Wake-up Quality Research Articles

The Efficacy of Remifentanil Combined with Propofol in Craniotomy for Tumor Was Evaluated by Wake Quality, Hemodynamics, and Adverse Reactions.

In order to investigate the effect of remifentanil combined with propofol on awakening of craniotomy for tumor, a retrospective analysis is conducted. 86 patients who underwent craniotomy for brain tumor in our hospital from July 2020 to December 2021 are chosen to observe the quality of awakening, hemodynamic parameters, and the occurrence of adverse reactions. All patients are divided into group A (n = 43) and group B (n = 43) according to the use of anesthesia drugs. The intraoperative awakening quality and the hemodynamic parameters during different periods of the two groups are compared. The experimental results show that the incidence of postoperative adverse reactions in group B is significantly lower than that in group A (P < 0.05). It is clearly evident that remifentanil combined with protocol has good intraoperative wake-up effect in craniotomy for tumor and maintain the hemodynamic stability of patients. Also, it can obtain high wake-up quality and effectively reduce postoperative adverse reactions.

Dexmedetomidine dosage in critically ill patients undergoing intraoperative wake-up test

Objective:The aim of this study was to find the optimum dosage of dexmedetomidine in Spinal Orthopedic Scoliosis Correction Surgery when used in combination with propofol and remifentanil in American Society of Anesthesiologists (ASA) III patients with severe scoliosis undergoing intraoperative wake-up test.Materials and methods:We selected a total of 60 ASA III ≤40 years old patients who underwent Spinal Orthopedic Scoliosis Correction Surgery (SOSCS) and randomized them into groups A, B, and C. Group A was administered 0.2 μg/(kg·h) of dexmedetomidine, group B 0.3 μg/(kg·h), and group C 0.4 μg/(kg·h). The main parameters monitored were: wake-up time; wake-up quality; adverse effects that occur while the patient is awake; postoperative awareness of intraoperative wake-up test; heart rate (HR); mean arterial pressure (MAP); and oxygen saturation (SpO2). Values of these parameters were monitored at 7 timestamps separated by 5 minutes >30 minutes.Results:Group B had a higher MAP at 10 minutes before wake-up (P = .03) and at the moment of wake-up (P = .04) than group A. The Wake-up time of group A was 14.95 ± 7.42 minutes, group B was 14.7 ± 6.52 minutes, which was significantly shorter than that of group C 21.3 ± 10.02 minutes (P = .02). The wake-up quality was excellent. All other parameters had no significant statistical differences.Conclusion:Doses of 0.2 to 0.3 μg/(kg·h) have shorter wake-up time and fewer hemodynamic fluctuations compared to 0.4 μg/(kg·h).

Effectiveness of dexmedetomidine for intraoperative wake-up test during spinal surgery: a meta-analysis of randomized placebo-controlled clinical trials

Objective To explore the safety and effectiveness of dexmedetomidine in intraoperative wake-up during spinal surgery. Methods We searched PubMed, EMbase, Web of Science, Chinese biomedical database (CBM) and China national knowledge infrastructure (CNKI) for clinical randomized controlled trials about the effects of dexmedetomidine on intraoperative wake-up during spinal surgery. RevMan 5.3 software was used for Meta analysis of the included studies. Results Fourteen randomized controlled trials involving 696 patients were included in the Meta-analysis study. The patients were divided into two groups: a dexmedetomidine group (n=348) and a control group (n=348). Results showed that no significant difference in wake-up time was found between two groups [mean deviation (MD)=0.18, 95%CI:-0.27-0.36, P=0.44]. However, compared with the control group, the dexmedetomidine group presented substantially improvement in wake-up quality [relative risk (RR)=2.02, 95%CI: 1.58-2.68, P<0.001. RR=1.69, 95%CI: 1.30-2.21, P<0.001], and lower MAP and HR levels at wake-up time (MD=-13.39, 95%CI: -18.20-8.58, P<0.01. MD=-14.53, 95%CI: -17.44-11.61, P<0.01]. Conclusions Dexmedetomidine can not prolong wake-up time and may contribute to improvement in wake-up quality and maintain hemodynamic stability during wake-up period in spinal surgery. However, due to the existence of various biases, more high quality studies are needed to confirm the results. Key words: Dexmedetomidine; Spinal surgery; Wake-up; Meta-analysis

Analysis of dexmedetomidine on the quality of awakening during neurosurgery

Dexmedetomidine has a dose-dependent sedative and analgesic effect. To further evaluate the wake-up quality of dexmedetomidine in patients undergoing neurosurgery, a meta-analysis of dexmedetomidine in a randomized controlled trial of general anesthesia was performed. Firstly, an experimental algorithm was proposed, and then the data fusion algorithm was used to conduct randomized controlled trials. The clinical efficacy and safety of dexmedetomidine in the acupuncture of neurosurgical patients were evaluated one by one for quality evaluation and data extraction. The effect of different input variables on the depth of anesthesia was studied by using a multi-data fusion approach. The results show that the data fusion algorithm proposed can effectively connect redundant information and complementary information in multiple data, and estimate the real parameters of the measured object. In addition, data fusion brings great convenience to the design of control algorithms and controllers, and provides an effective basis for system simplification. Experiments have shown that dexmedetomidine is effective and safe in the operation of neurosurgical motor function, and the management of the recovery period is safe and effective. Based on the research, it can provide some reference for the awakening of patients undergoing neurosurgery, and promote the progress and development of medicine.

Sleep status varies by age among Japanese women during preconception and pregnancy in a nationwide birth cohort study [the Japan Environment and Children’s Study (JECS)

Pregnant women have more sleep problems compared to non-pregnant women. Our objective was to investigate the differences in sleep patterns by age among Japanese women enrolled in the Japan Environment and Children’s Study during preconception and pregnancy. Questionnaires on sleep status were administered to pregnant women twice in the first, second and/or third trimesters. Wake-up time, bedtime, sleep duration and quality of sleep were analyzed in 103,099 respondents. Women younger than 20 years of age awoke and slept the latest in comparison to all other age groups during preconception and pregnancy. Sleep time of women younger than 20 years of age was the longest in comparison to other age groups. The wake-up time and bedtime of teenage mothers were delayed from preconception to second or third trimester, but they did not display any statistically significant changes in other age groups. Moreover, the younger the pregnant women were the more sleep trouble they had despite reportedly being tired, and felt more sleep-deprived despite having had enough sleep time in both second and third trimesters. The sleep state of pregnant women differed by age, with younger women experiencing more sleep trouble and feeling less rested compared to other groups. In future studies, the influences of sleep during pregnancy on the health and development of the children of these pregnant women will be clarified.

Comparison of intraoperative wake-up test performed under different methods of anesthesia in patients undergoing scoliosis correction

Objective To compare the intraoperative wake-up test performed under different methods of anesthesia in the patients undergoing scoliosis correction. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 14-35 yr, undergoing elective scoliosis correction, were divided into dexmedetomidine-based anesthesia group(D group)and sevoflurane-based anesthesia group(S group), with 30 cases in each group.Patients were tracheally intubated after induction of anesthesia.Maintenance of anesthesia was as follows: remifentanil 0.3 μg·kg-1·min-1 was intravenously infused, dexmedetomidine 0.2 μg·kg-1·h-1 was intravenously infused in group D, and group S inhaled low flow sevoflurane 1 L/min with the end-tidal concentration of 0.8%-1.5%.Narcotrend index value was maintained at 30-45.The wake-up time, adverse events, requirement for vasoactive agents and blood loss during wake-up test were recorded.The wake-up quality was evaluated. Results All the patients successfully completed wake-up tests.Compared with group S, the wake-up quality was significantly increased, the incidence of agitation and bucking was decreased during wake-up test, the blood loss was reduced during wake-up test(P 0.05). Conclusion Dexmedetomidine-based anesthesia produces better efficacy for intraoperative wake-up test than sevoflurane-based anesthesia in the patients undergoing scoliosis correction. Key words: Dexmedetomidine; Anesthetics, inhalation; Scoliosis; Wake-up test

Impact of Dexmedetomidine on Intraoperative Wake-Up Tests in Patients Undergoing Spinal Surgery

To evaluate the impact of dexmedetomidine (DEX) on intraoperative wake-up tests. American Society of Anesthesiologists category I or II patients were divided into two groups: a propofol-remifentanil group (group R, n = 20) and a DEX-propofol-remifentanil group (group D, n = 20). The patients in group D received DEX, whereas the patients in group R received the same volume of saline. The other anesthetic methods and drugs (propofol and remifentanil) were the same in both groups. During the wake-up test, patients were repeatedly asked to move their fingers. All the wake-up tests were successfully performed. There was no significant difference in the mean wake-up time between the two groups. Eighteen patients exhibited better wake-up quality in group D as did eight patients in group R. The patients in group D had a significantly better overall wake-up quality than those in group R (P <.05). DEX did not affect the wake-up time and increased the wake-up quality.

Effect of dexmedetomidine on quality of wake-up test in patients undergoing posterior osteotomy correction surgery

Objective To evaluate the effect of dexmedetomidine on quality of wake-up test in the patients undergoing posterior osteotomy correction surgery. Methods Ninety-seven patients of both sexes, aged 17-59 yr, of ASA physical status Ⅰor Ⅱ, with body mass index 18.5-25.0 kg/m2 and global kyphosis angle>60°, scheduled for elective posterior osteotomy correction surgery under general anesthesia, were randomly divided into 2 groups using a random number table: control group C (n=46) and group D (n=51). In group D, dexmedetomidine 1.0 μg/kg was infused over 15 min before induction of anesthesia, and group C received the equal volume of normal saline instead.Anesthesia was induced with iv midazolam, propofol, fentanyl, vecuronium and dexamethasone in C and D groups.Mechanical ventilation was performed after tracheal intubation.Anesthesia was maintained with infusion of cisstracurium, propofol and remifentanil.Dexmedetomidine 0.3 μg·kg-1·h-1 was infused throughout the surgery in group D, and meanwhile normal saline was given throughout the surgery in group C. The anesthetic drugs for maintenance except dexmedetomidine were discontinued at the beginning of the wake-up test.The wake-up time was recorded and the wake-up quality was assessed.Ramsay sedation scores and Riker sedation-agitation scale scores were also recorded when all the patients were successfully awakened.The development of cardiovascular events during wake-up test and intraoperative awareness was recorded. Results The wake-up quality was significantly higher, Riker sedation-agitation scale scores were lower, Ramsay sedation scores were higher, the incidence of nausea and vomiting was lower, and no significant change was found in wake-up time in group D. No intraoperative awareness was observed in the two groups. Conclusion Dexmedetomidine can raise wake-up quality without prolonging wake-up time and with stable hemodynamics and fewer side effects in the patients undergoing posterior osteotomy correction surgery. Key words: Dexmedetomidine; Wake-up Test; Orthopedic Procedures

Effects of dexmedetomidine on wake-up tests of patients undergoing scoliosis surgery

Objective To investigated the effect of dexmedetomidine(Dex) on wake-up tests of patients undergoing scoliosis surgery.Methods Forty patients,aged 12 y-20 y,ASA Ⅰ-Ⅱ,undergoing elective scoliosis surgery were randomly divided into 2 groups:Dex group (group D,n=20)and control group (group C,n=20).Group D received loading dose of Dex 0.8 μg/kg within 10 min before induction followed by 0.2 μg·kg-1 ·h-1 throughout the surgery.Group C received equal volume of normal saline intravenously.The maintenance drugs were withdrawed at the beginning of wake-up tests.Wake-up time was recorded.BIS values and hemodynamic index,such as HR,MAP,were recorded at the time points of withdrawal and awakening.At the same time,the wake-up time and wake-up quality score,the amount of bleeding during the wake-up tests were also recorded.Results There was no significant difference in wake-up time between two groups.MAP,HR of patients in group D decreased significantly than that in control group(P＜0.05) during wake-up.The wake-up quality of group D was better than that in control group(P＜0.01).Conclusions Dex can increase the wake-up quality of scoliosis surgery significantly without prolonged wake-up time,meanwhile it keeps hemodynamic stable. Key words: Dexmedetomidine; Scoliosis surgery; Wake-up tests

Effect of morning exercise in sunlight on the sleep-wake cycle in adolescents.

A delay in bedtime occurs in adolescence compared with childhood. However, the early waking that morning school hours impose leads to partial sleep deprivation. Although exposure to light is the most important regulator of circadian rhythm in mammals, physical exercise influences circadian synchronization. To assess the effect of morning physical exercise in sunlight on the sleep-wake cycle (SWC) in adolescents, 160 first- and second-year high-school students were exposed to classes in their usual classroom (Group C) or in a swimming pool exposed to sunlight (Group E) while physically exercising (EE; i.e., swimming) or resting (EL). At baseline, we applied Health and Sleep and Horne & Ostberg chronotype assessment questionnaires. One week later and during the intervention, we applied the Sleep Diary and Karolinska Sleepiness Scale. During the intervention we observed no changes in bedtime, time in bed and in indices of irregularity of bedtime and wake-up time. The changes observed in wake-up time (i.e., a delay in the EE group on Saturday), sleep quality (i.e., an improvement), and sleepiness (i.e., an increase) were also observed in the control group, discarding an intervention effect. We suggest that morning physical exercise in sunlight had no effect on SWC parameters, sleep quality, or daytime sleepiness, possibly because of the large irregularity in the SWC between weekdays and weekends in adolescent students as well as the low frequency and duration of exercise during the intervention. Therefore, studies that evaluate a higher frequency or duration of exercise are needed to assess its effect on the SWC in adolescents.