Dex Group Research Articles

Dexmedetomidine–Oxycodone combination for conscious sedation during colonoscopy in obese patients: A randomized controlled trial

BackgroundObesity is a risk factor for sedation-related respiratory depression during colonoscopy. In a colonoscopy, propofol is frequently used because of its strong sedative and hypnotic properties. However, propofol is associated with marked respiratory depression. The objective of this trial was to investigate the effectiveness and safety of dexmedetomidine plus oxycodone for conscious sedation during colonoscopy in obese patients. MethodsA total of 120 patients had colonoscopies, and they were divided into two groups at random: Dexmedetomidine and oxycodone were used to sedate group Dex + oxy; while group Pro + oxy received anesthesia with propofol plus oxycodone. Parameters including blood pressure, heart rate, respiration, blood oxygen saturation, injection pain, and recovery time were recorded for both groups. ResultsThe incidence of hypoxemia was significantly reduced in group Dex + oxy compared with group Pro + oxy (4.9% vs 20.3%, P = 0.011). Blood pressure was lower, and heart rate was higher in group Pro + oxy compared with group Dex + oxy (P < 0.05). In addition, group Dex + oxy showed a significantly shorter caecal insertion time, recovery time to orientation, and recovery time to walking than group Pro + oxy (P < 0.05). Endoscopist satisfaction scores were significantly higher in group Dex + oxy compared with group Pro + oxy (P = 0.042). ConclusionFor obese patients, dexmedetomidine plus oxycodone effectively sedate them with few adverse effects, while also reducing colonoscopy operation difficulty by allowing obese patients to reposition. Thus, dexmedetomidine plus oxycodone could be used safely as a conscious sedation method for colonoscopy in obese patients. Trial registrationThe protocol was registered at www.chictr.org.cn (ChiCTR1800017283, July 21, 2018).

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.

Dexmedetomidine attenuates postoperative spatial memory impairment after surgery by reducing cytochrome C

BackgroundAnesthesia and surgery can induce perioperative neurocognitive disorders (PND). Mitochondrial dysfunction has been proposed to be one of the earliest triggering events in surgery-induced neuronal damage. Dexmedetomidine has been demonstrated to attenuate the impairment of cognition in aged rats induced by surgery in our previous study.MethodsMale Sprague-Dawley rats underwent hepatic apex resection under anesthesia with propofol to clinically mimic human abdominal surgery. The rats were divided into three groups: Control group, Model group and Dexmedetomidine (Dex) group. Cognitive function was evaluated with the Morris water maze (MWM), Open Field Test (OFT)and Novel object recognition task (NOR). Ultrastructural change in neuronal mitochondria was measured by transmission electron microscopy. Mitochondrial function was measured by mitochondrial membrane potential and activities of mitochondrial complexes. Neuronal morphology was observed with H&E staining and the activation of glial cells was observed by immunohistochemistry in the hippocampus. Protein levels were measured by Western blot (WB) and immunofluorescence at 3 and 7 days after surgery.ResultsSurgery-induced cognitive decline lasts three days, but not seven days after surgery in the model group. Transmission electron microscope showed the mitochondrial structure damage in the model group, similar changes were not induced in the Dex group. Dexmedetomidine may reverse the decrease in mitochondrial membrane potential and mitochondrial complex activity. Compared with the Control group, the expression of cytochrome c was significantly increased in model group by Western blot and immunofluorescence on days 3, but not day 7. Rats from the Model group expressed significantly greater levels of Iba-1 and GFAP compared with the Control group and the Dex group.ConclusionDexmedetomidine appears to reverse surgery-induced behavior, mitigate the higher density of Iba-1 and GFAP, reduce the damage of mitochondrial structure and function by alleviating oxidative stress and protect mitochondrial respiratory chain, thus increasing cytochrome c oxidase (COX) expression and downregulate the expression of cytochrome c protein in the hippocampus of rats.

Effects of dexmedetomidine combined with sufentanil on injury and expression of high mobility group box protein B1/toll-like receptors signaling pathway in rats with pancreatitis

Pancreatitis is a common disease of digestive system, easy to deteriorate, acute onset, poor prognosis, high fatality rate. Analgesic and sedative drugs are often used to treat pancreatitis. Dexmedetomidine is an adrenergic receptor agonist, and Sufentanil is a common analgesic sedative. However, the mechanism of their combined use in the treatment of pancreatitis injury has not been fully elucidated. Wistar rat pancreatitis Model was established and randomly divided into 4 groups: Dex group, Dex+Suf group, model group and Sufentanil group. Compare and analyze heart rate, oxygen saturation, body temperature, and respiration. The onset time, duration, analgesic time and adverse reactions were recorded. Serum amylase, creatinine and alanine aminotransferase were detected. Serum IL-6 and IL-1β levels were detected, and apoptotic activity was detected by Caspase 3 activity kit. The expression of HMGB1, TLR2 and TLR4 mRNA in pancreatic tissues. Dexmedetomide alone or combined with sufentanil can improve the general indicators, sedation and analgesia time is shorter, longer duration. Serum secretion of IL-6 and IL-1β decreased, expression of HMGB1, TLR2 and TLR4 decreased, pancreatic serological serum amylase, creatinine, alanine aminotransferase activities decreased, Caspase 3 activity decreased. The curative effect of combination group was significantly higher than that of model group (p &lt; 0.01). Dexmedetomidine combined with sufentanil can affect the expression of HMGB1/TLRs, inhibit inflammation, improve sedation and analgesia, and inhibit apoptosis, so as to alleviate the injury of acute pancreatitis.

Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study

Background &amp; Objective: Erector Spinae Plane block (ESPB) is used in patients subjected to modified radical mastectomy (MRM) as a part of balanced anesthesia technique, and to offer prolonged postoperative analgesia. Local anesthetic agents are usually combined with various adjuvants to augment the effect. We compared dexmedetomidine (Dex) versus dexamethasone as adjuvants to ESPB in patients undergoing MRM.&#x0D; Methodology: This randomized controlled study involved 90 patients subjected to MRM under general anesthesia with preoperative ESPB using 30 ml levobupivacaine 0.25%. They were randomly assigned into three equal groups according to the adjuvants used. Dex Group (n = 30) received 1 µg/kg dexmedetomidine, Dexa Group (n = 30) received 10 mg dexamethasone, and ESPB Group (n = 30) received no adjuvants. Patients were monitored for pain using VAS scores and vital signs. The primary outcome measure was total morphine consumption. The secondary outcomes were intraoperative fentanyl consumption, pain intensity, and analgesia duration.&#x0D; Results: The postoperative analgesia duration was significantly longer in the Dex group compared with the ESPB group (P = 0.029) but not in the dexamethasone group. Intraoperative fentanyl and postoperative morphine consumption were significantly lower in the Dex group than in the ESPB group. VAS scores were significantly lower in the Dex group than in the ESPB group at rest and movement. VAS scores of the Dexamethasone group were similar to that of the ESPB group at rest and movement.&#x0D; Conclusion: As an adjuvant to levobupivacaine in erector spinae plane block, dexmedetomidine reduces pain at rest and with movement, reduces intraoperative fentanyl and postoperative morphine consumption, and prolongs the analgesia duration. It is superior to dexamethasone in pain reduction and duration of analgesia.&#x0D; Key words: Analgesia; Dexamethasone; Dexmedetomidine; Erector Spinae Plane Block; Radical Mastectomy; Postoperative Pain&#x0D; Citation: Ahmed HI, Ali AR, El Emam NH, Magdy M, Gamal RM. Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study. Anaesth. pain intensive care 2022;27(1):65−72.&#x0D; DOI: 10.35975/apic.v27i1.2122&#x0D; Received: Oct 08, 2022; Reviewed: Nov 10, 2022; Accepted: Nov 22, 2022

Preliminary experience on systemic effects of perineural dexamethasone sodium phosphate and methylprednisolone acetate through adductor canal block in total knee arthroplasty: A single center retrospective study.

Glucocorticoids are commonly utilised as adjuvants to enhance nerve block quality and prolong the analgesic duration. Its systemic effects, after a single-injection adductor canal block (ACB) followed by a continuous infusion, are unclear. The aim of the study was to assess the systemic effects of a single dose of dexamethasone sodium phosphate (DEX), or a combination of DEX and methylprednisolone acetate (MPA), on fasting blood glucose (FBG) and white blood cell count (WBC) when administered perineurally via ACB. A single-center retrospective study on total knee arthroplasty (TKA) was performed and a total of 95 patients were included in the final analysis. Patients were divided into three groups based on adjuvants received in ACB: Control group (N = 41) and two treatment groups, DEX group (N = 33) and DEX/MPA group (N = 21). Our primary outcomes were the change of FBG from its preoperative baseline value on postoperative day (POD) 2. The secondary outcomes included change of FBG on POD 0 and POD 1, and change of WBC on POD 0, POD 1, and POD 2. The FBG change from baseline in the DEX group was significantly higher than that in the control group (difference = 14.04, 95% CI: 1.3 to 26.77), P = 0.031) on POD 0. The WBC change from baseline in the DEX/MPA group was statistically significant higher than control on POD 0 (2.62 (1.52 to 3.37), P < 0.0001). No significant differences between DEX and DEX/MPA group were found on any given postoperative days for FBG and WBC. This study provided preliminary safety data on the use of a combination of glucocorticoids with hydrophilic (DEX) and lipophilic (MPA) properties as local anesthetic adjuvants in ACB, which induced similar levels of changes on FBG and WBC as those from both control and DEX alone group.

Impact of Bilateral Quadratus Lumborum Block Using Different Doses of Dexmedetomidine for Postoperative Analgesia in Laparoscopic Myomectomy: A Randomized Controlled Trial.

The optimal dosage of dexmedetomidine (DEX) for postoperative analgesia of quadratus lumborum block (QLB) after laparoscopic myomectomy is not clear. Our study evaluated the analgesic and adverse effects of different doses of locally administered DEX. Patients underwent laparoscopic myomectomy were enrolled in this randomized controlled trial. Transmuscular bilateral QLB was conducted postoperatively using local anesthetic plus different doses of DEX, as an adjuvant, per side. Numeric rating scales (NRS) of pain score and heart rate (HR) were assessed after performing QLB. Additional analgesics through patient-controlled analgesia pump, recovery time to first flatus, hospital stay, and other outcomes were also compared. A total of 150 participants were randomly divided into 3 groups (DEX1 group: 0.1μg/kg; DEX2 group: 0.3μg/kg; DEX3 group: 0.5μg/kg), 50 for each group. Compared with the DEX1 group, NRS pain scores were lower in groups DEX2 and DEX3 ( P <0.017) 20 minutes after QLB and the significance lasted for 24 hours. Patients in groups DEX2 and DEX3 needed fewer additional analgesics than the group DEX1 ( P <0.017). HR in groups DEX2 and DEX3 was lower than the group DEX1 10 minutes and 20 minutes after QLB, respectively ( P <0.017). Sixty minutes after QLB, HR in the DEX3 group was still lower than the other groups. More patients in the DEX3 group were found bradycardia. Satisfaction score of postoperative analgesia was higher in groups DEX2 and DEX3 than the DEX1 group ( P <0.017). The results suggest that solution of DEX 0.3μg/kg in ropivacaine 0.25% for QLB is recommended to relieve postoperative pain after laparoscopic myomectomy effectively and safely.

Effects of dexmedetomidine on evoked potentials in spinal surgery under combined intravenous inhalation anesthesia: a randomized controlled trial

ObjectiveWe aimed to investigate the effects of different doses of dexmedetomidine (Dex) on evoked potentials in adult patients undergoing spinal surgery under intravenous anesthesia with low-concentration desflurane.MethodsNinety patients were divided into three groups at random. To maintain anesthesia in the control group (group C), desflurane 0.3 MAC (minimal alveolar concentration), propofol, and remifentanil were administered. Dex (0.5 μg·kg−1) was injected for 10 min as a loading dose in the low-dose Dex group (group DL), then adjusted to 0.2 μg·kg−1·h−1 until the operation was completed. Dex (1 μg·kg−1) was injected for 10 min as a loading dose in the high-dose Dex group (group DH), then adjusted to 0.7 μg·kg−1·h−1 until the operation was completed. The additional medications were similar to those given to group C. The perioperative hemodynamics, body temperature, intraoperative drug dosages, fluid volume, urine volume, blood loss, the latency and amplitude of somatosensory evoked potentials (SEPs) at four different time points, the incidence of positive cases of SEPs and transcranial motor evoked potentials (tcMEPs), and perioperative adverse reactions were all recorded.ResultsData from 79 patients were analyzed. The MAP measured at points T2-T4 in group DH was higher than at corresponding points in group C (P < 0.05). The MAP at point T4 in group DL was higher than at corresponding points in group C (P < 0.05). The remifentanil dosage in group DH was significantly lower than in group C (P = 0.015). The fluid volume in group DL was significantly lower than in group C (P = 0.009). There were no significant differences among the three groups in the amplitude and latency of SEP at different time points, nor in the incidence of warning SEP signals. The incidence of positive tcMEP signals did not differ significantly between groups C and DL (P > 0.05), but was significantly higher in group DH than in groups DL (P < 0.05) or C (P < 0.05). The incidence of intraoperative hypertension was significantly higher in group DH than in group C (P = 0.017).ConclusionsLow-dose Dex has no effect on the SEPs and tcMEPs monitoring during spinal surgery. High-dose Dex has no effect on SEPs monitoring, but it may increase the rate of false positive tcMEPs signals and the incidence of intraoperative hypertension.Trial registrationThis study has completed the registration of the Chinese Clinical Trial Center at 11/09/2020 with the registration number ChiCTR2000038154.

Efficacy of dexmedetomidine as an adjuvant in erector spinae plane block in breast cancer surgery: a randomized controlled trial

Background: The erector spinae plane block (ESPB) is a new potential inter-fascial block technique used to decrease pain after breast surgery. Dexmedetomidine (Dex) is used as an adjuvant to local anesthetics and is thought to improve the analgesic profile and duration of different anesthetic techniques. We evaluated the effect of adding Dex in local anesthetic solution for ESPB in breast cancer surgeries regarding the analgesic effect and duration.&#x0D; Methodology: This prospective randomized controlled study included 60 female patients scheduled for breast cancer surgery. All patients were anesthetized in a standard manner, and then were randomized into three equal groups; 1. ESP group, to receive an ultrasound-guided ESPB with 20 ml bupivacaine 0.5%; 2. Dex group, to receive ESPB with 19 ml bupivacaine 0.5% and 1 ml of normal saline containing 1 µg/kg Dex, and the control group received the standard general anesthesia only. The intraoperative fentanyl and postoperative morphine consumption were noted. Postoperative pain was assessed on numerical pain rating scale (NRS)&#x0D; Results: The duration of analgesia was significantly prolonged in ESPB and Dex groups than in the control group and in the Dex group than in ESPB group (P &lt; 0.001). Intraoperative fentanyl and postoperative morphine consumption were significantly lower in ESPB and Dex groups than in the control group. NRS pain scores were comparable in the three groups during the first 24 h.&#x0D; Conclusions: Adding dexmedetomidine 1 µg/kg to bupivacaine 0.5% prolongs the duration of analgesia of the ESPB in breast cancer surgeries.&#x0D; Key words: Analgesia; Breast Cancer; Breast Surgery; Bupivacaine; Dexmedetomidine; Nerve Block&#x0D; Citation: Hassan ME, Abdelgalil AS. Efficacy of dexmedetomidine as an adjuvant in erector spinae plane block in breast cancer surgery: a randomized controlled trial. Anaesth. pain intensive care 2022;27(1):16−22; DOI: 10.35975/apic.v27i1.2109&#x0D; Received August 16, 2022; Reviewed: November 13, 2022; Accepted: December 03, 2022

Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing Midazolam, Clonidine, and Dexmedetomidine

PurposeSedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia. DesignA single-center randomized controlled trial. MethodsThis is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period. FindingsThe final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group. ConclusionsWhen used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

Radioprotective effects of dexmedetomidine on X-ray-induced testicular damage.

Approximately 70% of cancer patients require radiotherapy. However, despite its effectiveness in the treatment of cancer, radiotherapy can also affect and damage surrounding healthy tissues in addition to tumorous tissues. Since testicular tissues are highly radiosensitive, radiotherapy can cause impairments in spermatogenesis leading to infertility. The purpose of this study was to examine the potential radio-protective effect of dexmedetomidine (Dex), an α2-adrenoceptor agonist, on oxidative stress and apoptosis in testicular tissues caused by x-irradiation in rats. Thirty male Sprague-Dawley rats were allocated into three groups of ten (n=10): control, irradiation (IR), and IR + Dex groups. The IR group was exposed to a single dose of 2 Gy IR. The IR+Dex group was given a single intraperitoneal (i.p.) dose of 100 µg/kg Dex before IR. The control group received a single dose of saline solution i.p. Testicular tissues removed 24 hours after IR were subjected to histochemical, biochemical, and immunohistochemical analysis. IR resulted in increased malondialdehyde (MDA) activity and significant changes in testis tissues. However, the application of Dex elevated glutathione levels by preventing MDA formation. In addition, Dex decreased tubular epithelial apoptosis via elevated Cleaved Caspase-3 expressions. Dex exhibited a radio-protective effect against lipid peroxidation and apoptosis caused by IR.

Protective effects of melatonin receptor agonists on endotoxin-induced uveitis in rats.

Melatonin has an important role in regulating a variety of physiological functions of the body. We investigated the protective effects of Agomelatine (AGO) and Ramelteon (RAME) on Endotoxin-Induced Uveitis (EIU) in rats. 70 rats were randomly divided into fourteen groups. Healthy group normal saline, (IP), Uveitis group (200 μg/kg lipopolysaccharide (LPS), SC), DEX group (200 μg/kg LPS plus 1 mg/kg dexamethasone, IP), AGO20 group received 200 μg/kg LPS plus 20 mg/kg AGO, AGO40 group received 200 μg/kg LPS plus 40 mg/kg AGO, RAME2 group received 200 μg/kg LPS plus 2 mg/kg RAME, and group RAME4 received 200 μg/kg LPS plus 4 mg/kg RAME. Each group had two subgroups: the 3rd and 24th hr. The eye tissues were collected and investigated biomicroscopically (clinical manifestations and scoring, molecularly(qRT-PCR analyses of tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and caspase 3 and caspase 9 mRNA expression), biochemically (Superoxide dismutase activity (SOD), Glutathione (GSH), and malondialdehyde levels (MDA)) and histopathologically (staining with Harris Hematoxylin and Eosin Y). Melatonin receptor agonist treatment reduced the clinical score count of ocular inflammation in the uveitic rats. TNF-α, VEGF, caspase 9, and caspase 3 levels markedly decreased in the uveitic rats. Melatonin receptor agonists significantly ameliorated fixed changes in GSH, SOD, and MDA levels. Melatonin receptor agonists also ameliorated histopathological injury in eye tissues associated with uveitis. Melatonin receptor agonists ameliorated the inflammatory response in EIU. These findings suggest that melatonin receptor agonists may represent a potential novel therapeutic drug for uveitis treatment.

Effect of Dexmedetomidine on Inflammatory Response in Aortic Dissection.

To study the effect of dexmedetomidine (Dex) on perioperative inflammatory response in aortic dissection (AD) patients. From June 2020 to June 2022, 50 patients with Stanford type B AD underwent endovascular stent-graft exclusion (EVAR) at our hospital. They randomly were assigned to two groups (N = 25): the control group (C group) and the Dex group. Patients in the Dex group received 0.5ug/kg Dex intravenously 10 minutes before induction of anesthesia and 0.5µg/kg/h Dex during the intervention until 15 minutes before the end of surgery. In contrast, the C group received the same volume of normal saline at the same time points. The two groups were induced and maintained with the same anesthetic agents. Venous blood samples were taken 3 days before operation (T1), 1 day before operation (T2), 1 day after operation (T3) and 3 days after operation (T4) to detect levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC). At T3 and T4, CRP and ESR in the Dex group were significantly improved compared with those in the C group. Dexmedetomidine can reduce the inflammatory reaction of aortic dissection.

Comparison between Different Anaesthesia Techniques for Protecting Renal Function in Children Undergoing Radical Nephrectomy

Background and Aim: Most primary renal neoplasms are caused by renal cell carcinomas (RCCs). There is a high risk of morbidity and mortality following radical nephrectomy due to acute kidney injury (AKI). It is crucial to detect and prevent this complication as early as possible. The present study aimed to anesthesia comparison after radical nephrectomy for kids: a study with different anesthesia techniques. Patients and Methods: This retrospective study was carried out on 84 children of the age up to 12 years undergoing radical nephrectomy in the department of Anaesthesiology, Chaudhary Muhammad Akram Hospital (CMA) Lahore during three years, from August 2019 to July 2022. Prior to study conduction, ethical approval was taken from research and ethical committee. Patients were allocated to three different groups: Group-D (Dexmedetomidine group), Group-C (Caudal group), and Group-P (Placebo group). Children were evaluated by taking history, physical examination, and laboratory examinations such as liver function, CBC, kidney functions, and coagulation profile. SPSS version 28 was used for data analysis. Results: A total of 84 children investigated with different anesthesia techniques. Each group was assigned 28 children undergoing radical nephrectomy. A significant difference did not appear between the three groups in terms of serum creatinine at any of the times of measurement. Group D showed significant lower values for cystatin C and NGAL compared with group C and group P regardless of the measurement period. In all three studied groups, there were no significant differences in age, gender, or weight of the patients (p&gt; 0.05). Comparatively to the other two groups, the Dex Group had significantly higher urine output, more sedation, and lower objective pain scores. Conclusion: Clinical prediction schemes using cystatin C and NGAL biomarkers showed that dexmedetomidine prevents AKI in children undergoing renal replacement therapy. The Dex Group had significantly higher urine output, more sedation, and lower objective pain scores as compare to the other two groups. Furthermore, dexmedetomidine provides renal protection and sedation as well as analgesia. Keywords: Radical nephrectomy; Dexmedetomidine; Cystatin C; Children

The effect of dexamethasone and flunixin-meglumine on ovulation, endometrial oedema, and inter-ovulatory interval length in the mare

The use of flunixin-meglumine (a potent non-steroidal anti-inflammatory drug) during the critical period of intrafollicular prostaglandin production before ovulation (24 and 36 h after hCG treatment) results in a high rate of ovulatory failure and formation of haemorrhagic anovulatory follicles (HAF) in the mare. Dexamethasone is commonly used to prevent persistent mating-induced endometritis in susceptible mares, but the effect on ovulation blockage within the pre-ovulatory critical window of intrafollicular prostaglandins production following hCG administration has not been determined. Six mares were followed during four consecutive cycles in a crossover design; once in oestrus with a follicle of >32 mm in diameter, mares were treated with hCG (Hour 0) and assigned to one of 4 groups randomly: 1) FM, mares received 1.7 mg/kg flunixin-meglumine at Hour 24 and 36; 2) CON, mares received no further treatment. 3) DEX1, mares received 0.1 mg/kg dexamethasone at Hour 24, and 4) DEX2, mares received 0.1 mg/kg dexamethasone at Hour 24 and 36. For all groups, ovulation and HAF rates, endometrial oedema profiles and the inter-ovulatory intervals (IOI) were determined and compared statistically. All CON and DEX mares ovulated normally and did not form any HAF. On the contrary, FM mares developed a HAF in 83% of cycles (P < 0.01). The endometrial oedema score was lower following DEX administration than FM (P < 0.05). The mean IOI was longer (P < 0.05) in DEX1 and DEX2 groups (26.5 and 26 days, respectively) than in CON and FM groups (21.5 and 22 days, respectively). In conclusion, dexamethasone treatment given either once or twice during the critical window of hCG-induced ovulation did not block or delay ovulation, but had a similar ovulation rate than untreated control mares. However, the inter-ovulatory intervals of dexamethasone treated mares was longer than control and FM treated mares. Finally, dexamethasone treatment was more effective in reducing endometrial oedema than FM.

Cardiopulmonary and propofol-sparing effects of dexmedetomidine in total intravenous anesthesia in cats undergoing ovariohysterectomy.

This study aimed to assess the effect of dexmedetomidine on the propofol-based anesthesia of cats subjected to ovariohysterectomy. Twenty-eight cats were randomly allocated to four groups (seven cats in each) and premedicated with either 5 µg/kg dexmedetomidine (groups Dex 1, Dex 3 and Dex 5) or 0.05 ml saline (Prop group) intramuscularly. After the induction of anesthesia with propofol, total intravenous anesthesia was initiated with 300 µg/kg/min propofol plus 3 ml/kg/h NaCl 0.9% (Prop), or 200 µg/kg/min propofol plus dexmedetomidine at the rates of 1 µg/kg/h (Dex 1), 3 µg/kg/h (Dex 3) or 5 µg/kg/h (Dex 5). Cardiorespiratory variables were assessed 5 mins after induction and every 10 mins thereafter, until the end of anesthesia. The propofol infusion rate was adjusted every 10 mins (± 50 µg/kg/min) to maintain anesthetic depth. The times to extubation, sternal recumbency, ambulation and total recovery were recorded. Pain scoring was performed 1, 2, 4, 8, 12 and 24 h after the end of anesthesia. Dexmedetomidine produced a propofol-sparing effect of 72.8%, 71.1% and 74.6% in the Dex 1, Dex 3 and Dex 5 groups, respectively. Cats in the Prop group maintained higher heart rate values than the other groups, and the mean arterial pressure remained higher in the Dex 3 and Dex 5 groups. Rescue intraoperative analgesia (fentanyl bolus) was most frequent in the Prop group. There was no significant difference in the time of extubation. Cats in the Dex 1 and Dex 3 groups had a faster anesthetic recovery, with shorter times to achieving sternal recumbency, regaining ambulation and reaching full recovery. Cats in the Dex 1 and Dex 5 groups presented the best recovery quality scores, with 4 (range 4-5) and 4 (range 3-5), respectively, while the Prop group scored 1 (range 1-3), the worst anesthetic recovery score among the groups. The use of dexmedetomidine as a total intravenous anesthesia adjuvant, especially at doses of 1 and 3 µg/kg/h, reduces propofol consumption and improves cardiorespiratory stability and intraoperative analgesia, while promoting a better and quicker recovery from anesthesia.

Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly

PurposeThe aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly.MethodsThis study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients.ResultsThe volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2–8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349).ConclusionsThe combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).

Influence of Dexmedetomidine on Myocardial Injury in Patients with Simultaneous Pancreas-Kidney Transplantation.

Diabetes is one of the most common chronic diseases in the world. End-stage renal disease (ESRD) caused by diabetes is the most serious long-term complication. The main cause of death in patients with simultaneous pancreas-kidney transplantation (SPKT) is cardiovascular disease. Although dexmedetomidine (Dex) has unique advantages in heart protection against ischaemic/reperfusion injury, few clinical studies have been conducted on its cardioprotective effect in SPKT. This study aimed to explore the influence of Dex on myocardial injury in patients undergoing SPKT and to analyze its possible mechanism. A randomized controlled trial (RCT) was performed from July 1, 2018 to December 1, 2020. Eighty patients, regardless of gender, scheduled for SPKT were randomly allocated into a Dex group (D group) receiving Dex at a rate of 1 µg/kg for 10 minutes before anaesthesia induction and then continuous infusion at 0.5 µg/kg/hour until the end of surgery and control group (C group) receiving equivalent capacity of saline. Serum cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), tumour necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were recorded at 5 minutes after anaesthesia induction (baseline,T0), 5 minutes before renal arteriovenous opening (T1), 30 minutes after renal arteriovenous opening (T2), 30 minutes after pancreatic related arteriovenous opening (T3), immediately after surgery (T4), 4 hours after surgery (T5), and 24 hours after surgery (T6). Adverse cardiovascular events were recorded during the perioperative period. Changes in ECG S-T segments and T waves were monitored at T0-T6. Myocardial infarction and percutaneous coronary intervention were recorded with an average follow-up of one year. Compared with T0, TNF-α and IL-6 concentrations significantly increased at T1-T6 in the C and D groups (P < 0.05). IL-6 concentration increased significantly after renal artery opening and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, TNF-α, and IL-6 concentrations were significantly reduced in group D at T2-T6 (P < 0.05). Compared with T0, cTnI and CK-MB concentrations were significantly increased at T3-T6 in the C and D groups (P < 0.05). cTnI and CK-MB concentrations increased significantly after the opening of renal artery, and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, cTnI and CK-MB concentrations were significantly reduced in the D group at T3-T6 (P < 0.05). There was no significant difference in patient characteristics amongst groups, including the proportion of intraoperative vasoactive drug use and adverse cardiovascular events during the follow-up period. Heart rate, mean blood pressure, central venous pressure, and cardiac output were not remarkably different between the two groups at any time point. Perioperative reperfusion could aggravate myocardial injury in SPKT. Dex may be considered a way to reduce myocardial injury caused by inflammatory action by decreasing the release of inflammatory factors. Trial Registration Number: Chinese Clinical Trial Registry ID: ChiCTR2200060084.

Differential Fibrinolysis Profile in COVID-19 Patients Dependent on Immunosuppressive Treatment Regimen: A Nested Case-Control Study

Introduction: Severe coronavirus disease 2019 (COVID-19) is associated with thrombotic complications, despite prophylactic and therapeutic anticoagulation. The disease course of critically ill COVID-19 patients has been characterized by severe hypercoagulability and hypofibrinolysis leading to an increased risk of venous thromboembolism. In COVID-19 (low molecular weight) heparins do not provide sufficient protection against venous thromboembolism. Since the start of the COVID-19 pandemic, several immune modulatory interventions have been introduced to improve outcome, including dexamethasone and tocilizumab. Whether dexamethasone and tocilizumab would alter the course of hypercoagulability by modifying inflammation, is unknown. Tocilizumab, that reduces IL-6 binding to its cellular receptors, has been shown to reduce the plasma plasminogen activator inhibitor-1 (PAI-1). On the other hand, dexamethasone can induce PAI-1 release. Data on the net impact of dexamethasone and tocilizumab on fibrinolysis in critically ill COVID-19 patients is lacking. Therefore, we aimed to characterize the fibrinolytic profile of severe COVID-19 patients on different treatment regimens and to unravel underlying mechanisms of the hypofibrinolytic state of these patients. Methods: A nested case-control study within the Maastricht Intensive Care COVID (MaastrICCht) cohort on mechanically ventilated COVID-19 patients was conducted. Patients receiving tocilizumab and dexamethasone (toci group) were age- and sex-matched with patients receiving only dexamethasone (dexa group) and patients receiving neither tocilizumab nor dexamethasone (control group). Whole blood was collected from these patients at three different time points after intubation (week 1, 2, and 3). The dexa and toci group received dexamethasone treatment before intubation and the toci group received one bolus of tocilizumab before or on the day of intubation. All blood samples were collected thereafter. Whole blood tissue plasminogen activator rotational thromboelastometry (tPA-ROTEM) was performed and subsequently inflammatory markers (c-reactive protein (CRP), ferritin, IL-6, fibrinogen), fibrinolysis parameters (tPA, PAI-1, thrombin activatable fibrinolysis inhibitor (TAFI), plasmin-alpha-2-antiplasmin complex (PAP)) and coagulation biomarkers (D-dimer, prothrombin fragment 1.2 (F1.2)) were measured in plasma samples. All markers were analyzed with linear mixed-effects regression models to estimate the differences between treatment groups over time. Results: Matching showed similar groups (Table 1.) for the baseline characteristics. At week 1 the dexagroup's IL-6 level was significantly lower, whereas the toci group's IL-6 level was significantly higher compared to the control group (difference[95%CI]: -198.37 [-350.86- -45.88], p=0.017 and 269.59 [113.91-425.27], p=0.002, respectively). CRP levels were significantly lower at week 1 in both dexa and toci groups compared to the control group (median [IQR] 60.50 [30.75 - 131.25] and 18.50 [6.00 - 60.00] vs. 296.00 [223.75 - 347.00]) suggesting effective immune suppression. Divergent fibrinolysis was seen at week 1 by tPA-ROTEM showing lower lysis time (LT) in the toci group compared to the control group (difference[95%CI]: -1,759.21 [-2752.05 - -766.34; p=0.002), whereas the dexa group did not differ. Interestingly, LT decreased over time in the control group, while an increase was seen in the toci group (Figure 1.). PAI-1 levels were lower in week 1 in the toci group compared to the control group (difference [95%CI] -7.32 [-14.95 - 0.30], p=0.071) and the tocigroup showed an overall increase in PAI-1 levels, while the control and dexa group showed a decrease over time. High TAFI and tPA levels were observed in all groups at week 1 and over time regardless of the treatment regimens. Coagulation biomarkers D-dimer and prothrombin fragment 1.2 were elevated but did not differ or change over time between groups. Conclusions: The differences and changes over time revealed by tPA-ROTEM and the fibrinolysis markers between the three different treatment regimens show the direct interaction between inflammation and fibrinolysis in these patients. The lower LT and PAI-1 levels upon tocilizumab treatment could be indicative for better fibrinolytic activity in these patients. This study was supported by the Dutch Covid and Thrombosis Coalition (DCTC). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Dexmedetomidine Reduce Multiple Organ Injury Induced by Lung Ischemia/ Reperfusion of Mice Through Inhibiting Endoplasmic Reticulum Stress Response

To investigate the effect of Dexmedetomidine reduce brain, myocardium and kidney injury induced by lung ischemia/reperfusion of mice through inhibiting endoplasmic reticulum stress response. SPF C57BL/6J male mice were randomly divided into 5 groups (n = 10): the sham operation group (group sham), the ischemia reperfusion Group (Group I/R), the Atipamezole Group (Group Atip), dexmedetomidine Group (Group-DEX) and dexmedetomidine+AtipamezoleGroup (Group DA). Lung ischemia reperfusion models were established with the method of 30min in-vivo left hilus occlusion followed by 180min reperfusion. In addition to the steps same as Group I/R, the mice in Groups Atip, Dex and DA were given Atip(250μg/kg), Dex(20μg/kg), and Dex+ Atip(20μg/kg+250μg/kg) respectively by intraperitoneal injection 30min before hilar occlusion. After reperfusion, the blood was taken from the eye-orbit to determine the activity of serum CK-MB and LDH and the levels of serum creatinine and urea nitrogen. The brain tissue was taken to determine the brain water content. The tissue of myocardium, brain and kidney was taken to observe the cellular morphology change under the light microscope. The expression of Caspase3 activity in heart, brain and kidney was determined with Thermos Scientific Microplate Reader. The TUNEL method was used to detect the apoptotic index of heart, brain and kidney. The Western blot and RT-PCR were used to determine the expression of proteins and mRNA of JNK, Caspase12, CHOP and GRP78. Compared with Group Sham, obvious injury in the tissue of myocardium, brain and kidney was observed in the other four groups under the light microscope. The activity of CKMB and LDH, and the levels of serum creatinine, urea nitrogen and brain water content were significantly increased as well. The apoptotic index, Caspase3 activity, and the expression of the proteins and mRNA of JNK, Caspase12, CHOP and GRP78 were also significantly elevated. Compared with Group I/R, Atip and DA, the mitigated injury in the myocardium, brain and kidney was observed in Group DEX under the light microscope. The activity of CK-MB and LDH, and the levels of serum creatinine, urea nitrogen and brain water content were decreased and the apoptotic index, Caspase3 activity, and the expression of the proteins and mRNAs of JNK, Caspase12 and CHOP were also significantly decreased in Group DEX, but the proteins and mRNA expression of GRP78 were significantly elevated. For the comparison among theGroup I/R, Atip and DA, there is no significant difference was found.(grp78).The pre-administration of DEX can mitigate the heart, brain and kidney injury induced by lung ischemia reperfusion. The mechanism may be related to the activation of α2-adrenergic receptor and inhibition of endoplasmic reticulum over-response.