Intravenous Administration Of Dexmedetomidine Research Articles

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

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

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

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

The role of dexmedetomidine administered via intravenous infusion as adjunctive therapy to mitigate postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing regional anesthesia: a meta-analysis of randomized controlled trials

Study objectiveThis meta-analysis aimed to assess whether continuous intravenous administration of DEX during surgery can be part of the measures to prevent the onset of postoperative delirium and postoperative cognitive dysfunction in elderly individuals following regional anesthesia.MethodsWe searched the databases of PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure (by June 1, 2023) for all available randomized controlled trials assessing whether intravenous application of dexmedetomidine can help with postoperative delirium and postoperative cognitive dysfunction in the elderly with regional anesthesia. Subsequently, we carried out statistical analysis and graphing using Review Manager software (RevMan version 5.4.1) and STATA software (Version 12.0).Main resultsWithin the scope of this meta-analysis, a total of 18 randomized controlled trials were included. Among them, 10 trials aimed to assess the incidence of postoperative delirium as the primary outcome, while the primary focus of the other 8 trials was on the incidence of postoperative cognitive dysfunction. The collective evidence from these 10 studies consistently supports a positive relationship between the intravenous administration of dexmedetomidine and a decreased risk of postoperative delirium (RR: 0.48; 95%CI: 0.37 to 0.63, p < 0.00001, I2 = 0%). The 8 literature articles and experiments evaluating postoperative cognitive dysfunction showed that continuous intravenous infusion of dexmedetomidine during the entire surgical procedure exhibited a positive preventive effect on cognitive dysfunction among the elderly population with no obvious heterogeneity (RR: 0.35; 95%CI: 0.25 to 0.49,p < 0.00001, I2 = 0%).ConclusionAdministering dexmedetomidine intravenously during surgery can potentially play a significant role in preventing postoperative delirium and postoperative cognitive dysfunction in patients older than 60 years with regional anesthesia according to this meta-analysis.

Effects of different dexmedetomidine doses on haemodynamic variability during laryngoscopy and intubation: A randomized double-blind study

Background: Effective airway management is vital in anesthesiology for preserving patient lives. Laryngoscopy and endotracheal intubation, commonly used procedures, can lead to undesirable outcomes due to vagal activation and sympathoadrenal reaction. This double-blind, randomized interventional study aimed to assess the impact of two different doses of dexmedetomidine on heart rate and blood pressure during laryngoscopy and intubation, which often induce tachycardia and hypertension, particularly risky for patients with hypertension, myocardial insufficiency, and cerebrovascular disease. Methods: Seventy-six participants, aged 20-60 years and classified as American Society of Anesthesiologists (ASA) Grade I &amp; II, were enrolled after Institutional Ethics Committee approval. Random allocation assigned them to two groups: Group A (0.5 µg/kg dexmedetomidine) and Group B (1.0 µg/kg dexmedetomidine) before anesthesia induction. Hemodynamic measurements were recorded at various time points: pre- and post-drug administration, before intubation, and at intervals thereafter. Results: Both groups exhibited similar age, weight, and gender distribution. Group B consistently demonstrated lower hemodynamic variables compared to Group A after laryngoscopy and intubation. Additionally, Group B required a smaller induction dose of propofol than Group A. No significant adverse effects were reported in either group during the study. Conclusion: The study suggests that intravenous administration of dexmedetomidine at a rate of 1 µg/kg is more effective than 0.5 µg/kg in attenuating the physiological response to laryngoscopy and intubation. Moreover, it reduces the required propofol dose for anesthesia induction. These findings highlight the potential benefits of higher dexmedetomidine doses in mitigating adverse physiological effects during airway management procedures

Effects of different dexmedetomidine doses on haemodynamic variability during laryngoscopy and intubation: A randomized double-blind study

Background: Effective airway management is vital in anesthesiology for preserving patient lives. Laryngoscopy and endotracheal intubation, commonly used procedures, can lead to undesirable outcomes due to vagal activation and sympathoadrenal reaction. This double-blind, randomized interventional study aimed to assess the impact of two different doses of dexmedetomidine on heart rate and blood pressure during laryngoscopy and intubation, which often induce tachycardia and hypertension, particularly risky for patients with hypertension, myocardial insufficiency, and cerebrovascular disease. Methods: Seventy-six participants, aged 20-60 years and classified as American Society of Anesthesiologists (ASA) Grade I &amp; II, were enrolled after Institutional Ethics Committee approval. Random allocation assigned them to two groups: Group A (0.5 µg/kg dexmedetomidine) and Group B (1.0 µg/kg dexmedetomidine) before anesthesia induction. Hemodynamic measurements were recorded at various time points: pre- and post-drug administration, before intubation, and at intervals thereafter. Results: Both groups exhibited similar age, weight, and gender distribution. Group B consistently demonstrated lower hemodynamic variables compared to Group A after laryngoscopy and intubation. Additionally, Group B required a smaller induction dose of propofol than Group A. No significant adverse effects were reported in either group during the study. Conclusion: The study suggests that intravenous administration of dexmedetomidine at a rate of 1 µg/kg is more effective than 0.5 µg/kg in attenuating the physiological response to laryngoscopy and intubation. Moreover, it reduces the required propofol dose for anesthesia induction. These findings highlight the potential benefits of higher dexmedetomidine doses in mitigating adverse physiological effects during airway management procedures

Pharmacologic methods to minimise coughing during extubation in the era of COVID-19.

Given the current severe acute respiratory syndrome coronavirus 2 pandemic, coughing at the time of extubation is at risk of creating aerosolisation. This may place health care workers at risk of nosocomial infection during the perioperative period. This study aims to summarise the current pharmacologic methods to minimise cough at the time of extubation, and to determine whether some strategies could be more beneficial than others. This is a summary of systematic reviews. A comprehensive search through MEDLINE was performed. Thirty-three publications were screened for eligibility. Only the manuscripts discussing pharmacologic methods to minimise coughing on extubation were included in this review. Many pharmacological agents have been proposed to decrease the incidence of cough at the time of extubation. Of these, intravenous administration of dexmedetomidine (relative risk 0.4; 95% CI: 0.4-0.5) or remifentanil (RR 0.4; 95% CI: 0.4-0.5) seems to have the largest effect to reduce cough on extubation. The available data in the current literature is sparse. Yet, dexmedetomidine and remifentanil seem to be the most efficient agents to decrease the incidence of emergence coughing.

Dexmedetomidine postconditioning provides renal protection in patients undergoing laparoscopic partial nephrectomy: A randomized controlled trial.

Background: For localized disease, partial nephrectomy of small tumors continues to be the gold-standard treatment. However, temporary clamping is routinely performed during this process to control renal blood flow, which can cause renal ischemic/reperfusion injury. We evaluated whether dexmedetomidine postconditioning (DPOC) can reduce renal ischemic/reperfusion injury for patients receiving laparoscopic partial nephrectomy (LPN). Methods: This randomized double-blind controlled trial included 77 patients who were scheduled for LPN at our hospital. Patients were randomly allocated to the DPOC or control group. DPOC was performed via intravenous administration of dexmedetomidine at 0.6 μg kg−1 for 10 min immediately after unclamping the renal artery. In the control group, saline was administered in place of dexmedetomidine under the same protocol. All participants underwent a 6-month follow-up. The primary outcome were the values of 99mTc-DTPA-GFR in the affected kidney at one and 6 months post-LPN. Result: The GFR values in the DPOC group (35.65 ± 4.89 ml min−1.1.73 m−2) were significantly higher than those the control group (33.10 ± 5.41 ml min−1.1.73 m−2; p = 0.022) at 1 month after LPN. There was no statistically significant difference in GFR value between the two groups at 6 months after LPN. Conclusion: DPOC provides therapeutic benefits to LPN patients, at least on a short-term basis, by alleviating renal ischemic/reperfusion injury. Clinical Trial Registration: Chinese Clinical Trial Registry, identifier [ChiCTR-TRC-14004766].

Development of Sedative Dexmedetomidine Sublingual In Situ Gels: In Vitro and In Vivo Evaluations.

Intravenous dexmedetomidine (DEX) is currently approved by the FDA for the sedation of intubated patients in intensive care units to reduce anxiety and to augment postoperative analgesia. Bradycardia and hypotension are limitations associated with the intravenous administration of DEX. In this study, DEX sublingual in situ gels were developed and assessed for their pH, gelling capacity, viscosity, mucoadhesion and in vitro drug release. The optimized gelling system demonstrated enhanced mucoadhesion, superior gelling capacity, reasonable pH and optimal rheological profile. In vivo, compared to the oral solution, the optimal sublingual gel resulted in a significant higher rate and extent of bioavailability. Although the in situ gel had comparable plasma levels to those observed following intravenous administration, significant amelioration of the systemic adverse reactions were attained. As demonstrated by the hot plate method, a sustained duration of analgesia in rats was observed after sublingual administration of DEX gel compared to the intravenously administered DEX solution. Furthermore, no changes in systolic blood pressure and heart rate were recorded in rats and rabbits, respectively, after sublingual administration of DEX. Sublingual administration of DEX in situ gel provides a promising approach for analgesia and sedation, while circumventing the reported adverse reactions associated with intravenous administration of DEX.

Administration of Intravenous Dexmedetomidine and Acetaminophen for Improved Postoperative Pain Management in Primary Palatoplasty.

Suboptimal pain management after primary palatoplasty (PP) may lead to complications such as hypoxemia, and increased hospital length of stay. Opioids are the first option for postoperative acute pain control after PP; however, adverse effects include excessive sedation, respiratory depression, and death, among others. Thus, optimizing postoperative pain control using opioid-sparing techniques is critically important. This paper aims to analyze efficacy and safety of combined intravenous (IV), dexmedetomidine, and IV acetaminophen during PP. Review of a cohort of patients who underwent PP from April 2009 to July 2018 at a large free-standing children's hospital was performed, comparing patients who received combined IV dexmedetomidine and acetaminophen with those who did not receive either of the 2 medications. Efficacy was measured through opioid and nonopioid analgesic dose and timing, pain scores, duration to oral intake, and length of stay. Safety was measured by 30-day complication rates including readmission for bleeding and need for supplementary oxygen. Total postoperative acetaminophen (P = 0.01) and recovery room fentanyl (P < 0.001) requirements were significantly lower in the study group compared with the control group. Length of stay, oral intake duration, pain scores, total postoperative opioid requirements, and complications rates trended favorably in the study group, though differences did not reach statistical significance. Intraoperative IV dexmedetomidine and acetaminophen during PP provides safe and effective perioperative pain control, resulting in statistically significant decreased need for postoperative acetaminophen and fentanyl. Larger studies are necessary to determine if other trends identified in this study may be significant.

Difficult Airway Management in Pediatric with a Large Cystic Hygroma Colli Undergoing One-Stage Excision Surgery

Background: A large cystic hygroma colli is a complicating factor in airway management in pediatric. Proper preparation, planning, and anticipation can reduce the risk of complications, morbidity, and mortality during difficult airway management. The fundamental principle of difficult airway management is to maintain adequate oxygenation and avoid hypoxemia by maintaining spontaneous ventilation. Case: A 22-month-old girl, weighing 9 kg, diagnosed with a large cystic hygroma colli who underwent single-stage excision surgery. Cystic hygroma was experienced since birth and with age, the cysts enlarge to a size of 25 x 17 x 12 cm which extends towards the face and shoulders. The patient did not experience stridor and symptoms of airway obstruction. The chest x-ray reveals no expansion of the cyst into the chest cavity and showed minimal tracheal deviation to the right. The difficult airway management was accomplished while maintaining the patient's spontaneous breathing. Sedation and analgesia obtained with intravenous administration of dexmedetomidine, ketamine, and nebulized lidocaine. A video laryngoscope is used to facilitate intubation. Awake extubation was performed after confirming that there was no risk of complications of laryngeal edema, laryngeal nerve injury, and tracheomalacia using a cuff-leak test. Conclusion: Maintaining spontaneous breathing, optimal levels of sedation and analgesia by administering dexmedetomidine, ketamine, and nebulizing lidocaine, and the use of a video laryngoscope can provide successful management of difficult airways due to a large cystic hygroma colli in pediatric patients.

Comparison of the effects of combined neuraxial anesthesia and multicomponent low-flow inhalation anesthesia in the structure of perioperative anesthesia management in arthroscopic knee surgeries

Background. Arthroscopic knee surgery is one of the most common types of surgeries in the world. But the optimal anesthesia management for this type of orthopedic surgery is still debatable. The purpose of the study was to improve the quality of anesthesia management for arthroscopic interventions on the knee joint by introducing a personalized perioperative anesthesia management. Materials and methods. One hundred and forty-two patients aged 18–78 years, who underwent arthroscopic knee surgery, took part in the study. They were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82), individuals underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) — multicomponent low-flow inhalation anesthesia with sevoflurane combined with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, we have evaluated the level of postoperative pain by the visual analogue scale, the incidence of postoperative nausea and vomiting, and overall patient’s satisfaction with the surgery. Results. The level of pain according to the visual analogue scale, the incidence of postoperative nausea and vomiting, the level of satisfaction in the study groups did not differ significantly. The level of preoperative stress had a significant impact on the patient’s choice regarding the type of anesthesia. Conclusions. Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.

Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: a meta-analysis.

ObjectivePostoperative sore throat (POST) is an undesirable intubation-related complication after surgery. Several studies have investigated the efficacy of perioperative intravenous dexmedetomidine administration for the prevention of POST, but the results have been inconsistent. We aimed to summarize all existing evidence and draw a more precise conclusion to guide future clinical work.MethodsPubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were comprehensively searched for all randomized controlled trials published before 1 February 2021 that investigated the efficacy of dexmedetomidine for the prevention of POST.ResultsNine studies involving 400 patients were included in our meta-analysis. Compared with the control groups (i.e., saline and anesthetic drugs), perioperative intravenous use of dexmedetomidine significantly reduced the incidence of POST [risk ratio (RR): 0.56; 95% confidence interval (CI): 0.40–0.77; I2 = 0%) and coughing on the tube during extubation (RR: 0.58; 95% CI: 0.41–0.82; I2 = 0%). Additionally, patients in the dexmedetomidine group were more likely to develop bradycardia (RR: 2.46; 95% CI: 1.28–4.71; I2 = 0%) and hypotension (RR: 3.26; 95% CI: 1.14–9.33; I2 = 0%) during the administration of dexmedetomidine than those in the control group.ConclusionPerioperative intravenous administration of dexmedetomidine has a positive effect on the prevention of POST.

COMPARISON OF THE EFFECTS OF COMBINED NEURAXIAL ANESTHESIA AND MULTICOMPONENT LOW-FLOW INHALATION ANESTHESIA IN THE STRUCTURE OF PERIOPERATIVE ANESTHETIC MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC INTERVENTIONS ON THE KNEE JOINT

Abstract. Arthroscopic knee surgery (AKS) is one of the most common types of surgery in the world. But there is still a debate about the optimal type of anesthetic management for this type of orthopedic surgery. The purpose of the study was to improve the quality of anesthetic management of arthroscopic interventions on the knee joint by introducing personalized perioperative anesthesia management. Materials and methods: 142 patients, aged 18-78 years, who were planned for AKS, took part in the study. The patients were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82) patients underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) – multicomponent low-flow inhalation anesthesia with sevoflurane in combination with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, the level of postoperative pain was assessed by the VAS, the incidence of PONV, and overall patient satisfaction with the surgery. Results: the level of pain according to the VAS, the incidence of PONV, the level of satisfaction in the study groups did not differ significantly. Conclusions: Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. The patient’s choice of one or another type of anesthetic aid was significantly influenced by the level of preoperative stress. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.

Effects of Intrathecal and Intravenous Administration of Dexmedetomidine on Motor Function Recovery and Inflammatory Response in Rats with Spinal Cord Injury

To analyze the effects of intrathecal and intravenous dexmedetomidine on motor function recovery and inflammatory response in rats with spinal cord injury. The rats were divided into three groups, the right femoral sheath injection group (3 μg/kg), the right femoral sheath injection group (3 μg/kg) Dexmedetomidine (μg/kg), Inhibitor kappa B kinase inhibitor group (intrathecal injection of 50 μL/kg BMS-345541). Neuromotor function, pathological changes of spinal cord tissue, apoptosis rate of spinal cord tissue and changes of inflammatory factors were observed. The neuromotor function scores of rats in intrathecal group, intravenous group and intrathecal+intravenous group were significantly higher than those in model group at 24 h and 48 h after treatment (p<0.05) and those in intrathecal+intravenous group were significantly higher than those in intrathecal group at 24 h and 48 h after treatment, with statistical significance (p<0.05). In intrathecal group, vein group and intrathecal+vein group, the injury of nerve tissue structure was mild, the cells were slightly swollen and the cytoplasm was uniform. The apoptosis number of spinal cord injury tissue in intrathecal group, intravenous group and intrathecal+venous group was significantly lower than that of model group (p<0.05), and the apoptosis number of intrathecal+venous group was significantly lower than that of intrathecal group (p<0.05). The expression of Interleukin-1β, Interleukin-6 and Tumor Necrosis Factor-α messenger RNA in intrathecal group, intravenous group and intrathecal+venous group was significantly lower than that in model group (p<0.05), while the mRNA expression of Interleukin-1β, Interleukin-6 and Tumor Necrosis Factor-α in intrathecal+venous group was significantly lower than that in intrathecal group (p<0.05). The expressions of Inhibitor kappa B kinase β, nuclear factor kappa-light-chain-enhancer of activated B cells messenger RNA and protein in the Inhibitor kappa B kinase β inhibitor group and dexmedetomidine group were significantly lower than those in the model group (p<0.05) and the expressions of Inhibitor kappa B kinase β, nuclear factor kappa-light-chainenhancer of activated B cells messenger RNA and protein in the dexmedetomidine group were significantly lower than those in the Inhibitor kappa B kinase β inhibitor group (p<0.05). Intrathecal and intravenous dexmedetomidine can significantly improve the recovery of neuromotor function and reduce inflammatory response in rats with spinal cord injury. The mechanism may be related to the inhibition of Inhibitor kappa B kinase/ nuclear factor kappa-light-chain-enhancer of activated B cells signaling pathway.

Pharmacological Management of Acute Sleep Disorders During the First 48 hours of the Postoperative Period. A Narrative Review

Abstract Introduction: The positive effects of restorative sleep must be carefully considered during the early postoperative period. The literature on the treatment of acute sleep disorders taking place during the postoperative period is scarce. Most pharmacological therapies are based on the administration of benzodiazepines; however, a personalized approach is strongly recommended, due to their side effects. The objective of this narrative review was to evaluate rational pharmacological therapies for the management of acute sleep disorders during the first 48 hours of the postoperative period in patients undergoing scheduled surgery procedures. Methods: A narrative review was conducted in the Embase, PubMed, and Cochrane databases. Only controlled randomized trials and systematic reviews were considered for inclusion. Outcome: The primary outcome was the improvement of sleep patterns after pharmacological treatments for acute sleep disorders, its administration routes, and its impact on postoperative descents. Results: The initial search yielded 271 studies, however only 7 met the eligibility criteria. Pharmacological therapies based on the administration of Zolpidem at a dose of 5 milligrams at night, Gabapentin at doses> 900 mg/day, and Dexmedetomidine intravenous infusion at a 0.05 mcg/kg/h dose were reported as being effective for the treatment of these disorders during the early postoperative period. Conclusions: The oral administration of Zolpidem and Gabapentin and the intravenous administration of Dexmedetomidine are effective for the management of acute sleep disorders in carefully selected postoperative patients. Somehow, due to drug side effects, non-pharmacological management alone or combined with pharmacological therapy should be always considered.

Dexmedetomidine versus lidocaine as an adjuvant to general anesthesia for elective abdominal gynecological surgeries

Study objectiveThe current study was conducted to compare the effect of perioperative administration of intravenous dexmedetomidine versus lidocaine on the perioperative hemodynamic changes, anesthetic consumption, anesthesia induction, and recovery times in patients undergoing elective abdominal gynecological surgeries under general anesthesia.Materials and methodsNinety female patients undergoing elective abdominal gynecological surgeries were enrolled in the current study. Patients were randomly distributed to one of three equal groups: group L received lidocaine (1.5 mg/kg loading, 2 mg/kg/h infusion), group D received dexmedetomidine (1 μg/kg loading, 0.5 μg/kg/h infusion), and group C received isotonic saline 0.9% in the same volume and pattern as the study drugs. Hemodynamic parameters including mean arterial pressure (MAP) and heart rate (HR), anesthetic consumption and induction, recovery times, and time to the first postoperative analgesic demand were recorded.ResultsThe MAP and HR after endotracheal intubation and in the subsequent recordings were significantly lower in group L and D when compared with group C with no significant difference between group D and L. The propofol induction dose and mean end-tidal isoflurane concentration were significantly lower in group L and D when compared with group C and were also significantly lower in group D when compared with group L. The intraoperative fentanyl consumption was significantly lower in group L and D when compared with group C with no significant difference between group D and L. The anesthesia induction time was significantly shorter in group L and D when compared with group C; it was also significantly shorter in group D when compared with group L with no significant difference as regards the anesthesia recovery time and the response time between the three study groups. The time to the first postoperative analgesic requirement was significantly longer in group D and L when compared with group C; it was also significantly longer in group D when compared with group L.ConclusionBoth dexmedetomidine and lidocaine could be a useful adjuvant to general anesthesia in patients undergoing abdominal gynecological surgeries. However, dexmedetomidine has a better sparing effect on intraoperative anesthetic consumption and longer time to the first postoperative analgesic demand than that of lidocaine with no significant difference between both agents on intraoperative analgesic demand.

Effect of dexmedetomidine infusion on desflurane consumption and hemodynamics during BIS guided laparoscopic cholecystectomy: A randomized controlled pilot study

BackgroundDexmedetomidine is an α-2 adrenoceptor agonist with sedative and analgesic properties. Desflurane is the most rapidly washed volatile anesthetic agent allowing rapid recovery with minimal metabolism. Having a MAC of 6 vol % made it important to look for an adjuvant that would minimize its consumption. This study was undertaken to analyze desflurane consumption when combined with dexmedetomidine infusion guided by bispectral index as well as calculating intraoperative fentanyl requirements and recording hemodynamic changes associated with this technique.MethodsForty adult patients ASA class I and II of either sex scheduled for elective laparoscopic cholecystectomy were included in this study. Patients were randomized to one of two groups: Group ‘D’ (Dexmedetomidine group) receiving 1μg/kg over 10 minutes followed by an infusion at 0.5 μg/kg/hr and Group ‘P’ (Placebo group) who received same volumes of normal saline. Desflurane was started at a concentration of 6% then adjusted to keep BIS level within the range of 40-50. Desflurane consumption, fentanyl requirements as well as hemodynamics were either calculated or recorded.ResultsDesflurane consumption and total fentanyl usage were significantly lower in group D versus group P with P value < 0.001. As regards hemodynamics, group D showed statistically significant lower readings versus the preoperative levels (P<0.05) as well as versus group P at the same timings (P<0.05) for most of the readings.ConclusionsContinuous intravenous administration of dexmedetomidine resulted in significant reduction of desflurane consumption and intraoperative fentanyl requirements with attenuation of hemodynamic response to intubation, pneumoperitoneum and extubation.

Effect of dexmedetomidine infusion on desflurane requirement and perioperative hemodynamic changes during laparoscopic gastric sleeve operations: a study based on entropy

Context Obese patients undergoing laparoscopic gastric sleeve operations are sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for intraoperative management of those patients. Dexmedetomidine is a highly selective α2 agonist with anesthetic and analgesic sparing properties that makes it an adjuvant in general anesthesia. Aim The aim of this study was to assess the effect of intravenous administration of dexmedetomidine during laparoscopic gastric sleeve operations on desflurane requirements, perioperative hemodynamic changes, and also postoperative recovery. This study was based on entropy to monitor the depth of anesthesia. Patients and methods Eighty patients of American Society of Anesthesiologists II and III who were scheduled for laparoscopic gastric sleeve operations were randomly allocated to two groups of 40 patients each. Dexmedetomidine at a loading dose of 1 μg/kg was given over 10 min before anesthesia induction, followed by 0.5 μg/kg/h maintenance throughout the operation in group II, and saline (placebo) was given in group I at the same volume and rate. Routine induction with propofol, fentanyl, and cisatracurium was carried out. Anesthesia was maintained with desflurane that was adjusted to maintain adequate depth of general anesthesia with response entropy between 40 and 60 and a difference of less than 10 with the state entropy. Desflurane inspired fraction and desflurane expired fraction were monitored. Results End-tidal concentration of desflurane was significantly low at 15, 30, 45, and 60 min of operation. End-tidal concentration of desflurane decreased by 13.2–21.8% with the use of dexmedetomidine in comparison with group I. Systolic blood pressure, diastolic blood pressure, and heart rate were significantly decreased with the use of dexmedetomidine at different time intervals throughout the operation in comparison with group I and in comparison with the baseline in group II. Perioperative fentanyl consumption was significantly low with the use of dexmedetomidine in group II in comparison with group I. It was 325±55 μg in group II in comparison with 178±45 μg in group I. There was no significant difference between the two study groups as regards the extubation time. Pain score was significantly higher in group I in comparison with group II on admission to the postoperative acute care unit, and at 1 and 2 hlater. Conclusion In conclusion, the use of dexmedetomidine as preanesthetic medication followed by infusion during laparoscopic sleeve gastrectomy reduces desflurane requirement, maintains hemodynamic stability due to attenuation of stress response, and reduces the fentanyl requirement during intraoperative and early postoperative period, with decreased risk for respiratory depression in the postoperative acute care unit for morbidly obese patients who are at great risk for obstructive sleep apnea and oxygen desaturation.

Corrective effect of norepinephrine on hypotension induced by dexmedetomidine in critically ill patients.

To evaluate the corrective effect of norepinephrine on hypotension induced by dexmedetomidine through monitoring sedation status, hemodynamics as well as oxygen metabolism. 100 patients administered standard-dose dexmedetomidine therapy with RASS between -2 and 0 in the intensive care unit (ICU) were included in the study. According to the application of norepinephrine to correct hypotension after dexmedetomidine therapy, the patients were divided into two groups: group A and group B. Group A (dexmedetomidine + norepinephrine group): those who had a systolic arterial pressure <90mmHg, a mean arterial pressure <70mmHg, or a decline in systolic arterial pressure >40mmHg or more than 30% of its base value after dexmedetomidine therapy and then received additional norepinephrine intravenously in order to maintain the arterial pressure at its base value. Group B (dexmedetomidine group): patients received the equivalent dose of dexmedetomidine to maintain the pressure at normal value without extra vasoconstrictor substance. Sedation (CPOT and RASS) and hemodynamic and oxygen metabolism indexes (heart rate, mean arterial pressure, respiratory rate, arterial oxygen saturation, central venous pressure, venous oxygen saturation, arteriovenous carbon dioxide difference, blood lactate level, blood lactate clearance rate, and average hourly urine output) were evaluated in the two groups at baseline, 6th hour, 12th hour, and 24th hour after the administration of intravenous dexmedetomidine. 39 cases were enrolled in group A and 61 cases in group B. Patients of both groups received adequate analgesia and sedation, and there was no significant statistical difference in analgesia and sedation at any point (both p>0.05). Basal hemodynamic indexes and oxygen metabolism indexes also had no significant statistical difference (both p>0.05). Central venous pressure (CVP) of group A was significantly higher than that of group B at the 6th hour and 12th hour after administration of intravenous dexmedetomidine (p=0.005), and the heart rate (HR) of group A was markedly higher than that of group B at the 24th hour after dexmedetomidine therapy (p=0.017), while the other indexes had no significant difference at any point (both p>0.05). Dexmedetomidine plays an important role in ICU patients due to its pharmacological ability of sedation and analgesia. In our study, dexmedetomidine was successfully applied to ensure goal-directed sedation therapy (GDST). Norepinephrine can correct hypotension and bradycardia induced by intravenous dexmedetomidine. According to the hemodynamic indexes and oxygen metabolism indexes, the application of dexmedetomidine or the combination of dexmedetomidine with norepinephrine are both safe and appropriate to maintain the sedation status and hemodynamic situation in ICU patients. .

Pulse oximetry–derived pleth variability index can predict dexmedetomidine-induced changes in blood pressure in spontaneously breathing patients

Study objectiveHypertension or hypotension in patients receiving continuous infusions of dexmedetomidine (DEX) is often due to changes in vascular resistance caused by α2 receptor stimulation. We investigated whether baseline perfusion index (PI) and pleth variability index (PVI), derived from pulse oximetry readings, could predict DEX-induced changes in the hemodynamic status in spontaneously breathing patients. DesignObservational study. SettingOperating room. PatientsPatients (American Society of Anesthesiologists performance status 1 or 2) scheduled to undergo lower extremity or abdominal procedures under regional anesthesia were approached. InterventionsThe PI and PVI were set as baseline upon arrival in theater and were then measured at 2.5-minute intervals. Upon attaining stable hemodynamic status under spontaneous breathing, intravenous administration of DEX was initiated at 6 μg kg−1 h−1 for 10minutes, followed by continuous infusion at 0.6 μg kg−1 h−1. MeasurementsBlood pressure, heart rate, PI, and PVI were measured. Hypertension was defined as an increase in systolic blood pressure (SBP) >15% and hypotension as a decrease in SBP <15% from baseline. Main resultsBaseline PI and PVI correlated with the degree of change in SBP. The maximum percentage increase as well as the maximum percentage of decrease in SBP from baseline correlated with baseline PI (r=0.418 [P=.005] and r=0.507 [P<.001], respectively) and PVI (r=−0.658 [P<.001] and r=−0.438 [P=.003], respectively). PVI <15 identified DEX-induced hypertension (sensitivity 94%, specificity 85%) and PVI >16 identified DEX-induced hypotension (sensitivity 83%, specificity 64%). ConclusionsPVI may predict DEX-induced changes in blood pressure in spontaneously breathing patients.