation, when compared to BC group of 6.03 ± 0.669 in 1 hour reduced to 4.17 ± 0.699 at 6 hour post extubation. Dexmedetomidine combination significantly reduced the total dose of rescue analgesic required in 24 hours as compared to Clonidine combination.

Comparative Study between Dexmedetomidine Infusion Combination with Ketamine versus Fentanyl for Analgesia for Positioning of Spinal Anesthesia in Elderly Patients with Proximal Femoral Fracture

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Spinal anesthesia is preferred in anesthesia of fracture femur surgeries. But the problem is positioning of the patient for spinal anesthesia as the patient is in agony and pain. In our study we chose dexmedetomidine for this goal. We preferred to add an adjuvant to limit side effects of dexmedetomidine and to control pain beside sedation. 70 patients with proximal femoral fracture were blinded and randomized divided into two groups dexmedetomidine ketamine (k) and dexmedetomidine fentanyl (f) each group has 45 patients. There is significant better analgesic effect and sedation of k group than f group. But no significant difference on hemodynamics and postoperative complications. Objective The objective of this study is to compare the analgesic effect of combination of ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture. Patients and Methods We aimed by our study to compare the analgesic effect of combination of (ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture and we applied our study on 70 patients will be divided into two equal groups: Group k: will receive 1mg/kg of intravenous ketamine with loading dose of dexmedetomidine 1 μg/kg over 10 minutes and Group F : will recieve 1 μg/kg of intravenous fentanyl with loading dose of dexmedetomidine 1 μg/kg over 10 minutes, with the same inclusion and exclusion criteria. then dexmedetomidine infusion only will continued at 0.6 μg/kg/h for following 20 minutes, and titrated at rate of 0.2 to 0.6 μg/kg/h until the end of surgery. Results The results of this study revealed that the pain score in lateral position was significally lower in k group than f group (0-1 vs 2-3); p < 0.001. and pain score during hip flexion was significally lower in k group than f group (0-1 vs 2-3 ) respectively p < 0.001. sedation level was much higher in k group than f group (3-4 vs 2-3) p value 0.023. But both groups shows equivalent effect on hemodynamics after dexmedetomidine administration. hypotension, Bradycardia and desaturation was common i in both groups. Regarding post operative complications no significant difference between both groups while incidence of delirium in k group (17.1%) is higher in comparison to f (11.4%) group but not significally difference. Conclusion the combination of dexmedetomidine ketamine is a good choice for analgesia of the pain during spinal anesthesia in elderly with fracture femur but need further assessment for dosage and regimen of administration and for better evaluation of the hemodynamic effects

A Comparative Study of Intramuscular Ketamine and a Combination of Intramuscular Dexmedetomidine and Ketamine as Premedication in Paediatric Anesthesia

Introduction: Preoperative anxiety is an issue of concern in paediatric anaesthesia practice. Forceful transfer of children into the operating room can cause long-term psychological trauma. This clinical study compares intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine as anaesthetic premedicants in terms of +anxiolysis, sedation and ease of IV cannulation.
 Objectives: To compare the level of preoperative anxiety, sedation and ease of cannulation following premedication between intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine.
 Methods: Total of 60 patients belonging to American Society of Anaesthesiologists physical status I-II, in the age group of two to ten years, scheduled for elective surgery under general anaesthesia were included in the study; Group A patients received ketamine 3mg/kg body weight while Group B patients received ketamine 2mg/kg body weight and dexmedetomidine 1mcg/kg body weight intramuscular. The outcome variables were sedation score (Richmond Agitation Sedation Scale), IV cannula acceptance (IV cannula Acceptance Score), and parental separation (Separation Score).
 Results: The groups were comparable in patient characteristics and hemodynamic parameters between the groups. Median (IQR) sedation score at 10 min were -1 (-2—0) and 0(-1—1) (p< 0.001); mean parental separation scores were 3.76± 0.43 and 3.36±0.55 (p< 0.001); IV cannula acceptance score were 3.73±0.44 and 4.53±7.27 (p= 0.001) in Group A and Group B respectively.
 Conclusion: Combination of dexmedetomidine and ketamine is superior to ketamine alone in terms of sedation at 15 min and ease of IV cannulation but comparable in terms of anxiolysis.

Spatial and Spectral Components of the BOLD Global Signal in Rat Resting-State Functional MRI.

In resting-state fMRI (rs-fMRI), the global signal average captures widespread fluctuations related to unwanted sources of variance such as motion and respiration, as well as widespread neural activity; however, relative contributions of neural and non-neural sources to the global signal remain poorly understood. This study sought to tackle this problem through the comparison of the BOLD global signal to an adjacent non-brain tissue signal, where neural activity was absent, from the same rs-fMRI scan obtained from anesthetized rats. In this dataset, motion was minimal and ventilation was phase-locked to image acquisition to minimize respiratory fluctuations. Data were acquired using three different anesthetics: isoflurane, dexmedetomidine, and a combination of dexmedetomidine and light isoflurane. A power spectral density estimate, a voxel-wise spatial correlation via Pearson's correlation, and a co-activation pattern analysis were performed using the global signal and the non-brain tissue signal. Functional connectivity was calculated using Pearson's linear correlation on default mode network (DMN) regions. We report differences in the spectral composition of the two signals and show spatial selectivity within DMN structures that show an increased correlation to the global signal and decreased intra-network connectivity after global signal regression. All of the observed differences between the global signal and the non-brain tissue signal were maintained across anesthetics. These results show that the global signal is distinct from the noise contained in the tissue signal, as support for a neural contribution. This study provides a unique perspective to the contents of the global signal and their origins.

The Limited Use Of Dexmedetomidine For Subarachnoid Blocks In Pakistan.

Respected Madam, Dexmedetomidine is a selective alpha-2 adrenoceptor agonist. It acts by binding to the presynaptic alpha-2 adrenoceptors and inhibits the release of norepinephrine. Thereafter, it causes a decrease in the sympathetic tone and terminates the propagation of pain signals. As a result, the haemodynamic and the endocrine stress responses of the body to surgery and anesthesia are attenuated, the blood pressure and heart rate are decreased, and the requirement for other anaesthetic agents is reduced. These effects have meant that dexmedetomidine has been widely used prior to endotracheal intubation to optimize the patients and prevent the likelihood of hemodynamic adverse effects (1). In addition to its use in general anesthesia, peri-operative physicians worldwide are now becoming increasingly aware of the dexmedetomidine’s potential usefor subarachnoid blocks. A few studies have documented the efficacy of intravenous (IV) dexmedetomidine in prolonging the duration of sensory and motor blockade induced by agents such as bupivacaine, prilocaine, and ropivacaine up to 4 hours (2), (3). Recent studies have found that intrathecal administration of dexmedetomidine in combination with the local anesthetic agent yields similar benefits (4). This has been attributed to the activation of presynaptic alpha2-A receptors at locus ceruleus and the termination of pain signal propagation via the medullospinal noradrenergic pathway (4). Therefore, it is no surprise that the use of dexmedetomidine in conjunction with local anesthetics for the subarachnoid block is common practice in peri-operative physicians throughout the globe. While Pakistani peri-operative physicians are aware of the benefits of dexmedetomidine prior to endotracheal intubation (5), the same cannot be said for subarachnoid blocks induced in Pakistan. Peri-operative physicians in Pakistan are either yet to realize the potential benefits the use of dexmedetomidine can provide for subarachnoid blocks or still adhere to conventional spinal anesthesia practices. Since the effects of a conventional subarachnoid block last from 2 to 3 hours, in any case of a surgical adverse event that prolongs the surgery, severe pain, nausea, vomiting, and derangement of the hemodynamic status have been noted in patients. Often times, this results in a shift towards general anesthesia midway through the procedure. Ultimately, the postoperative stay is prolonged which directly impacts the clinical outcome and the quality of life for these patients. ---Continue

A randomized double-blinded study assessing the dose-response of ropivacaine with dexmedetomidine for maintenance of labor with epidural analgesia in nulliparous parturients.

Background: The combination of ropivacaine and dexmedetomidine has been used as an epidural analgesic for inducing labor. However, there is limited data regarding the administration of epidural analgesia for labor maintenance, hence, this study aimed to determine the optimum concentration through dose-response curves of ropivacaine plus dexmedetomidine, which could be used along with the Programmed Intermittent Epidural Bolus (PIEB) technique. Methods: One hundred parturients were randomized into 4 groups who were administered four different doses of ropivacaine (dexmedetomidine at 0.4μgmL-1): 0.04%, 0.06%, 0.08%, and 0.1%. The primary outcome that was determined included the proportion of patients experiencing breakthrough pain during their 1st stage of labor. Breakthrough pain was described as a visual analog scale [VAS] score of >30mm, requiring supplemental epidural analgesia after the administration of at least one patient-controlled bolus. The effective concentration of analgesia that was used for labor maintenance in 50% (EC50) and 90% (EC90) of patients were calculated with the help of probit regression. Secondary outcomes included epidural block characteristics, side effects, neonatal outcomes, and patient satisfaction. Results: The results indicated that the proportion of patients without breakthrough pain was 45% (10/22), 55% (12/22), 67% (16/24), and 87% (20/23) for 0.04%, 0.06%, 0.08%, and 0.10% doses of the analgesic that were administered, respectively. The EC50 value was 0.051% (95% confidence interval [CI], 0.011%-0.065%) while the EC90 value was recorded to be 0.117% (95% CI, 0.094%-0.212%). Side effects were similar among groups. Conclusion: A ropivacaine dose of 0.117% can be used as epidural analgesia for maintaining the 1st stage of labor when it was combined with dexmedetomidine (0.4μgmL-1) and the PIEB technique. Clinical Trial Register: https://www.chictr.org.cn/index.aspx, identifier ChiCTR2200059557.

Intrathecal Morphine versus Morphine-Dexmedetomidine Combination for Postoperative Pain Control After Total Knee Replacement: A Randomized Controlled Trial.

This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR). This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient's level of sedation were recorded. About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two groups. While at movement, patients in the dexmedetomidine group felt pain at 4 hrs postoperatively with significantly higher VAS than the other two groups. At the same time, the sedation score was significantly lower in the dexmedetomidine group than in the other two groups. 22.2% of cases in the morphine group developed nausea and vomiting with a significant difference between the three groups. Despite the absence of substantial side effects, our findings did not suggest enhanced analgesia with the combination of intrathecal morphine and dexmedetomidine.

Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam.

To assess the sedative failure rate over different dose combinations of intranasal dexmedetomidine and oral midazolam for procedural sedation. This was a retrospective study. Four groups were established according to the initial dose of sedatives. The primary outcome was the sedative failure rate for different doses of the two-drug combination. The risk factors associated with sedation failure were analyzed. A total of 2165 patients were included in the final analysis. Of these, 394 children were classified as sedation failure after the initial dose of a combination of intranasal dexmedetomidine and oral midazolam. Although the initial doses of intranasal dexmedetomidine and oral midazolam administered to patients varied widely, no significant differences were detected in the sedation outcomes among the groups. Multivariate analysis showed that sedation history, a history of sedation failure, and echocardiography were independent risk factors for sedation failure after an initial dose of intranasal dexmedetomidine and oral midazolam. In contrast, patients undergoing lung function and MRI were more likely to be successfully sedated. A combination of low-dose intranasal dexmedetomidine and oral midazolam provides adequate sedation efficacy without any increase in side effects, especially for patients undergoing MRI or lung function examination. This is an original article about the risk factors of sedation failure with an initial dose of intranasal dexmedetomidine and oral midazolam for procedure sedation. For patients undergoing echocardiogram, it is better to choose other sedatives, while a combination of intranasal dexmedetomidine and oral midazolam is a good option for patients undergoing MRI or lung function. The selection of sedative drugs should be personalized according to different procedures.

The perioperative analgesic effect of opioid free anesthesia using combination of dexmedetomidine, ketamine and lidocaine in adolescent patients undergoing Scoliosis Surgery; A randomized Controlled Trial

ABSTRACT Background Posterior spinal fusion treatment is one of the most painful options accessible to teenagers with idiopathic scoliosis. Objectives This study evaluated the opioid-sparing anesthesia analgesic effect using a combination of dexmedetomidine, ketamine and lidocaine versus opioid-based anesthesia (OBA) with fentanyl in adolescent patients undergoing scoliosis surgery. Methods This prospective, double-blinded, randomized study was conducted on 50 patients, American Society of Anesthesiologists (ASA) physical state I–II, scheduled for surgical correction of adolescent idiopathic scoliosis under general anesthesia. Patients were equally categorized into two groups: group I – opioid-free anesthesia (OFA) and group II – OBA. Intraoperative magnesium, total postoperative morphine consumption, time to first postoperative rescue analgesia and adverse effects were recorded. Results Total postoperative morphine consumption at 24 h was insignificantly different between groups. The proportion of patients requiring intraoperative magnesium was significantly higher in OBA (P < 0.001). Visual analog scale was only significant at 1 and 2 h which was significantly higher in group OBA than group OFA (P = 0.012 and < 0.001, respectively). Time to first postoperative rescue analgesia was significantly earlier in OBA than in OFA. Hemodynamic stability was insignificantly different between both groups. Bradycardia, postoperative nausea and vomiting and respiratory depression were insignificantly different between groups. Conclusions In adolescent patients ASA I-II undergoing scoliosis correction surgery, OFA with a combination of dexmedetomidine, ketamine and lidocaine could provide adequate intra- and postoperative pain management, which can obviate the use of intraoperative opioids minimizing the total postoperative opioid requirements compared to OBA using fentanyl.

Postoperative analgosedation with dexmedetomidine in combination with paracetamol in pediatric cardiac surgery

BACKGROUND: Although the principles of postoperative multimodal analgesia have been discussed in several articles, this issue remains insufficiently studied in pediatric cardiac surgery.&#x0D; AIM: To increase the effectiveness of postoperative analgosedation in children after heart surgery by combining intravenous dexmedetomidine and paracetamol.&#x0D; MATERIALS AND METHODS: Prospective, nonrandomized, controlled study (n = 65, 24 yr). Elective heart surgeries were performed in children with congenital heart defects, such as ventricular and/or interatrial septal defect and tetralogy of Fallot, under cardiopulmonary bypass and general anesthesia. Patients were divided into two groups according to the type of postoperative analgesia: group 1, main (n = 35): 30 min after surgery, infusion of dexmedetomidine with a loading dose of 1.0 g/kg/h or 10 min, then infusion of 0.8 g/kg/h during the day against the background of planned analgesia with paracetamol (15 mg/kg, intravenously) 2 h after surgery and then every 8 h during the day; group 2, comparisons (n = 30), 0.3 mg/kg morphine, intramuscularly. The effectiveness of postoperative analgosedation in children was analyzed using the Richmond scale and FLACC + hemodynamics, acid-base balance, blood gases, cortisol, glucose, and blood lactate.&#x0D; RESULTS: Sufficient stabilization of the main hemodynamics and respiratory indicators confirmed the adequacy of postoperative analgosedation in group 1 patients. There was a 14% drop in heart rate, specific peripheral resistance, and mean arterial pressure. There was no respiratory depression observed, and the decrease in blood pressure and heart rate was hemodynamically modest. Postoperative stability of blood lactate, glucose, and cortisol levels demonstrated the absence of major metabolic diseases and emotional and physical stress in the main group of children. The transfer of 74.3% of the first group's patients to the specialized department 42.3 5.5 h after the procedure decreased costs and strain on the intensive care unit staff.&#x0D; CONCLUSIONS: Dexmedetomidine combined with paracetamol provides an adequate level of sedation, suppresses extubation irritations, prevents psychomotor agitation, and provides sufficient analgesia.

Comparison between the effects of epidural lidocaine, tramadol, and lidocaine–tramadol on postoperative pain in cats undergoing elective orchiectomy

BackgroundIn veterinary clinical practice, orchiectomy is one of the most common surgical procedures for cats and is performed mainly in young animals. The purpose of this study was to compare three different epidural (EP) analgesic protocols used in cats undergoing orchiectomy in order to determine which protocol resulted in superior outcomes in terms of perioperative analgesia. Twenty-one client-owned male cats were premedicated with a combination of dexmedetomidine (10 µg/kg) and midazolam (0.2 mg/kg) injected intramuscularly. Anesthesia was induced intravenously with propofol. Cats were randomly divided in three treatment groups of seven animals each: Group L received EP lidocaine (2 mg/kg), Group T received EP tramadol (1 mg/kg), and Group LT received EP lidocaine (2 mg/kg) plus tramadol (1 mg/kg). The post-operative pain level was assessed using two different scales: the Glasgow Composite Measure Pain Scale-Feline (CMPS-F) and the Feline Grimace Scale (FGS). Rescue analgesia was administered when the CMPS-F total score was ≥5 or the FGS total score was ≥4.ResultsNo adverse effects related to tramadol or lidocaine were observed. Based on post-operative pain assessments, significant differences between groups were observed according to both pain scoring systems. In particular, in Group LT, the CMPS-F and FGS scores decreased significantly in the first six hours following castration.ConclusionsBased on our results, EP lidocaine plus tramadol provided the best post-operative analgesic effects in cats submitted to orchiectomy lasting 6 h and could also be a choice to consider for longer surgical procedures.

Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia

Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.

Mini-dose esketamine–dexmedetomidine combination to supplement analgesia for patients after scoliosis correction surgery: a double-blind randomised trial

BackgroundPatients often experience severe pain after scoliosis correction surgery. Esketamine and dexmedetomidine each improves analgesia but can produce side-effects. We therefore tested the hypothesis that a mini-dose esketamine-dexmedetomidine combination safely improves analgesia. MethodsTwo hundred male and female adults having scoliosis correction surgery were randomised to patient-controlled sufentanil analgesia (4 μg kg−1 in normal saline) with either a combined supplement (esketamine 0.25 mg ml−1 and dexmedetomidine 1 μg ml−1) or placebo. The primary outcome was the incidence of moderate-to-severe pain within 72 h, defined as a numeric rating scale (NRS: 0=no pain and 10=worst pain) score ≥4 at any of seven time points. Amongst secondary outcomes, subjective sleep quality was assessed with an NRS score (0=best sleep and 10=worst sleep) for the first five postoperative nights. ResultsThere were 199 subjects included in the intention-to-treat analysis. Mean infusion rates were 5.5 μg kg−1 h−1 for esketamine and 0.02 μg kg−1 h−1 for dexmedetomidine. The primary outcome incidence was lower with the combined supplement (65.7% [65/99]) than with placebo (86.0% [86/100]; relative risk 0.76; 95% confidence interval: 0.65–0.90; P=0.001). Subjects given the combined supplement had lower pain intensity at rest at five time points (median difference –1 point; P≤0.005), lower pain intensity with movement at six time points (median difference –1 point; P≤0.001), and better subjective sleep quality for the first 5 postoperative nights (median difference –2 to –1 points; P<0.001). Adverse events did not differ between groups. ConclusionsThe mini-dose esketamine–dexmedetomidine combination safely improved analgesia and subjective sleep quality after scoliosis correction surgery. Clinical trial registrationNCT04791059.

Comparison of the effect of a combination of low dose ketamine and dexmedetomidine with a combination of low dose ketamine and midazolam on hemodynamic changes and pain in electroconvulsive therapy.

Background: Currently, electroconvulsive therapy (ECT) is used as an effective treatment method in many psychiatric disorders. The basis of a successful electroshock session is to create a seizure with the precise intensity, quality and duration. In addition to the appropriate method of shock induction, appropriate anesthesia methods should be used to cause such seizures. The present study compared a combination of low-dose ketamine and dexmedetomidine (Ketodex) with a combination of low-dose ketamine and midazolam (Ketomid) on hemodynamic changes in electroshocks applied to patients referred from the psychiatric ward.&#x0D; Methodology: This study was a randomized triple-blind clinical trial performed after obtaining permission from the Medical Ethics Committee of the Isfahan University of Medical Sciences. For this purpose, 70 patients were selected for electroshock therapy and randomly distributed into two groups of 35 people. In the first group, 0.04 mg/kg midazolam was combined with ketamine 0.1 mg/kg and in the second group, 0.5 μg/kg dexmedetomidine with 0.1 mg/kg ketamine. The patients were placed under complete cardiovascular monitoring. Hemodynamic changes of patients were measured and recorded before injection, after injection, after shock, and at 5 and 10 min after the end of seizures.&#x0D; Results: In this study, 70 patients who were candidates for receiving ECT were equally divided into two groups of 35: one group received a mixture of Ketodex and the second group a combination of Ketomid. The two study groups showed no significant difference in terms of systolic pressure (P = 0.883), diastolic (P = 0.443), mean arterial pressure (P = 0.443), oxygen saturation (P = 0.018), and heart rate (P = 0.286). Complications such as headache, muscular pain (P = 0.01), bradycardia, nausea and vomiting were reported in the dexmedetomidine and ketamine groups.&#x0D; Conclusion: Our study showed that although systolic, diastolic and mean arterial blood pressure, heart rate and oxygen saturation were significantly reduced in both study groups, no significant difference was observed between the two groups in terms of hemodynamic changes and neither drug group in our study population was different from the other in terms of these parameters. In addition, neither option was superior to the other. However, due to the fact that complications such as headache, muscular pain, bradycardia, nausea and vomiting were reported in the dexmedetomidine and ketamine groups, the combination of midazolam and ketamine appeared to be a more appropriate combination in patients undergoing electroconvulsive therapy.&#x0D; Key words: Electroshock therapy; Midazolam; Ketamine; Dexmedetomidine; Hemodynamic changes; Headache pain&#x0D; Citation: Nazemroaya B, Manian N. Comparison of the effect of low dose ketamine plus dexmedetomidine vs low dose ketamine plus midazolam on hemodynamic changes and pain in electroconvulsive therapy. Anaesth. pain intensive care 2023;27(3):364−370; DOI: 10.35975/apic.v27i3.1981&#x0D; Received: September 02, 2022; Reviewed: December 03, 2022; Accepted: April 23, 2023

A comparative study of the efficacy of intravenous paracetamol and dexmedetomidine alone and in combination on perioperative hemodynamics and post-operative analgesia for patients undergoing laparoscopic cholecystectomy under general anesthesia

Background: With increase in incidence of gallbladder stone disease, the laparoscopic cholecystectomy is most preferred surgical technique. Laryngoscopy and peritoneal gas insufflation leads to hemodynamic stress response and pain during and after the procedure. Multimodal analgesia is recommended to reduce the stress response and prevent the post laparoscopic pain. Intravenous paracetamol and intravenous dexmedetomidine are both effective components in respect of multimodal analgesia. Aims and Objectives: The aim of this study was to compare and evaluate the effects of intravenous paracetamol and dexmedetomidine alone and in combination as part of multimodal analgesia on perioperative hemodynamics and post-operative analgesia. Materials and Methods: One hundred and five patients between the of age 18–60 years posted for laparoscopic cholecystectomy were randomly assigned to three groups (n=35). Before induction patients in Group D received dexmedetomidine 0.5 μg/kg/h and patients in Group P and Group P+D received 1 g paracetamol infusion over 15 min. Intraoperatively as continuous infusion patients in Group D and Group P+D received dexmedetomidine 0.2 μg/kg/h and Group P received 0.2 mL/kg NS until the removal of gallbladder. Perioperative hemodynamic variables, postoperatively, the need for rescue analgesia and any complications or side effects were recorded, compared, and analyzed. Results: Intraoperative hemodynamic variables were significantly higher in Group P compared to Group D and Group P+D (P&lt;0.05). Prolonged rescue analgesia found in Group P+D (9.06±1.16 h) then Group D (5.52±1.22 h) and Group P (4.35±0.99 h), respectively, which was strongly significant among the groups (P&lt;0.0001). Conclusion: Our study concluded that the combination of paracetamol and dexmedetomidine maintains the better hemodynamic stability and prolonged the duration of analgesia, with the benefit of high patient satisfaction. In addition, there was significantly less post-operative bradycardia and shivering.

Uncovering the Benefits of the Ketamine-Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic.

This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation.

Patient-controlled intravenous administration of dexmedetomidine with nalbuphine versus sufentanil for post cesarean delivery analgesia: A retrospective observational study.

This retrospective observational study aims to investigate the patient-controlled intravenous analgesia (PCIA) of dexmedetomidine (DEX) with nalbuphine (NAL) versus sufentanil (SUF) for post-cesarean delivery management. A total of 300 women were evaluated who underwent cesarean section surgery with combined spinal-epidural anesthesia. After surgery, all patients were connected to a patient-controlled analgesia pump. The PCIA protocol was programmed with 0.11 μg/kg/h DEX in combination with 0.03 μg/kg/h SUF in Group I (n = 150) or 0.11 μg/kg/h DEX in combination with 0.03 mg/kg/h NAL in Group II (n = 150). There was no significant difference in incision pain and sedation level between the two groups within 48 h after the surgery assessed by visual analog scale (VAS) and Ramsay sedation scale, respectively. However, at 2, 6, 12, and 24 h after surgery, visceral pain at rest and at mobilization was alleviated in the Group II as compared with the Group I with lower VAS scores. Moreover, fewer adverse reactions were found in the Group II when compared with Group I, including postpartum respiratory depression, nausea/vomiting, urinary retention, and cardiovascular events. Overall, there was an increased patient satisfaction in the Group II as compared with the Group I. Based on the results of this study, it seems that adding NAL to PCIA with DEX, as compared to SUF with DEX, have an effect on reducing the intensity of visceral pain after cesarean section with less adverse reactions and higher patient satisfaction.

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction.

Dexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions. Patients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of "loss of consciousness", and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed. Through the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of "loss of consciousness" were 2.899 (95% CI: 2.703-3.115) and 5.001 (95% CI: 4.544-5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain. This study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.

Propofol/dexmedetomidine Versus Desflaurane Effects on Post Hepatectomy Hepatocellular Injury

ABSTRACT Objective The Pringle maneuver used during hepatectomy causes ischemic reperfusion injury to the liver remnant. In this study, we compared the effect of maintenance of general anesthesia with propofol dexmedetomidine intravenous infusion versus desflurane inhalational anesthesia on post-hepatectomy hepatocellular injury in patients undergoing partial hepatectomy during the first six postoperative days. Methods Group A (15 patients) received total intravenous anesthesia with a combination of propofol and dexmedetomidine for anesthesia maintenance, and group B (15 patients) received desflurane for anesthesia maintenance. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin, serum bilirubin, prothrombin time (PT), and international normalized ratio (INR) were measured before surgery and at 1, 3, and 6 days after surgery. Results Transaminase levels, which were comparable in both groups, peaked between the first and the third postoperative days. The peak ALT was 224.27 ± 29.7 and 318.20 ± 52.5 U/L in group A and group B, respectively (P < 0.001). The peak AST was 265.60 ± 22.3 U/L in group A and 349.27 ± 56.1 U/L in group B (P < 0.001). Albumin levels at day 1 showed no significant differences between both groups, but at days 3 and 6, group A showed significantly higher albumin levels than group B. Other liver function tests including serum albumin, total and direct bilirubin, PT, and INR showed lower values in the propofol/dexmedetomidine group. Conclusion The main finding of this study is that propofol/dexmedetomidine as a technique for the maintenance of anesthesia resulted in less hepatocellular injury and better hepatic functions than desflurane in patients undergoing partial hepatectomy during the first six postoperative days.

Effects of Tourniquet Inflation on Blood Pressure, Mean Arterial Pressure, and Pulse Rate during the Maintenance of Anesthesia Using a Combination of Dexmedetomidine and Isoflurane for Patients Undergoing Lower Extremity Surgery

Introduction: The utilization of pneumatic tourniquets in surgery can help surgeons optimize the surgical field and reduce the amount of bleeding. It can also cause hyperdynamic cardiovascular responses, such as increased blood pressure, mean arterial pressure, and pulse rate, which the administration of analgesia, anti-hypertension, and increased depth of anesthesia cannot correct. Excessive hemodynamic responses can lead to complications due to the utilization of tourniquets, namely increased intracranial pressure and acute heart failure. This study aims to analyze differences in the effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane compared to that using only isoflurane for patients undergoing lower extremity surgery. Methods: This observational cohort study. The statistical test in this study was conducted using the Shapiro-Wilk test for normality and the Spearman test for correlation. The Chi-Square test was carried out to ensure the characteristics of patients in the two groups. Results: The results showed no significant effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane. Meanwhile, tourniquet inflation during the maintenance of anesthesia using only isoflurane resulted in significant effects on blood pressure, mean arterial pressure, and pulse rate. The results also indicated significant differences between the effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane and that using only isoflurane on the blood pressure, mean arterial pressure and pulse rate of patients undergoing lower extremity surgery. Conclusion: There are no significant effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane on the blood pressure, mean arterial pressure, and pulse rate of patients undergoing lower extremity surgery.