Received Dexmedetomidine Infusion Research Articles

Effect of dexmedetomidine constant rate infusion on the analgesic duration of peripheral nerve blocks in dogs: a randomized clinical study

The aim of this study was to evaluate whether a constant rate infusion of dexmedetomidine could prolong the analgesic effect of peripheral nerve blocks. Twenty client-owned dogs were enrolled and randomly divided into 2 groups. The DEX group received dexmedetomidine infusion at 1 mcg kg−1 h−1, and the NaCl group received an equivalent volume infusion of saline. Infusions were started after securing vascular access and continued for 10 min, after which intravenous (IV) methadone at 0.2 mg kg−1 and propofol to effect were administered. All animals were maintained with isoflurane in 70% oxygen. Sciatic, saphenous and obturator nerve blocks were performed using 0.1 mL kg−1 0.5% ropivacaine/block. Intraoperative fentanyl was administered if the heart rate and/or mean arterial pressure (MAP) increased > 15% from the previous measurement, and vasopressors were administered if MAP was ≤ 70 mmHg. Postoperative pain was assessed every hour using the Glasgow Composite Pain Scale (GCPS) until the first rescue analgesia administration. Postoperative rescue analgesia (methadone (0.2 mg kg−1 IV) and carprofen (2 mg kg−1 IV)) was administered if the pain score was higher than 6/24 or 5/20. Duration of analgesia was defined as the time between the nerve block procedure and initial postoperative rescue analgesia. Ambulation, proprioception, and skin sensitivity were evaluated to assess the duration of the motor and sensory block. A Student T and chi-square test were used to compare groups for duration of postoperative analgesia and intraoperative fentanyl and vasopressor use, respectively (p values ≤ 0.5 considered significant). A greater number of dogs in the NaCl group required fentanyl (5/10 p = 0.03) and vasopressors (8/10, p = 0.02) than did those in the DEX group (0/10 and 2/10, respectively). The duration of postoperative analgesia was significantly longer (604 ± 130 min) in the DEX group than in the NaCl group (400 ± 81 min, p = 0.0005).Dexmedetomidine infusion at 1 mcg kg−1 h−1 delays the time to first administration of rescue analgesia and reduces intraoperative analgesic and vasopressor requirements during Tibial Tuberosity Advancement surgery.

Effects of Dexmedetomidine on Perioperative Glycemic Control in Adult Diabetic Patients Undergoing Cardiac Surgery.

To study the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetes mellitus (DM) patients undergoing cardiac surgery. A prospective, observational study was conducted on 100 adult diabetic patients aged between 18 and 75 years undergoing cardiac surgery with cardiopulmonary bypass (CPB). The patients were divided into two groups (group D and group C) of 50 each. Group D patients received DEX infusion, whereas the group C patients received 0.9% normal saline infusion. The blood glucose levels, heart rate, mean arterial pressure, and serum potassium levels at different time points were comparable between the two groups (P > 0.05). The mean dose of insulin required in the combined population as well as in both controlled and uncontrolled DM patients was significantly less in group D than in group C (combined population - 36.03 ± 22.71 vs 47.82 ± 30.19 IU, P = 0.0297; uncontrolled DM - 37.36 ± 23.9 IU vs 48.16 ± 25.15 IU, P = 0.0301; controlled DM - 34.7 ± 21.5 IU vs 47.63 ± 35.25 IU, P = 0.0291). Duration of mechanical ventilation and VIS were comparable between the two groups. The incidence of arrhythmias (20% vs 46%, P = 0.0059) and delirium (6% vs 20%, P = 0.0384) was significantly less in group D than in group C. None of the patients in either group had stroke, myocardial ischemia, and mortality. The results suggested that DEX infusion during the intraoperative period was very effective for perioperative glycemic control and reduction of insulin requirement in DM patients undergoing cardiac surgery.

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.

Effects of Dexmedetomidine on the Recovery Quality of Donors Undergoing Pure Laparoscopic Donor Hepatectomy

To investigate the effects of intraoperative intravenous administration of dexmedetomidine (DEX) on the recovery quality of donors undergoing pure laparoscopic donor hepatectomy. A total of 56 liver donors who were going to undergo scheduled pure laparoscopic donor hepatectomy were enrolled and randomly assigned to two groups, a DEX group ( n=28) and a control group ( n=28). Donors in the DEX group received DEX infusion at a dose of 1 μg/kg over 15 minutes through a continuous pump, which was followed by DEX at 0.4 μg/(kg·h) until the disconnection of the portal branch. Donors in the control group were given an equal volume of 0.9% normal saline at the same infusion rate and over the same period of time as those of the dex infusion in the DEX group. The primary outcome was the incidence of emergence agitation (EA). The Aono's Four-point Scale (AFPS) score was used to assess EA. The secondary observation indicators included intraoperative anesthesia and surgery conditions, spontaneous respiration recovery time, recovery time, extubation time, scores for the Ramsay Sedation Scale, the incidence of chills, numeric rating scale (NRS) score for pain, and blood pressure and heart rate after extubation. The incidence of EA was 10.7% and 39.3% in the DEX group and the control group, respectively, and the incidence of EA was significantly lower in the DEX group than that in the control group ( P=0.014). The APFS scores after extubation in the DEX group were lower than those in the control group (1 [1, 1] vs. 2 [1, 3], P=0.005). Compared to the control group, the dosages of intraoperative propofol and remifentanil were significantly reduced in the DEX group ( P<0.05). During the recovery period, the number of donors requiring additional boluses of analgesia, the blood pressure, and the heart rate were all lower in the DEX group than those in the control group ( P<0.05). No significant differences between the two groups were observed in the spontaneous respiration recovery time, recovery time, extubation time, the incidence of chills, NRS score, scores for the Ramsay Sedation Scale, and the length-of-stay in postanesthesia care unit (PACU) ( P>0.05). DEX can reduce the incidence of EA after pure laparoscopic donor hepatectomy and improve the quality of recovery without prolonging postoperative recovery time or extubation time.

Effect of Dexmedetomidine Premedication on Sevoflurane Requirement using BIS during General Anaesthesia in Laparoscopic Cholecystectomy

Background: Dexmedetomidine is a highly selective α2-adrenoreceptor agonist with sedative, anxiolytic and analgesic properties without any respiratory depression. It decreases the requirement of volatile anaesthetics with better hemodynamic stability in surgical patients. We avoided the risk of awareness under anaesthesia by using Bispectral index. Aims: To evaluate the efficacy of Dexmedetomidine pre-medication on Sevoflurane requirement and to assess the haemodynamic stability during elective laparoscopic cholecystectomy surgeries. Methods: Randomized double-blind control study. Design: Forty eight patients were randomly allocated into two groups. Group A received saline infusion and Group 2 received Dexmedetomidine infusion in a dose of 1µg/kg over 15 min before induction. Vital parameters and bispectral index were noted throughout the surgery. Patients were induced and intubated as per the standard protocol and maintained with Oxygen &amp; Nitrous oxide (1 litre Oxygen + 2 litre Nitrous oxide) with Sevoflurane concentration adjusted to achieve BIS values of 45–55. Demographic profile, hemodynamic parameters total Sevoflurane consumption were noted. Statistical Analysis: Statistical analysis was performed using SPSS software version 22.0. Percentage analysis was done for qualitative data. Parametric data were compared using an unpaired t-test. Nonparametric data were compared with Fisher’s exact test or Chi-square test. Results: Mean Sevoflurane consumption in Group A and Group B were 0.379 ± 0.10, 0.169 ± 0.05 ml/min respectively with P&lt;0.001 which was statistically significant. A 55.4% reduction in Sevoflurane consumption was found in patients receiving Dexmedetomidine premedication. Conclusions: Dexmedetomidine premedication is useful to reducing Sevoflurane consumption during general anesthesia and it provides better haemodynamic stability.

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

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

Management of Incidental Uncontrolled Elevation of Intraoperative Blood Pressure: A Comparative Study on Nitroglycerine Versus Dexmedetomidine Infusion.

Uncontrolled elevation of intraoperative blood pressure can result in deleterious effects with increased risk of morbidity and mortality. We aimed to compare nitroglycerine infusion with dexmedetomidine infusion in controlling accidental intraoperative uncontrolled hypertension. This comparative study was conducted on 73 hypertensive patients undergoing cancer surgeries who experienced uncontrolled intraoperative hypertension. The data of 38 patients were retrieved from the medical records for the nitroglycerine group and 35 patients were prospectively enrolled for the dexmedetomidine group. Group N received nitroglycerine infusion (0.3 - 1 µg/kg/min), while group D received dexmedetomidine infusion (0.2 - 0.7 µg/kg/h). Both groups were comparable regarding their demographic data and clinical characteristics. Systolic, diastolic, and mean arterial pressure (MAP) values were significantly lower in group N compared to group D during the period between 60 and 120 minutes intraoperatively (P < 0.001). Heart rate values were significantly lower in group D than in group N (P < 0.001). Postoperative sedation scores were better for group D with lower analgesic requirements (P < 0.001). Dexmedetomidine infusion can be used to manage the uncontrolled intraoperative elevation of blood pressure in selected patient population.

Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial.

BackgroundDuring functional endoscopic sinus surgery (FESS), intranasal bleeding affects operative field visibility and increases the frequency of complications. Therefore, hypotensive anesthesia is a widely used technique to improve surgical outcomes. This study aimed to compare the efficacy of propofol and dexmedetomidine infusion for hypotensive anesthesia in patients undergoing FESS.MethodsThis prospective randomized trial was conducted in 80 adult patients who were scheduled for FESS under general anesthesia. Patients were randomly divided into two groups: group P (n = 40) received propofol infusion of 100–200 µg/kg/min and group D (n = 40) received dexmedetomidine infusion with a loading dose of 1 µg/kg over 10 min after induction, followed by maintenance infusion of 0.4–0.8 µg/kg/h. Intraoperative blood loss, quality of the surgical field (Fromme– Boezaart scale), hemodynamic control, and patient recovery were recorded. Statistical analysis was performed using Student’s t-test, chi-square test, and Mann– Whitney U test.ResultsThe mean arterial pressure and heart rate were significantly lower in group D throughout the surgery than in group P. Blood loss was significantly higher in group P (100.73 ± 18.12 ml) than in group D (85.70 ± 18.56 ml). The average number of patients with Fromme’s score 1/2/3 was comparable between the groups. Intraoperatively, only one incidence of bradycardia and hypotension was observed in group D (2.5%) compared to group P.ConclusionsBoth dexmedetomidine and propofol are efficacious and safe drugs for facilitating controlled hypotension during FESS; however, dexmedetomidine provides better hemodynamic control and is associated with lesser blood loss without any significant adverse effects.

Transient Asystole Linked to Dexmedetomidine Infusion

This is a case series of five adult patients obtained from the medical intensive care unit in a community teaching hospital between May 2019 through August 2020. These patients were each receiving dexmedetomidine infusion while on invasive mechanical ventilation leading to periods of asystole that resolved after stopping dexmedetomidine infusion in all five patients.

A Randomized Control Trial of Three Intravenous Dexmedetomidine Doses for Procedural Sedation in Patients Undergoing Minor Gynaecological Surgery.

Background: Minor gynaecological procedures are usually done in outpatient settings. Early discharge with minimal haemodynamic compromise is an essential requirement of these procedures. Many sedative drugs are being used for outpatient surgeries. Of the sedative agents available, dexmedetomidine, which has sedative and analgesic sparing effects, has the best safety profile in the cardiorespiratory system. Therefore, we evaluated the optimum dexmedetomidine dose for providing better procedural sedation.Methodology: This randomized, double-blinded study included 120 ASA grade I and II patients aged 18-45 years who were undergoing short gynaecological procedures in a tertiary care hospital. Patients were randomly allocated into three groups of 40 each. After a loading dose of 1 µg/kg over 10 min, group A received dexmedetomidine infusion at a rate of 0.2 µg/kg/hr, group B at a rate of 0.4 µg/kg/hr, and group C at a rate of 0.6 µg/kg/hr. Perioperative hemodynamic changes, intraoperative adjuvant drug requirements, and postoperative recovery were also compared in the three different dexmedetomidine groups.Results: Heart rate, blood pressure, oxygen saturation, and respiratory rate remained within the normal physiological range in all three groups at most perioperative time points. The time to achieve the Modified Aldrete Score and the post-anesthetic discharge scoring system was maximum in group C and minimum in group A. Ketamine had to be supplemented in almost half of the patients in group A and less than a quarter of the patients in group B. In group C, surgery was completed without any drug supplementation. Two patients in group B and four patients in group C had an episode of bradycardia. Oxygen saturation decreased in one patient in group C, necessitating oxygen supplementation.Conclusions: Dexmedetomidine, at a dose of 0.4 µg/kg/hr with ketamine supplementation, provides the most appropriate procedural sedation and analgesia (PSA) without any significant hemodynamic compromise.

Effects of dexmedetomidine on surgery for type A acute aortic dissection outcome

No study has evaluated the effect of dexmedetomidine in patients who received surgery for type A aortic dissection. This is the first study to evaluate the effect of dexmedetomidine in aortic dissection patients. This study was executed using data from the Chang Gung Research Database in Taiwan. The CGRD contains the multi‐institutional standardized electronic medical records from seven Chang Gung Memorial hospitals, the largest medical system in Taiwan. We retrospectively evaluate patients who received surgery for acute type A aortic dissection between January 2014 and December 2018. Overall, 511 patients were included, of whom 104 has received dexmedetomidine infusion in the postoperative period. One-to-two propensity score-matching yielded 86 cases in the dexmedetomidine group and 158 cases in the non-dexmedetomidine group. The in-hospital mortality and composite outcome including all-cause mortality, acute kidney injury, delirium, postoperative atrial fibrillation, and respiratory failure, were considered primary outcomes. The in-hospital mortality and composite outcome were similar between groups. The risk of Acute Kidney Injury Network stage 3 acute kidney injury was significantly lower in the dexmedetomidine group than in the non-dexmedetomidine group (8.1% vs 19.0%; OR, 0.38; 95% CI, 0.17–0.86; p = 0.020. The risk of newly-onset dialysis was also significantly lower in the dexmedetomidine group than in the non-dexmedetomidine group (4.7% vs 13.3%; OR, 0.32; 95% CI, 0.11–0.90; p = 0.031). Post-operative dexmedetomidine infusion significantly reduced the rate of severe acute kidney injury and newly-onset dialysis in patients who received surgery for acute type A aortic dissection.

Dexmedetomidine versus propofol in reducing atrial fibrillation after cardiac surgery

ABSTRACT Objectives Atrial fibrillation is a common complication associated with cardiac surgery after cardiopulmonary bypass with a deleterious effect on morbidity and mortality. The current study aimed to compare between dexmedetomidine and propofol in reducing atrial fibrillation after cardiac surgery. Design A randomized prospective cohort study. Setting Conducted in Alexandria main university hospital. Participants 98 patients of either sex ASA II physical status aged 40–60 years. Interventions All patients were subjected to either propofol or dexmedetomidine infusion after cardiac surgery according to the assigned group. Measurements and Main Results The patients were divided into two groups where first group received dexmedetomidine infusion as postoperative sedation and the second group received propofol infusion. Both groups were assessed for incidence of atrial fibrillation, hypotension and length of intensive care stay. Incidence with atrial fibrillation was 0.9% in dexmedetomidine group vs. 13% in propofol group (P = 0.001) and intensive care stay was prolonged in propofol group 4.6 ± 1.2 day vs. 2.7 ± 1 for dexmedetomidine group (P = 0.002). There was no statistically significant difference between both groups regarding blood pressure or heart rate. Conclusion The use of dexmedetomidine for sedation after cardiac surgery was associated with a lower incidence of atrial fibrillation and hence decreased the duration of intensive care stay.

Outcome of intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy

ABSTRACT Background and Aims Laparoscopic cholecystectomy (LC) is favored by less postoperative pain compared with the open approach; nevertheless, pain is still a frequent complaint. Dexmedetomidine is a centrally acting α2 agonist that has sedative, sympatholytic, and analgesic properties. We aimed primarily to study the effect of different doses of dexmedetomidine on the quality of anesthesia in the patients undergoing LC. The secondary aims were to detect the implications of these different doses on the postoperative outcome (postoperative pain, nausea, and vomiting. Methods Sixty patients of the American Society of Anesthesiologists (ASA) physical grades I and II scheduled for elective LC were randomly divided into three equal groups. Group Dex 0.2, Group Dex 0.4, and Group Dex 0.6 (patients received dexmedetomidine infusion at 0.2 mcg/kg/h, 0.4 mcg/kg/h, and 0.6 mcg/kg/h, respectively) 15 min before induction and throughout the surgical procedure. Hemodynamic parameters, spontaneous respiratory recovery time, extubation time, incidence of cough, postoperative pain, and postoperative nausea and vomiting (PONV) were recorded. Results Significantly attenuated hemodynamic stress response was observed in Dex 0.4 and Dex 0.6 groups. The incidence of cough, PONV, was significantly less and postoperative analgesic requirements were fewer in Dex 0.6 group compared to the other two groups. Nevertheless, the time of spontaneous respiratory recovery and extubation in Dex 0.6 group was insignificantly longer compared to the other two groups. Conclusion Intravenous infusion of 0.6 μg/kg/h dexmedetomidine before induction can attenuate hemodynamic stress response, reduce cough incidence, PONV, and postoperative analgesic requirements in patients undergoing LC without significant prolongation of spontaneous respiratory recovery time.

The safety of high-dose dexmedetomidine after cardiac surgery: a historical cohort study.

The off-label use of dexmedetomidine beyond the monograph-recommended maximum dose of 0.7 µg·kg-1·hr-1 is common in postoperative cardiac surgical units; however, limited data exist on the association of higher doses and adverse hemodynamic effects. We sought to compare the rate of hypotension or bradycardia in cardiac surgery patients receiving peak infusion doses below and above 0.7 µg·kg-1·hr-1 for any indication or duration. In this historical cohort study, we reviewed all patients who received dexmedetomidine infusion after cardiac surgery between June 2013 and July 2017 at a single centre. Regardless of the duration of exposure at the peak infusion dose, patients were categorized into high- or standard-dose groups using 0.7 µg·kg-1·hr-1 as the cutoff value. We compared rates of the primary composite outcome of hypotension or bradycardia, and secondary outcomes (i.e., arrhythmia and hyperglycemia) between groups using the two-proportion z test. Exploratory regression models were fitted to adjust for potential confounders. The median [interquartile range (IQR)] peak infusion dose was 1.0 [1.0-1.4] µg·kg-1·hr-1 in the high-dose group (N = 121) and 0.5 [0.4-0.7] µg·kg-1·hr-1 in the standard-dose group (N = 124). The rates of the primary composite outcome were 73% and 65%, respectively (absolute risk difference, 8%; 95% confidence interval, -3 to 20; P = 0.17).There was no significant difference in primary or secondary outcomes between groups. There was a high overall rate of hypotension or bradycardia in patients receiving dexmedetomidine after cardiac surgery; infusion rates below or above 0.7 µg·kg-1·hr-1 had similar rates of adverse hemodynamic events.

Clonidine for the Treatment of Agitation After Dexmedetomidine Discontinuation in Pediatric Patients: A Retrospective Cohort Study.

Dexmedetomidine has become a widely used drug in PICUs for sedation. We aim to determine the effects of clonidine on pediatric patients after dexmedetomidine use. This was a retrospective cohort study that evaluated all pediatric patients admitted to a tertiary PICU who received dexmedetomidine infusion for >48 hours. Outcomes in patients exposed to clonidine (CLON) were compared with those of patients who were not exposed (NoCLON). A total of 216 patients were included in this study (43 CLON and 173 NoCLON). The primary outcome, agitation, was less in the CLON cohort (9.3%) than in the NoCLON cohort (9.3% versus 29.5%, respectively; p < 0.01). Hospital LOS was longer in the CLON group (59 versus 20 days, p < 0.01), as was PICU LOS (37.4 versus 11.1 days, p < 0.01). There was no significant difference in the occurrence of increased heart rate or blood pressure between the 2 cohorts. Patients exposed to concurrent midazolam and opioid infusions had higher incidence of agitation when they did not receive clonidine (CLON 8% versus NoCLON 37%, OR 0.15; 95% CI, 0.05-0.51; p < 0.01). In contrast, there was no difference in the incidence of agitation for the CLON group versus the NoCLON group when dexmedetomidine was administered alone (25% versus 19%, OR 1.4; p = 0.99). Our study confirms the importance and effectiveness of clonidine to treat agitation after dexmedetomidine discontinuation. A validated withdrawal scoring tool can help better define dexmedetomidine withdrawal in pediatric patients.

The Effect of Low Dose Ketamine Infusion versus Low Dose Dexmedetomidine Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery

Abstract Background In cardiac surgery, the extent of systemic inflammatory response is closely Mobile associated with patient’s outcome. A systemic inflammatory response syndrome (SIRS) may develop after operations using cardiopulmonary bypass (CPB). Aim of the Work to evaluate the 01006705713 potential effects of intravenous infusion of ketamine versus dexmedetomidine on attenuation f stress responses during coronary artery bypass grafting (CABG) operation. Patients and Email elsayed@hotmail.com Methods This randomized controlled interventional study was conducted on 90 patients who dinaunderwent elective CABG procedure at Ain Shams University Hospital over 24 months from Jan 2018 to Jan 2020. The patients were divided into 3 groups, 30 patients for each group. Group D: received dexmedetomidine infusion, Group K: received ketamine infusion and Group N (control group): received normal saline. Then following measurements recorded at following time interval before induction of anesthesia (T1), after weaning from CPB (T2), 24 h(T3) and 48 h(T4) after completion of the anastomoses. Mean arterial blood pressure records, heart rate &amp; Inflammatory and stress markers including CRP, cortisol, WBC count, glucose and lactate levels. Results Mean arterial pressure among three groups was not statistically significant. Also serum glucose level was not statistically significant between groups. Serum lactate level didn’t show statistically significant difference between groups. From aspects of inflammatory markers, we got good results which were superior for dexmedetomidine followed by ketamine infusion group suggested by statistically significant, suggesting that dexmedetomidine and ketamine may have a role in attenuation inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery. Conclusion Our study that compared Intravenous infusion of ketamine and dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation suggests that dexmedetomidine was superior to ketamine infusion in attenuation of inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.

COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS SEDATIVES IN AWAKE FIBEROPTIC INTUBATION IN CONTROLLED HYPERTENSIVE ADULT PATIENTS

Background: Flexible bronchoscopy has become the “gold standard” for managing the expected and unexpected difficult airway. Several drugs have been used to provide adequate sedation to optimize adequate fiberoptic intubation. Objective: To compare the sedative effects of dexmedetomidine and magnesium sulphate during awake fiberoptic nasal intubation in controlled hypertensive adults undergoing elective surgeries. Patients and methods: Sixty controlled hypertensive patients intubated using awake fiberoptic. They were divided into 2 equal groups: Patients received dexmedetomidine infusion at dose of 1ug/kg, and the other patients received magnesium sulphate at dose of 30mg/kg. Topicalization of airway was done using lidocaine “spray as you go technique”. After completing the loading dose, Ramsay score was assessed before intubation. The 2 groups were compared according to Ramsay score, cough score, facial grimace and hemodynamic changes. This study was done at Al-Azhar University Hospitals after approval of the medical ethical committee, from May 2019 till November 2020. Results: Ramsay score, cough score and facial grimace were favorable with less hemodynamic effects in dexmedetomidine group than magnesium group. Conclusion: Dexmedetomidine was effective sedative agent for awake fiberoptic intubation in controlled hypertensive patients in comparison with magnesium sulphate.

Prospective randomised control study of dexmedetomidine for controlled hypotension in functional endoscopic sinus surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Functional endoscopic sinus surgery is one of the commonly performed Surgeries. Induced hypotension is a method employed in functional endoscopic sinus surgery to reduce blood loss and to improve the visibility of the surgical field. This study aimed to evaluate the effect of dexmedetomidine infusion on the requirement of Isoflurane to produce controlled hypotension (mean arterial pressure of 60-70 mmHg), quality of the bloodless surgical field, duration of surgery, and the awakening time in patients undergoing Functional endoscopic sinus surgery (FESS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;50 patients were divided into Group D, Group C Group D. After successful tracheal intubation, anesthesia was maintained with 66% nitrous oxide + 33% oxygen + isoflurane titrated to achieve a mean arterial pressure (MAP) of 60-70 mmHg. Isoflurane and dexmedetomidine/saline infusion was stopped 10-15 minutes before the end of surgery. The intraoperative surgical field was assessed by using a 6 points Fromme-Boezaart scale.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A statistically significant (p&amp;lt;0.001) reduction in intraoperative isoflurane requirement in patients receiving dexmedetomidine infusion (0.387±0.102) in comparison to those receiving placebo (1.7±0.211). Both the group provided better visualization of the surgical field. The duration of surgery was statistically (p=0.004) low in Group D (76.84±14.174) compared to group C (94.1±25.083). The awakening time in min was statistically (p=0.001) low in group D (5.12±1.691) compared to group C (9.72±1.100).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Dexmedetomidine infusion helps in achieving a targeted reduction in MAP reduced intraoperative Isoflurane requirement, better bloodless field, and faster awakening in patients undergoing Functional endoscopic sinus surgery.&lt;/p&gt;

Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery.

We decided to compare dexmedetomidine with propofol regarding several anesthetic and surgical aspects, during stapedotomy done under conscious sedation. Thirty patients aged 20-50years with (American Society of Anesthesiology) ASA class I-II, were assigned to two groups of propofol and dexmedetomidine using a random number table. In dexmedetomidine group, patients received dexmedetomidine infusion (0.5µg/kg/h) and in the control group, propofol was administered (3mg/kg/h).Time to reach the desired Ramsey Sedation Score (RSS) and time to reach Aldrete score ≥ 9; incidence of inadvertent movement and amnesia; as well as patients' and surgeons' level of satisfaction and degree of bleeding was recorded. Data on hemodynamic variables were monitored and recorded at several intervals. The mean time taken to reach the RSS (2-4) was 10.3 ± 2.1min in dexmedetomidine group and 3.1 ± 1.2min in propofol group. Time to reach Aldrete score ≥ 9 for patients sedated with dexmedetomidine was 8.6 ± 2.1min and for propofol group was 4.6 ± 1.4min (p value < 0.05).There were also significant differences between two groups in terms of surgeon's satisfaction with sedation, and the amount of intra operative bleeding. According to the results of this study, it can be concluded that dexmedetomidine is a better choice for conscious sedation than propofol. However, the time to reach the required sedation in the dexmedetomidine group was significantly longer.