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Weng X, Liu H, Zhang X, Sun Q, Li C, Gu M, Xu Y, Li S, Li W, Du J. An α 2-adrenoceptor agonist: Dexmedetomidine induces protective cardiomyocyte hypertrophy through mitochondrial-AMPK pathway. Int J Med Sci 2020; 17:2454-2467. [PMID: 33029088 PMCID: PMC7532472 DOI: 10.7150/ijms.47598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
Aims: Dexmedetomidine (Dex) as a highly selective α2-adrenoceptor agonist, was widely used anesthetic in perioperative settings, whether Dex induces cardiac hypertrophy during perioperative administration is unknown. Methods: The effects of Dex on cardiac hypertrophy were explored using the transverse aortic constriction model and neonatal rat cardiomyocytes. Results: We reported that Dex induces cardiomyocyte hypertrophy with activated ERK, AKT, PKC and inactivated AMPK in both wild-type mice and primary cultured rat cardiomyocytes. Additionally, pre-administration of Dex protects against transverse aortic constriction induced-heart failure in mice. We found that Dex up-regulates the activation of ERK, AKT, and PKC via suppression of AMPK activation in rat cardiomyocytes. However, suppression of mitochondrial coupling efficiency and membrane potential by FCCP blocks Dex induced AMPK inactivation as well as ERK, AKT, and PKC activation. All of these effects are blocked by the α2-adrenoceptor antagonist atipamezole. Conclusion: The present study demonstrates Dex preconditioning induces cardiac hypertrophy that protects against heart failure through mitochondria-AMPK pathway in perioperative settings.
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Affiliation(s)
- Xiaojian Weng
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Hua Liu
- Department of Anesthesiology, The Ninth People's Hospital, Shanghai, China
| | - Xiaodan Zhang
- Department of ICU, Shanghai General Hospital, Shanghai, China
| | - Qianqian Sun
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Cheng Li
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Minglu Gu
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Yanyifang Xu
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Shitong Li
- Department of Anesthesiology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Li
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
| | - Jianer Du
- Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai, China
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152
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Huang J, Gou B, Rong F, Wang W. Dexmedetomidine improves neurodevelopment and cognitive impairment in infants with congenital heart disease. Per Med 2019; 17:33-41. [PMID: 31841075 DOI: 10.2217/pme-2019-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Explore if dexmedetomidine (DEX) improves neurodevelopment and cognitive impairment in infants with congenital heart disease. Materials & methods: We retrospectively analyzed 256 pediatric patients aged less than 2 years with heart disease undergoing thoracic surgery. The intelligence quotient and neurodevelopment were tested. Mortality, incidence of postoperation adverse events, duration of mechanical ventilation, and length of stay were recorded and compared. Results: Compared with those not administered DEX, intelligence quotient scores and neurodevelopment evaluation scores increased in patients receiving perioperative DEX. There were no significant differences in mortality, duration of mechanical ventilation or length of stay. Conclusion: The administration of DEX might improve neural development and reduce the adverse effects of general anesthesia in infants with congenital heart disease undergoing surgery and extracorporeal circulation.
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Affiliation(s)
- Jianting Huang
- Department of Anesthesiology, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, China
| | - Baojing Gou
- Department of Anesthesiology, Central Hospital of Kuandian Manchu Autonomous County, Dandong, Liaoning, China
| | - Fei Rong
- Department of Anesthesiology, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, China
| | - Wei Wang
- Department of Anesthesiology, Fudan University Affiliated Hospital, Shanghai, China
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153
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Gottula AL, Gorder KL, Peck AR, Renne BC. Dexmedetomidine for Acute Management of Intrathecal Baclofen Withdrawal. J Emerg Med 2019; 58:e5-e8. [PMID: 31759793 DOI: 10.1016/j.jemermed.2019.09.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intrathecal baclofen (ITB) is a mainstay of treatment for patients with chronic spasticity. Up to 40% of all patients receiving ITB experience overdose or withdrawal symptoms, which in the most severe cases can lead to multisystem organ failure and death. There is currently no well-established treatment for ITB withdrawal. One previous case report details an intubated pediatric patient who underwent baclofen pump removal in which dexmedetomidine was used in combination with other medications to prevent baclofen withdrawal. CASE REPORT We report a case of baclofen withdrawal where the decision was made to initiate a dexmedetomidine infusion, with subsequent improvement of the patient's hypertension and tachycardia. At no point during her stay did the patient require intubation for airway protection, and the patient was ultimately discharged to her previous nursing facility on hospital day 9 with no new neurologic deficits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of dexmedetomidine as a promising option for the treatment of ITB withdrawal in the acute setting. Although little evidence is currently present, dexmedetomidine was used successfully in this case, and should be considered as a temporizing treatment for ITB withdrawal. Dexmedetomidine holds promise in the management of ITB withdrawal compared to other previously described treatments, including oral baclofen, cyproheptadine, and dantrolene. In addition, dexmedetomidine has a superior safety profile compared to propofol or large doses of benzodiazepines. Further research will be useful in supporting the use of dexmedetomidine for this purpose.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kari L Gorder
- Department of Anesthesia, University of Cincinnati, Cincinnati, Ohio
| | - Amanda R Peck
- Department of Pharmacy, UC Health University Hospital, Cincinnati, Ohio
| | - B Christian Renne
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
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154
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Farina N, Alaniz C. Reconsidering Dexmedetomidine for Sedation in the Critically Ill: Implications of the SPICE III Trial. Ann Pharmacother 2019; 54:504-508. [PMID: 31744312 DOI: 10.1177/1060028019890672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dexmedetomidine is a sedative agent that has gained popularity for use in the intensive care unit over the past 20 years. Guidelines recommend dexmedetomidine as a first-line agent to achieve light sedation in mechanically ventilated adults. Recently, the SPICE III (Sedation Practice in Intensive Care Evaluation III) trial was published. This was a randomized controlled trial comparing initial sedation with dexmedetomidine with usual care sedation in adult patients receiving mechanical ventilation. The results of this trial have both validated and contradicted previous findings about dexmedetomidine. This editorial examines the merits of the SPICE III trial and the role of dexmedetomidine in practice following its publication.
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Affiliation(s)
| | - Cesar Alaniz
- Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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155
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Wang H, Tian Q, Quan P, Liu C, Fang L. Probing the Role of Ion-Pair Strategy in Controlling Dexmedetomidine Penetrate Through Drug-in-Adhesive Patch: Mechanistic Insights Based on Release and Percutaneous Absorption Process. AAPS PharmSciTech 2019; 21:4. [PMID: 31728769 DOI: 10.1208/s12249-019-1539-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/14/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of present study was to develop a controlled release drug-in-adhesive patch for transdermal delivery of dexmedetomidine (Dex) using ion-pair technique. Based on the in vitro transdermal experiment, the role of ion-pair on the Dex release behavior and percutaneous absorption process was also investigated. Fourier transform infrared spectroscopy (FTIR), molecular modeling, differential scanning calorimetry (DSC), and rheological test were conducted to probe the effect of ion-pair on the Dex release from patch. Besides, the tape stripping test, attenuated total reflectance Fourier transform infrared (ATR-FTIR), and molecular simulation were carried out to elaborate the action of ion-pair on the Dex percutaneous permeation process. Results showed that the optimized patch prepared with Dex-salicylic acid (SA) showed zero-order skin permeation profile within 24 h; Dex-SA had greater hydrogen bonding formation potential with pressure sensitive adhesive (PSA) than Dex, which resulted in the decrease in the formation ability of free volume of PSA and the increase with the improvement of mechanical strength and chain stiffness of PSA and thus controlled the release rate of Dex from transdermal patch. Besides, the physicochemical properties of Dex such as molecular weight and octanol/water partition coefficient were changed after forming ion-pair with SA, which decreased the permeation ability of Dex. In conclusion, a controlled release drug-adhesive patch for Dex was developed and the mechanism study of ion-pair on the Dex release and percutaneous permeation process was proposed at molecular level.
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156
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Song Q, Lin L, Chen L, Cheng L, Zhong W. Co-administration of N-acetylcysteine and dexmedetomidine plays a synergistic effect on protection of LPS-induced acute lung injury via correcting Th1/Th2/Th17 cytokines imbalance. Clin Exp Pharmacol Physiol 2019; 47:294-301. [PMID: 31631367 DOI: 10.1111/1440-1681.13196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 01/10/2023]
Abstract
Recently both N-acetylcysteine (NAC) and Dexmedetomidine (DEX) have shown emerging roles in protection of acute lung injury (ALI). However, how their protective roles work and whether they can provide synergistic effects in ALI remain unknown. Here we explored it from the hot research viewpoint of Th1/Th2/Th17 cytokines balance. Lipopolysaccharide (LPS)-induced ALI was established and treated with NAC and/or DEX. Mice were divided into Sham group, ALI group, NAC group, DEX group and NAC+DEX group. Mice were sampled at 6, 12 and 24 hours after the model construction. Histopathology, wet to dry ratio and myeloperoxidase (MPO) activity were assessed in lung tissues. Protein concentration and cell count were assessed in bronchoalveolar lavage fluid (BALF). Th1/Th2/Th17 cytokines were assessed in plasma, BALF and lung homogenate. ALI-induced lung morphological damage, edema and aberrant MPO activity can be attenuated by NAC or DEX and mostly by NAC+DEX. NAC with DEX significantly reduced ALI-induced protein leakage and cell infiltration in BALF. Th1/Th2/Th17 cytokines imbalance aggravated with ALI progression. NAC, DEX and especially NAC+DEX can effectively correct these unbalanced cytokines. Galectin-9 and Tim-3 were transcriptionally up-regulated in ALI. Combination of NAC with DEX obtained a maximum effect on decreasing Galectin-9/Tim-3 expression. In summary, Th1/Th2/Th17 cytokines imbalance is newly found to participate in LPS-induced ALI. NAC or DEX administration can attenuate ALI by rebalancing Th1/Th2/Th17 cytokines. Their protective roles can be enhanced when co-administration, because DEX may relieve the Galectin-9/Tim-3 axis-mediated immune suppression.
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Affiliation(s)
- Qitai Song
- Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Lin
- Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lin Chen
- College of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Lingxia Cheng
- College of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Wu Zhong
- Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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157
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Dexmedetomidine prevents septic myocardial dysfunction in rats via activation of α7nAChR and PI3K/Akt- mediated autophagy. Biomed Pharmacother 2019; 120:109231. [PMID: 31546082 DOI: 10.1016/j.biopha.2019.109231] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Dexmedetomidine (Dex) has been shown to elicit cardio-protective effects in sepsis. The aim of this study was to investigate the role of autophagy in the protective effects of Dex and its possible mechanism in vivo and vitro. EXPERIMENTAL APPROACH 6-8-week-old male Wistar rats were performed cecal ligation puncture (CLP) and administered 0.9% saline (CLP group), 50 μg/kg Dex (Dex group), Dex plus chloroquine (20 mg/kg; Dex + CQ group), or 40 μg/kg methyllycaconitin (Dex + MLA group), or 25 μM LY294002 (Dex + LY294002 group). After study, cardiac histology, cardiac function, level of autophagy, cardiomyocytes apoptosis and inflammatory mediators including protein IL-1β, IL-6, and TNF-α were measured. The LPS induced-H9C2 cardiomyocytes were treated with Dex, Dex + CQ and detected for cell apoptosis, autophagy level and cell cycle. KEY RESULTS CLP-induced sepsis resulted in cardiac dysfunction, apoptosis, and inflammatory response. Dex exhibited protective effects on the myocardium by the induction of myocardial autophagy and ameliorated the LPS-induced blockade of autophagic flux in H9C2 cells. CQ was found to significantly inhibit Dex-mediated protection of myocardial apoptosis and inflammation. CLP rats treated with Dex in combination with MLA, an antagonist of α7 nicotinic acetylcholine receptor (α7nAChR), exhibited decreased autophagy and increased inflammation and cell death, identifying α7nAchR was involved in the Dex-mediated pathway. In addition, we found that the PI3K/Akt pathway is involved in Dex-mediated autophagy and convergent with α7nAChR-mediated stimulation of autophagy response. CONCLUSIONS AND IMPLICATIONS For the first time, these data indicate that autophagy is central in Dex-mediated cardio-protection in sepsis. These observations provide the foundation for further study, and may serve as the basis for innovative therapeutic strategies against septic myocardial dysfunction.
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158
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Use of Dexmedetomidine for Deep Sedation and Reduction of Vasopressor Requirement? Crit Care Med 2019; 47:e721-e722. [DOI: 10.1097/ccm.0000000000003777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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159
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Tan D, Xia H, Sun S, Wang F. Effect of ancillary drugs on sevoflurane related emergence agitation in children undergoing ophthalmic surgery: a Bayesian network meta-analysis. BMC Anesthesiol 2019; 19:138. [PMID: 31370793 PMCID: PMC6670177 DOI: 10.1186/s12871-019-0810-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/25/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. METHODS The databases were retrieved in an orderly manner from the dates of their establishment to October, 2018, including PubMed, The Cochrane Library and Web of Science, to collect randomized controlled trials (RCT) of different anesthetic drugs combined with sevoflurane for ophthalmic surgery. Then a network meta-analysis was conducted using R and Stata 12.0 softwares. RESULTS The meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05). The network meta-analysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12-0.22), ketamine (OR = 0.30, 95% CrI 0.11-0.49), propofol (OR = 0.24, 95% CrI 0.09-0.63), fentanyl (OR = 0.16, 95% CrI 0.08-0.56), midazolam (OR = 0.20, 95% CrI 0.09-0.40), sufentanil (OR = 0.27, 95% CrI 0.14-0.41), remifentanil (OR = 0.18, 95% CrI 0.08-0.54) and clonidine (OR = 0.14, 95% CrI 0.07-0.41). The SUCRA of placebo, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine were respectively 0.26, 77.93, 27.71, 42.8, 69.43, 52.89, 59.83, 57.62 and 61.53%. CONCLUSIONS The effects of dexmedetomidine combine with sevoflurane in reducing risk of emergence agitation in children undergoing ophthalmic surgery was superior to other drugs.
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Affiliation(s)
- Dan Tan
- Editorial Office, Journal of New Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.
| | - Haifa Xia
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shujun Sun
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fuquan Wang
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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160
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Effect of Dexmedetomidine on Cerebral Vasospasm and Associated Biomarkers in a Rat Subarachnoid Hemorrhage Model. J Neurosurg Anesthesiol 2019; 31:342-349. [DOI: 10.1097/ana.0000000000000504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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161
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Shehabi Y, Howe BD, Bellomo R, Arabi YM, Bailey M, Bass FE, Bin Kadiman S, McArthur CJ, Murray L, Reade MC, Seppelt IM, Takala J, Wise MP, Webb SA. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med 2019; 380:2506-2517. [PMID: 31112380 DOI: 10.1056/nejmoa1904710] [Citation(s) in RCA: 256] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied. METHODS In an open-label, randomized trial, we enrolled critically ill adults who had been undergoing ventilation for less than 12 hours in the ICU and were expected to continue to receive ventilatory support for longer than the next calendar day to receive dexmedetomidine as the sole or primary sedative or to receive usual care (propofol, midazolam, or other sedatives). The target range of sedation-scores on the Richmond Agitation and Sedation Scale (which is scored from -5 [unresponsive] to +4 [combative]) was -2 to +1 (lightly sedated to restless). The primary outcome was the rate of death from any cause at 90 days. RESULTS We enrolled 4000 patients at a median interval of 4.6 hours between eligibility and randomization. In a modified intention-to-treat analysis involving 3904 patients, the primary outcome event occurred in 566 of 1948 (29.1%) in the dexmedetomidine group and in 569 of 1956 (29.1%) in the usual-care group (adjusted risk difference, 0.0 percentage points; 95% confidence interval, -2.9 to 2.8). An ancillary finding was that to achieve the prescribed level of sedation, patients in the dexmedetomidine group received supplemental propofol (64% of patients), midazolam (3%), or both (7%) during the first 2 days after randomization; in the usual-care group, these drugs were administered as primary sedatives in 60%, 12%, and 20% of the patients, respectively. Bradycardia and hypotension were more common in the dexmedetomidine group. CONCLUSIONS Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and required supplemental sedatives to achieve the prescribed level of sedation. More adverse events were reported in the dexmedetomidine group than in the usual-care group. (Funded by the National Health and Medical Research Council of Australia and others; SPICE III ClinicalTrials.gov number, NCT01728558.).
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Affiliation(s)
- Yahya Shehabi
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Belinda D Howe
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Rinaldo Bellomo
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Yaseen M Arabi
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Michael Bailey
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Frances E Bass
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Suhaini Bin Kadiman
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Colin J McArthur
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Lynnette Murray
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Michael C Reade
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Ian M Seppelt
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Jukka Takala
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Matt P Wise
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
| | - Steven A Webb
- From the School of Clinical Sciences (Y.S.) and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (B.D.H., R.B., M.B., L.M., S.A.W.), Monash University, Monash Health (Y.S.), the Faculty of Medicine, University of Melbourne (R.B., M.B.), Melbourne, VIC, and Austin Hospital, Heidelberg, VIC (R.B.), the Prince of Wales Clinical School of Medicine, University of New South Wales (Y.S.), Royal North Shore Hospital, the George Institute for Global Health (F.E.B.), the Sydney Medical School-Nepean, University of Sydney, and the Department of Clinical Medicine, Macquarie University (I.M.S.), Sydney, the Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane (M.C.R.), the Joint Health Command, Australian Defence Force, Canberra, ACT (M.C.R.), and St. John of God Subiaco Hospital, Subiaco, WA (S.A.W.) - all in Australia; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Y.M.A.); the Department of Anesthesiology and Intensive Care, IJN-UTM Cardiovascular Engineering Center, National Heart Institute, Kuala Lumpur, Malaysia (S.B.K.); the Department of Critical Care Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand (C.J.M.); Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (J.T.); and Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (M.P.W.)
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Chen N, Chen X, Xie J, Wu C, Qian J. Dexmedetomidine protects aged rats from postoperative cognitive dysfunction by alleviating hippocampal inflammation. Mol Med Rep 2019; 20:2119-2126. [PMID: 31257507 PMCID: PMC6691222 DOI: 10.3892/mmr.2019.10438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/03/2019] [Indexed: 12/11/2022] Open
Abstract
The present study investigated the effect of dexmedetomidine on hippocampal inflammation and cognitive function in rats with postoperative cognitive dysfunction (POCD). A total of 80 healthy male Sprague Dawley rats were used, 72 of which developed POCD. The rats were randomly divided into four groups: The control, model, low-dose and high-dose dexmedetomidine anesthesia groups. A POCD model was established and dexmedetomidine was administered. Cognitive function tests were performed and expression levels of interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α) and NF-κB biomarkers were evaluated on the first, third and seventh day following modeling. The cognitive function of rats was measured using a Y-maze test. The expression levels of IL-1β and TNF-α in the hippocampus were determined by ELISA. The protein expression levels of NF-κB p65 in the hippocampus were determined by western blotting. It was revealed that at 1, 3 and 7 days after surgery, there were no alterations in the exercise ability of rats in the different groups, as reflected by the number of rats passing the alternative arms in the Y-maze. On the first and third day after surgery, the cognitive dysfunction reflected by the alteration scores of the low-dose and high-dose dexmedetomidine anesthesia groups were significantly higher than those of the model group, and the increase in the high-dose group was more pronounced. Additionally, on the first day after surgery, the expression levels of IL-1β, TNF-α and NF-κB in the hippocampi of rats in the low- and high-dose dexmedetomidine anesthesia groups were significantly lower than those in the model group, and the decrease was more pronounced in the high-dose group. At 7 days after surgery, the differences in expression levels of IL-1β, TNF-α and NF-κB in the hippocampus among groups were not identified to be statistically significantly different. Taken together, the results of the present study indicated that dexmedetomidine may inhibit hippocampal inflammation induced by surgical trauma, and that dexmedetomidine may effectively improve postoperative cognitive function in rats.
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Affiliation(s)
- Nianping Chen
- Department of Anesthesiology, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing, Zhejiang 312000, P.R. China
| | - Xiufang Chen
- Department of Neurology, People's Hospital of Shaoxing, Shaoxing, Zhejiang 312000, P.R. China
| | - Jianping Xie
- Department of Neurology, People's Hospital of Shaoxing, Shaoxing, Zhejiang 312000, P.R. China
| | - Chenglong Wu
- Department of Neurology, People's Hospital of Shaoxing, Shaoxing, Zhejiang 312000, P.R. China
| | - Jiang Qian
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
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163
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Dardalas I, Stamoula E, Rigopoulos P, Malliou F, Tsaousi G, Aidoni Z, Grosomanidis V, Milonas A, Papazisis G, Kouvelas D, Pourzitaki C. Dexmedetomidine effects in different experimental sepsis in vivo models. Eur J Pharmacol 2019; 856:172401. [PMID: 31108055 DOI: 10.1016/j.ejphar.2019.05.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/07/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
Sepsis is a major cause of death and the most common cause of death among critically ill, non-ICU patients. Dexmedetomidine (DEX), an <alpha>2 adrenergic receptor agonist, presents sympatholytic action in certain parts of the brain with anxiolytic, sedative, and pain killing effects. Additionally, through the activation of <alpha>7 nicotinic acetylcholine receptor receptors, DEX reduces cytokine transcription and inhibits inflammation, rendering it beneficial during septic conditions. Moreover, there is a lot of interest in designing experimental sepsis models, where the administration of DEX is evaluated for its impact on multiple systems. This review focuses on experimental studies published between 1999 to March 2019 that were using DEX administration in sepsis in vivo models. From these, 36 articles were selected and summarized. Overall results show evidence that DEX may decrease mortality and inhibit inflammation, as it enhances the activity of the immune system while reducing its systemic reaction and lowering cytokine concentrations. Moreover DEX succeeds to alleviate heart injury during sepsis, acting beneficially for microcirculation and shows a neuroprotective role by inhibiting apoptotic pathways. In addition, DEX appears to have a protective role for liver and spleen as well as a beneficial role for the function of lungs and kidneys as it reduces sepsis-induced injuries and apoptosis in intra-abdominal experimental sepsis models.
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Affiliation(s)
- Ioannis Dardalas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Eleni Stamoula
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Panagiotis Rigopoulos
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Faye Malliou
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Georgia Tsaousi
- Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece
| | - Zoi Aidoni
- Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece
| | - Vasileios Grosomanidis
- Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece
| | - Antonios Milonas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
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164
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Ge Y, Li Q, Nie Y, Gao J, Luo K, Fang X, Wang C. Dexmedetomidine improves cognition after carotid endarterectomy by inhibiting cerebral inflammation and enhancing brain-derived neurotrophic factor expression. J Int Med Res 2019; 47:2471-2482. [PMID: 31014147 PMCID: PMC6567697 DOI: 10.1177/0300060519843738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives Carotid endarterectomy (CEA) is efficient in preventing stroke for patients with significant carotid stenosis, but results in mild cognitive dysfunction. Dexmedetomidine is neuroprotective in stroke models. We hypothesized that dexmedetomidine may improve cognition after CEA. Methods Forty-nine patients scheduled for elective CEA were randomly assigned to intravenous dexmedetomidine treatment group (n = 25) and control group C (normal saline, n = 24). Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA), as well as lactate, TNF-α, IL-6, and BDNF levels in blood, were assessed before, during, and after surgery. Results MMSE and MOCA scores showed subtle decline in both groups at 24 hours postoperatively; this decline remained at 48 hours postoperatively in group C. Both scores were higher in group D than in group C at 48 and 72 hours postoperatively. TNF-α and IL-6 were lower from 5 minutes post-clamping through 24 hours postoperatively in group D; lactate was lower at 5 minutes post-clamping in group D. BDNF was higher from 5 minutes post-clamping through 1 hour postoperatively in both groups, and remained high in group D at 24 hours postoperatively. Conclusions Dexmedetomidine improved recovery of cognition after CEA, potentially due to reduced inflammation and enhanced BDNF expression.
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Affiliation(s)
- Yali Ge
- 1 Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China
| | - Qian Li
- 2 Department of Anesthesiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yuyan Nie
- 2 Department of Anesthesiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Ju Gao
- 1 Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China
| | - Ke Luo
- 3 Department of Anesthesiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiangzhi Fang
- 1 Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China
| | - Cunjing Wang
- 1 Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China
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165
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Liu S, Wang Y, Zhu Y, Yu T, Zhao H. Safety and sedative effect of intranasal dexmedetomidine in mandibular third molar surgery: a systematic review and meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1301-1310. [PMID: 31114165 PMCID: PMC6485320 DOI: 10.2147/dddt.s194894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The focus of this meta-analysis was to assess the sedative effect and safety of intranasal dexmedetomidine (Dex) in mandibular third molar surgery. Methods The PubMed/Medline, Web of Science, Cochrane Library, and China National Knowledge Infrastructure databases were searched for studies published until May 1, 2018. Eligible studies were restricted to randomized controlled trials (RCTs) and controlled clinical trials. The evaluation indicators mainly included the bispectral index, observer assessment of alertness/sedation scale, systolic blood pressure, and heart rate. Data for each period in the Dex and control groups were pooled to evaluate its sedative effect and safety. Results Five RCTs met the inclusion criteria. This study included 363 patients: 158 patients received intranasal inhalation of Dex before surgery, and 158 patients were negative controls. The pooled results showed a good sedative effect during tooth extraction when intranasal inhalation of Dex was performed 30 minutes before third molar extraction (assessment of alertness/sedation, Dex vs control SMD −1.20, 95% CI −1.73 to −0.67, I2=0, P=0.95; bispectral index, Dex vs control SMD −11.68, 95% CI −19.49 to −3.87, I2=89%; P=0.0001), and parameters returned to normal within 90 minutes after inhalation. During the operation, blood pressure and heart rate decreased to some extent, but the decreases did not exceed 20% of the baseline, and all patients returned to normal conditions within 90 minutes after inhalation. Conclusion Intranasal inhalation of Dex 30 minutes before third molar extraction can provide a good sedative effect, and large-sample multicenter RCTs are needed to evaluate the analgesic effect of Dex.
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Affiliation(s)
- Shaopeng Liu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Ye Wang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Yong Zhu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Tingting Yu
- Department of Oral and Maxillofacial Surgery, Jinan Stomatological Hospital, Jinan, Shandong 250012, People's Republic of China,
| | - Huaqiang Zhao
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
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Park JH, Soh S, Kwak YL, Kim B, Choi S, Shim JK. Anesthetic Efficacy of Dexmedetomidine versus Midazolam When Combined with Remifentanil for Percutaneous Transluminal Angioplasty in Patients with Peripheral Artery Disease. J Clin Med 2019; 8:jcm8040472. [PMID: 30959941 PMCID: PMC6518185 DOI: 10.3390/jcm8040472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/10/2023] Open
Abstract
Anesthesia for percutaneous transluminal angioplasty (PTA) involves a high-risk population having a broad spectrum of pain character and intensity. This study delved the anesthetic efficacy of dexmedetomidine versus midazolam, when used with remifentanil. Seventy patients scheduled for femoropopliteal PTA were randomized into two groups receiving either intermittent midazolam boluses (0.03–0.05 mg/kg) (MR group) or dexmedetomidine 0.2–0.7 μg/kg/h after a loading dose of 1.0 μg/kg for 10 min (DR group), both with remifentanil. The primary endpoint was the patients’ satisfaction (1–5, 5; extremely satisfied). Secondary endpoints included postprocedural pain scores (0–10, 10; worst imaginable pain) and adverse events. The satisfaction level of patients was significantly greater in the DR group compared with the MR group (4.0 [3.0, 5.0] versus 4.0 [2.0, 5.0] p = 0.021). The number of patients having a postprocedural pain score of at least 3 was significantly greater in the MR group compared with the DR group (10 [29%] versus 2 [6%], p = 0.013). The number of patients with hypotensive episodes was higher in the DR group (5 [14.7%] versus 0, p = 0.025), which could all be restored with ephedrine. The use of dexmedetomidine in conjunction with remifentanil may be a safe option that provides excellent patient satisfaction while potentially attenuating postprocedural pain.
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Affiliation(s)
- Ji-Hyoung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426, Korea.
| | - Sarah Soh
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Bosung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426, Korea.
| | - Sohyun Choi
- Center of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju, Gangwondo 26426, Korea.
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
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Maagaard M, Barbateskovic M, Perner A, Jakobsen JC, Wetterslev J. Dexmedetomidine for the prevention of delirium in critically ill patients - A protocol for a systematic review. Acta Anaesthesiol Scand 2019; 63:540-548. [PMID: 30671925 DOI: 10.1111/aas.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Delirium is a common complication in critically ill patients and carries an increased risk of mortality and morbidity. Dexmedetomidine can potentially prevent delirium by diminishing predisposing factors. The evidence regarding the use of dexmedetomidine in preventing delirium is conflicting. This protocol aims to identify the beneficial and harmful effects of dexmedetomidine in the prevention of delirium. METHODS This protocol uses the recommendations of the Cochrane Collaboration, the Preferred Report Items of Systematic Reviews with Meta-Analysis Protocols, and the eight-step assessment procedure suggested by Jakobsen and colleagues. We wish to assess in critically ill patients, if dexmedetomidine versus placebo can reduce the incidence of delirium and improve clinical outcomes. We will include all randomised trials assessing the use of dexmedetomidine in the prevention of delirium. To identify trials, we will search the Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded on Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science Journal Database, and BIOSIS. Two authors will screen the literature and extract data. We will use the Cochrane risk of bias tool to evaluate trials. Extracted data will be analysed using Review Manager 5 and Trial Sequential Analysis. We will create a "Summary of Findings"-table in which we will present our primary and secondary outcomes. We will assess the quality of evidence using GRADE. DISCUSSION This systematic review can potentially aid clinicians in decision-making and benefit the many critically ill patients at risk of delirium.
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Affiliation(s)
- Mathias Maagaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marija Barbateskovic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Perner
- Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Intensive Care, Department 4131, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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168
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Maagaard M, Barbateskovic M, Perner A, Jakobsen JC, Wetterslev J. Dexmedetomidine for the management of delirium in critically ill patients-A protocol for a systematic review. Acta Anaesthesiol Scand 2019; 63:549-557. [PMID: 30701537 DOI: 10.1111/aas.13329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delirium is a common complication in critically ill patients and carries an increased risk of mortality and morbidity. Dexmedetomidine can potentially treat delirium by diminishing predisposing factors. The evidence regarding the use of dexmedetomidine in the management of delirium is conflicting. This protocol aims to identify the beneficial and harmful effects of dexmedetomidine in the management of delirium. METHODS This protocol uses the recommendations of the Cochrane Collaboration, the Preferred Report Items of Systematic reviews with Meta-Analysis Protocols, and the eight-step assessment procedure suggested by Jakobsen and colleagues. We wish to assess in critically ill patients with delirium, if dexmedetomidine vs placebo is effective in managing delirium and improving clinical outcomes. We will include all relevant randomised clinical trials assessing the use of dexmedetomidine in treating delirium. To identify trials, we will search the Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded on Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science Journal Database, and BIOSIS. Two authors will screen the literature and extract data. The Cochrane risk of bias tool will be used to evaluate included trials. Extracted data will be analysed using Review Manager 5 and Trial Sequential Analysis. We will create a 'Summary of Findings'-table in which we will present our primary and secondary outcomes. We will assess the quality of evidence using GRADE assessment. DISCUSSION This systematic review can potentially aid clinicians in decision making and benefit the many critically ill patients developing delirium.
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Affiliation(s)
- Mathias Maagaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marija Barbateskovic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Perner
- Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Intensive Care, Department 4131, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus C Jakobsen
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Fang S, Chen Y, Yao P, Li Y, Yang Y, Xu G. [Dexmedetomidine alleviates postoperative cognitive dysfunction in aged rats probably via silent information regulator 1 pathway]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 38:1071-1075. [PMID: 30377100 DOI: 10.12122/j.issn.1673-4254.2018.09.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the role of silent information regulator 1 (SIRT1) signaling pathway in mediating the effect of dexmedetomidine (DEX) to alleviate postoperative cognitive dysfunction (POCD) in aged rats. METHODS Seventy-two healthy male Sprague-Dawley rats aged 18-20 months (weighing 500-700 g) were randomized equally into normal control group, POCD model group, DEX pretreatment group, and DEX and SIRT1 inhibitor (EX527) pretreatment group. In the latter 2 groups, DEX (25 μg/kg) was injected intraperitoneally in the rats 30 min before the operation, and normal saline was injected instead in the other 2 groups; in EX527 group, EX527 (1 μg/kg) was injected intravenously 5 min before the operation. In all but the control group, the rats were subjected to laparotomy lasting 30 min, and on days 1, 3, and 5 following the operation, 6 rats were randomly selected from each group for Morris water maze test to evaluate their cognitive functions. Immediately after the test, the rats were sacrificed and the hippocampus was collected for determination of the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) using ELISA; Western blotting was used to detect the expression of SIRT1 and nuclear factor- κB (NF-κB) in the hippocampal neurons. RESULTS Compared with the control rats, the rats in POCD group and EX527 group showed significantly prolonged escape latency, decreased frequency of crossing the original platform, increased TNF-α and IL-6 levels, lowered SIRT1 expression in the hippocampal neurons, and increased NF-κB expression (P < 0.05), and these parameters were comparable between POCD group and EX527 group (P > 0.05). DEX pretreatment significantly alleviated cognitive dysfunction and attenuated the changes in TNF-α, IL-6, SIRT1, and NF-κB expressions induced by the operation (P < 0.05), and EX527 pretreatment of the rats obviously blocked the effects of DEX (P < 0.05). CONCLUSIONS DEX alleviates POCD in aged rats probably via SIRT1 signaling pathway.
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Affiliation(s)
- Sitong Fang
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
| | - Yong Chen
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
| | - Peng Yao
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
| | - Yiling Li
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
| | - Yujun Yang
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
| | - Guohai Xu
- Department of Anesthesiology, Second Affiliated Hospital of Nanchang University; Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330006, China
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A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine. Can J Anaesth 2019; 66:318-327. [PMID: 30674004 DOI: 10.1007/s12630-018-01289-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Delirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety. METHODS A systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length of stay. RESULTS From 10,860 studies identified, eight met the inclusion criteria: six studies assessed dexmedetomidine while the remaining two assessed loxapine and biofeedback. Pooled analysis of studies assessing dexmedetomidine showed reduced time-to-extubation (six studies, n = 303) by 10.9 hr compared with controls (95% confidence interval [CI], -15.7 to -6.1; I2 = 68%) and ICU length of stay (four studies, n = 191) by 2.6 days (95% CI, 1.9 to 3.3; I2 = 0%). Nevertheless, the evidence was deemed to be of low quality given the small sample sizes and high heterogeneity. Studies assessing other interventions did not identify improvements compared with controls. Safety assessment was globally poorly reported. CONCLUSIONS This systematic review and meta-analysis provides low quality evidence to suggest the use of dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety. Insufficient evidence was found regarding other interventions to provide any recommendation. TRIAL REGISTRATION PROSPERO (CRD42016042528); registered 15 July, 2016.
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Dexmedetomidine protects against lipopolysaccharide-induced early acute kidney injury by inhibiting the iNOS/NO signaling pathway in rats. Nitric Oxide 2019; 85:1-9. [PMID: 30659917 DOI: 10.1016/j.niox.2019.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
Abstract
Increasing evidence has demonstrated that dexmedetomidine (DEX) possesses multiple pharmacological actions. Herein, we explored the protective effect and potential molecular mechanism of DEX on lipopolysaccharide (LPS)-induced early acute kidney injury (AKI) from the perspective of antioxidant stress. We found that DEX (30 μg/kg, i.p.) ameliorated the renal dysfunction and histopathological damage (tubular necrosis, vacuolar degeneration, infiltration of inflammatory cells and cast formation) induced by LPS (10 mg/kg). DEX also attenuated renal oxidative stress remarkably in LPS-induced early AKI, as evidenced by reduction in production of reactive nitrogen species, decreasing malondialdehyde levels, as well as increasing superoxide dismutase activity and glutathione content. DEX prevented activator protein-1 translocation, inhibited phosphorylation of I-kappa B (IκB) and activation of nuclear factor kappa B (NF-κB) in LPS-induced early AKI, as assessed by real-time quantitative polymerase chain reaction and protein levels of c-Jun, c-Fos, IκB and NF-κB. Notably, DEX pretreatment had the same effect as intraperitoneal injection of an inhibitor of inducible nitric oxide synthase inhibitor (1400W; 15 mg/kg), and inhibited the activity of renal inducible nitric oxide synthase (iNOS) and decreased the expression of iNOS mRNA and NO production. However, the protective effect of DEX on LPS-induced early AKI was reversed by the alpha 2 adrenal receptor (α2-AR) inhibitor atipamezole, whereas the imidazoline receptor inhibitor idazoxan did not. Taken together, DEX protects against LPS-induced early AKI in rats by inhibiting the iNOS/NO signaling pathway, mainly by acting on α2-ARs instead of IRs.
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172
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Habibi V, Kiabi FH, Sharifi H. The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review. Braz J Cardiovasc Surg 2019; 33:404-417. [PMID: 30184039 PMCID: PMC6122757 DOI: 10.21470/1678-9741-2017-0253] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/08/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Acute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics. OBJECTIVE To review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain. METHODS Medline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements. RESULTS From 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension. CONCLUSION Dexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.
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Affiliation(s)
- Valiollah Habibi
- Department of Cardiac Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farshad Hasanzadeh Kiabi
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hassan Sharifi
- Department of Medical Surgical Nursing, Faculty of Nursing, Iranshahr University of Medical Sciences, Iranshahr, Iran
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Gazi M, Abitağaoğlu S, Turan G, Köksal C, Akgün FN, Ari DE. Evaluation of the effects of dexmedetomidine and remifentanil on pain with the analgesia nociception index in the perioperative period in hysteroscopies under general anesthesia. A randomized prospective study. Saudi Med J 2019; 39:1017-1022. [PMID: 30284585 PMCID: PMC6201036 DOI: 10.15537/smj.2018.10.23098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives To compare analgesia nociception index (ANI) values, visual analog scale (VAS) values, and hemodynamic parameters in hysteroscopy patients who received remifentanil and dexmedetomidine during general anesthesia. Methods: In total, 30 patients who underwent hysteroscopy between March and September 2016 at the University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, Ankara, Turkey were included in this prospective study. Standard hemodynamic monitoring, ANI, and bispectral index (BIS) monitoring were applied to the patients. At 10 min prior to induction, 1 μg/kg of remifentanil was applied in Group R (n=15) and 1 μg/kg of dexmedetomidine was applied in Group D (n=15). After induction, sevoflurane was used for maintenance with dexmedetomidine at 0.2-0.7 μg/kg/hour in Group D and remifentanil at 0.05-0.5 μg/kg/minute in Group R. Perioperative and postoperative analgesia levels (ANI and VAS, respectively), hemodynamics, and complications were recorded. Results: Even though the ANI levels in Group D were lower at the perioperative 5th and 10th minutes, the ANI values were between the targeted limits, except for the measurement after I-gel insertion, in both groups. Hemodynamic parameters were within normal limits, but the mean arterial pressures in Group R after induction, following I-gel placement, and at the perioperative 5th, 10th, and 20th minutes were lower and at postoperative 30th minute were significantly higher. Conclusion: Dexmedetomidine and remifentanil are both efficacious agents for perioperative analgesia in hysteroscopy cases.
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Affiliation(s)
- Mustafa Gazi
- Anesthesiology and Reanimation Department, University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, Turkey. E-mail.
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Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery. Case Rep Anesthesiol 2019; 2018:2896032. [PMID: 30627445 PMCID: PMC6304573 DOI: 10.1155/2018/2896032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/08/2018] [Accepted: 11/25/2018] [Indexed: 11/18/2022] Open
Abstract
Dexmedetomidine is an elective alpha-2 adrenergic agonist, being used in anesthesia practice. It offers sedative, anxiolytic, analgesic, muscle relaxant, and sympathetic lytic properties. While respiratory effects are considered minor, there are important cardiovascular side effects with bradycardia and hypotension being the most common. This article presents a case of a patient, with significant comorbidities and polypharmacy, who was scheduled for cataract surgery under dexmedetomidine sedation. During the administration, severe hemodynamic deterioration was observed with bradycardia and hypotension leading to asystole. Cardiac arrest was successfully managed in accordance with the guidelines of the European Resuscitation Council. Despite the promising role of dexmedetomidine in anesthesia practice, the associated adverse effects cannot be ignored. For this reason it is obligatory to have the minimum mandatory monitoring in accordance with the safety and quality guidelines.
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175
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Bush SH, Tierney S, Lawlor PG. Clinical Assessment and Management of Delirium in the Palliative Care Setting. Drugs 2019; 77:1623-1643. [PMID: 28864877 PMCID: PMC5613058 DOI: 10.1007/s40265-017-0804-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling. Depending on its precipitating factors, a delirium episode is often reversible, especially in the earlier stages of a life-threatening illness. Until recently, antipsychotics have played a pivotal role in delirium management, but this role now requires critical re-evaluation in light of recent research that failed to demonstrate their efficacy in mild- to moderate-severity delirium occurring in palliative care patients. Non-pharmacological strategies for the management of delirium play a fundamental role and should be optimized through the collective efforts of the whole interprofessional team. Refractory agitated delirium in the last days or weeks of life may require the use of pharmacological sedation to ameliorate the distress of patients, which is invariably juxtaposed with increasing distress of family members. Further evaluation of multicomponent strategies for delirium prevention and treatment in the palliative care patient population is urgently required.
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Affiliation(s)
- Shirley Harvey Bush
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Bruyère Research Institute (BRI), Ottawa, ON, Canada. .,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada. .,Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada.
| | - Sallyanne Tierney
- Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Peter Gerard Lawlor
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute (BRI), Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
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Zhao XY, Zhang EF, Bai XL, Cheng ZJ, Jia PY, Li YN, Guo Z, Yang JX. Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty. Med Princ Pract 2019; 28:457-462. [PMID: 30995645 PMCID: PMC6771060 DOI: 10.1159/000500261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/09/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous fem-oral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). MATERIALS AND METHODS Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg-1 × h-1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg-1 × h-1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. RESULTS The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. CONCLUSION The protocol of 0.05 μg × kg-1 × h-1 of DEX combined with 0.15% ro-pivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance. UNLABELLED X.-Y.Z. and E.-F.Z. have contributed equally to this research.
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Affiliation(s)
- Xiao-Ying Zhao
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Er-Fei Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Xiao-Li Bai
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zi-Jian Cheng
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Peng-Yun Jia
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Nan Li
- Shanxi Medical University, Taiyuan, China
| | - Zheng Guo
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Xin Yang
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China,
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Song Y, Kim DH, Kwon TD, Han DW, Baik SH, Jung HH, Kim JY. Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial. Int J Hyperthermia 2018; 36:1-8. [PMID: 30354794 DOI: 10.1080/02656736.2018.1526416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. OBJECTIVE To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. MATERIALS Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 μg/kg over 20 min followed by infusion at 0.5 μg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. RESULTS There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034). CONCLUSIONS Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: http://clinicaltrials.gov (NCT02641938).
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Affiliation(s)
- Young Song
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,b Anesthesia and Pain Research Institute , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Do-Hyeong Kim
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,b Anesthesia and Pain Research Institute , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Tae Dong Kwon
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,b Anesthesia and Pain Research Institute , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Dong Woo Han
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,b Anesthesia and Pain Research Institute , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Seung Hyuk Baik
- c Department of Surgery , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Hwan Ho Jung
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Ji Young Kim
- a Department of Anesthesiology and Pain Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,b Anesthesia and Pain Research Institute , Yonsei University College of Medicine , Seoul , Republic of Korea
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178
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Administration of Dexmedetomidine inhibited NLRP3 inflammasome and microglial cell activities in hippocampus of traumatic brain injury rats. Biosci Rep 2018; 38:BSR20180892. [PMID: 30232232 PMCID: PMC6435454 DOI: 10.1042/bsr20180892] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
The abnormally high nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activity is a typical characteristic of traumatic brain injury (TBI). Dexmedetomidine (Dex) is a highly selective α-2 adrenergic receptor agonist that inhibits the activation of NLRP3. Thus, it was hypothesized that Dex could attenuate TBI by inhibiting NLRP3 inflammasome activity in hippocampus. Rats were subjected to controlled cortical impact method to induce TBI, and treated with Dex. The effect of Dex treatment on the cognitive function, NLRP3 activity, and microglial activation in rat brain tissues was assessed. The administration of Dex improved performance of TBI rats in Morris water maze (MWM) test, which was associated with the increased neurone viability and suppressed microglia activity. Moreover, the administration of Dex inhibited the neuroinflammation in brain tissue as well as the expressions of NLRP3 and caspase-1. Additionally, Dex and NLRP3 inhibitor, BAY-11-7082 had a synergistic effect in inhibiting NLRP3/caspase-1 axis activity and improving TBI. The findings outlined in the current study indicated that the improvement effect of Dex on TBI was related to its effect on NLRP3 activity.
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179
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Shafiekhani M, Mirjalili M, Vazin A. Psychotropic drug therapy in patients in the intensive care unit - usage, adverse effects, and drug interactions: a review. Ther Clin Risk Manag 2018; 14:1799-1812. [PMID: 30319262 PMCID: PMC6168070 DOI: 10.2147/tcrm.s176079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Managing psychological problems in patients admitted to intensive care unit (ICU) is a big challenge, requiring pharmacological interventions. On the other hand, these patients are more prone to side effects and drug interactions associated with psychotropic drugs use. Benzodiazepines (BZDs), antidepressants, and antipsychotics are commonly used in critically ill patients. Therefore, their therapeutic effects and adverse events are discussed in this study. Different studies have shown that non-BZD drugs are preferred to BZDs for agitation and pain management, but antipsychotic agents are not recommended. Also, it is better not to start antidepressants until the patient has fully recovered. However, further investigations are required for the use of psychotropic drugs in ICUs.
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Affiliation(s)
- Mojtaba Shafiekhani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
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180
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Zheng Z, Zhang S, Ma W, Zhang L, Huang L, Huang W, Huang M, Wang Z, Li J. Determination of dexmedetomidine by UHPLC–MS/MS and its application to evaluate the effect of dexmedetomidine concentration on the target-controlled infusion concentration of propofol. J Pharm Biomed Anal 2018; 154:438-443. [DOI: 10.1016/j.jpba.2018.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 12/26/2022]
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181
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Wu J, Vogel T, Gao X, Lin B, Kulwin C, Chen J. Neuroprotective effect of dexmedetomidine in a murine model of traumatic brain injury. Sci Rep 2018; 8:4935. [PMID: 29563509 PMCID: PMC5862953 DOI: 10.1038/s41598-018-23003-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/05/2018] [Indexed: 12/24/2022] Open
Abstract
No FDA approved pharmacological therapy is available that would reduce cell death following traumatic brain injury (TBI). Dexmedetomidine (Dex) is a highly selective agonist of alpha-2 adrenergic receptors and has demonstrated neuroprotective effects in hippocampal slice cultures undergoing direct impact. However, no one has tested whether Dex, in addition to its sedative action, has neuroprotective effects in an animal model of TBI. Thus, in the present study, we investigated the effects of Dex on an animal model of TBI. Mice received different doses of Dex (1, 10, or 100 µg/kg bodyweight, n = 10 each group) or saline as control at 1 hour and 12 hours following TBI. The mice treated with Dex lost less cortical tissue than the control mice. Further analysis found that Dex treatment reduced cell death in the cortex and the hippocampus measured by Fluoro-Jade B (FJB) staining, prevented axonal degeneration detected by immunostaining with antibody against β-amyloid precursor protein (β-APP), and protected synapses from elimination with synaptophysin staining. Taken together, in an in vivo murine model of TBI, Dex at the dose of 100 µg/kg not only prevented tissue lesion and cell death, but also reduced axonal injury and synaptic degeneration caused by TBI.
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Affiliation(s)
- Jin Wu
- Department of Orthopaedics, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Todd Vogel
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA
| | - Xiang Gao
- Spinal Cord and Brain Injury Research Group, Stark Neuroscience Research Institute, Indianapolis, IN, USA
| | - Bin Lin
- Department of Orthopaedics, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Charles Kulwin
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA
| | - Jinhui Chen
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA. .,Spinal Cord and Brain Injury Research Group, Stark Neuroscience Research Institute, Indianapolis, IN, USA.
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182
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Gallego-Ligorit L, Vives M, Vallés-Torres J, Sanjuán-Villarreal TA, Pajares A, Iglesias M. Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia. J Cardiothorac Vasc Anesth 2017; 32:1426-1438. [PMID: 29325842 DOI: 10.1053/j.jvca.2017.11.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 12/16/2022]
Abstract
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus. At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
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Affiliation(s)
- Lucía Gallego-Ligorit
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Marc Vives
- Department of Anesthesiology and Critical Care Medicine, Hospital de Bellvitge, Barcelona, Spain
| | - Jorge Vallés-Torres
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T Alberto Sanjuán-Villarreal
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Azucena Pajares
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Mario Iglesias
- Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), Madrid, Spain
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183
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Krüger BD, Kurmann J, Corti N, Spahn DR, Bettex D, Rudiger A. Dexmedetomidine-Associated Hyperthermia. Anesth Analg 2017; 125:1898-1906. [DOI: 10.1213/ane.0000000000002353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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184
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Sullivan D, Lyons M, Montgomery R, Quinlan-Colwell A. Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective. J Trauma Nurs 2017; 23:361-375. [PMID: 27828892 PMCID: PMC5123624 DOI: 10.1097/jtn.0000000000000250] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns.
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Affiliation(s)
- Denise Sullivan
- Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell)
| | - Mary Lyons
- Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell)
| | - Robert Montgomery
- Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell)
| | - Ann Quinlan-Colwell
- Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell)
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185
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Bush SH, Tierney S, Lawlor PG. Clinical Assessment and Management of Delirium in the Palliative Care Setting. Drugs 2017. [PMID: 28864877 DOI: 10.1007/s40265‐017‐0804‐3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling. Depending on its precipitating factors, a delirium episode is often reversible, especially in the earlier stages of a life-threatening illness. Until recently, antipsychotics have played a pivotal role in delirium management, but this role now requires critical re-evaluation in light of recent research that failed to demonstrate their efficacy in mild- to moderate-severity delirium occurring in palliative care patients. Non-pharmacological strategies for the management of delirium play a fundamental role and should be optimized through the collective efforts of the whole interprofessional team. Refractory agitated delirium in the last days or weeks of life may require the use of pharmacological sedation to ameliorate the distress of patients, which is invariably juxtaposed with increasing distress of family members. Further evaluation of multicomponent strategies for delirium prevention and treatment in the palliative care patient population is urgently required.
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Affiliation(s)
- Shirley Harvey Bush
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Bruyère Research Institute (BRI), Ottawa, ON, Canada. .,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada. .,Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada.
| | - Sallyanne Tierney
- Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Peter Gerard Lawlor
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute (BRI), Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
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186
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Wu GJ, Chen JT, Tsai HC, Chen TL, Liu SH, Chen RM. Protection of Dexmedetomidine Against Ischemia/Reperfusion-Induced Apoptotic Insults to Neuronal Cells Occurs Via an Intrinsic Mitochondria-Dependent Pathway. J Cell Biochem 2017; 118:2635-2644. [DOI: 10.1002/jcb.25847] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/15/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Gong-Jhe Wu
- Department of Anesthesiology; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
- Comprehensive Cancer Center; Taipei Medical University; Taipei Taiwan
| | - Jui-Tai Chen
- Graduate Institute of Medical Sciences; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Hsiao-Chien Tsai
- Anesthesiology and Health Policy Research Center; Taipei Medical University; Taipei Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center; Taipei Medical University; Taipei Taiwan
| | - Shing-Hwa Liu
- Institute of Toxicology, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Ruei-Ming Chen
- Comprehensive Cancer Center; Taipei Medical University; Taipei Taiwan
- Graduate Institute of Medical Sciences; College of Medicine; Taipei Medical University; Taipei Taiwan
- Anesthesiology and Health Policy Research Center; Taipei Medical University; Taipei Taiwan
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187
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Cowan K, Landman RA, Saini A. Dexmedetomidine as an Adjunct to Treat Anticholinergic Toxidrome in Children. Glob Pediatr Health 2017; 4:2333794X17704764. [PMID: 28491929 PMCID: PMC5406198 DOI: 10.1177/2333794x17704764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Krista Cowan
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Landman
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Arun Saini
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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188
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The Benefit of Neuromuscular Blockade in Patients with Postanoxic Myoclonus Otherwise Obscuring Continuous Electroencephalography (CEEG). Crit Care Res Pract 2017; 2017:2504058. [PMID: 28265468 PMCID: PMC5317108 DOI: 10.1155/2017/2504058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/08/2017] [Accepted: 01/18/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53.3 years; 58.3% male) met inclusion criteria of clinical postanoxic myoclonus. The initial CEEG patterns immediately prior to neuromuscular blockade showed myoclonic artifact with continuous slowing (50%), burst suppression with myoclonic artifact (41.7%), and continuous myogenic artifact obscuring CEEG (8.3%). After intravenous administration of cisatracurium (0.1 mg–2 mg), reduction in artifact improved quality of CEEG recordings in 9/12 (75%), revealing previously unrecognized patterns: continuous EEG seizures (33.3%), lateralizing slowing (16.7%), burst suppression (16.7%), generalized periodic discharges (8.3%), and, in the patient who had an initially uninterpretable CEEG from myogenic artifact, continuous slowing. Conclusion. Short-acting neuromuscular blockade is useful in determining background cerebral activity on CEEG otherwise partially or completely obscured by muscle artifact in patients with postanoxic myoclonus. Fully understanding background cerebral activity is important in prognostication and treatment, particularly when there are underlying EEG seizures.
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189
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190
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Rashid MR, Najeeb R, Mushtaq S, Habib R. Comparative evaluation of midazolam, dexmedetomidine, and propofol as Intensive Care Unit sedatives in postoperative electively ventilated eclamptic patients. J Anaesthesiol Clin Pharmacol 2017; 33:331-336. [PMID: 29109631 PMCID: PMC5672512 DOI: 10.4103/joacp.joacp_380_15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Eclampsia is a common hypertensive disorder of pregnancy and treatment often includes termination of pregnancy with elective postoperative mechanical ventilation. The present study was aimed to compare midazolam, propofol, and dexmedetomidine for sedation and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy. Material and Methods: A total of ninety eclamptic patients administered general anesthesia for the termination of pregnancy through cesarean section and who also required postoperative ventilation were taken up for the study and were randomly allocated into three groups. All patients received MgSO4 (loading dose, 4 g intravenous) following first seizure episode followed by a continuous infusion for next 24 h. Midazolam group (GrM) received 0.05 mg/kg loading dose of midazolam, followed by infusion of 0.05–0.3 mg/kg/h, propofol group (GrP) received 1 mg/kg loading dose of propofol followed by infusion of 2–8 mg/kg/h, and dexmedetomidine group (GrD) received dexmedetomidine loading dose at 1 mcg/kg followed by infusion of 0.2–1.2 mcg/kg/h. Postoperatively, patients were assessed for hemodynamic stability, requirement of antihypertensive and analgesics, duration of sedation and stop sedation-discharge, and total time spent in the ICU. Results: Mean heart rate and mean arterial pressure recorded at different time intervals were lowest in GrD. Nearly 70% (n = 21) patients in the GrM required antihypertensive, 50% (n = 15) in GrP, and 36.6% (n = 11) in the GrD (P < 0.05). Duration of stop sedation-discharge from ICU was least in GrD. A number of patients demanding additional analgesics was also least in GrD. Conclusion: Sedation with dexmedetomidine produced better hemodynamic stability in eclamptic patients, and there was a significant reduction in requirement of additional analgesics (P = 0.035) and antihypertensive (P = 0.004). Total duration of ICU stay was also less in this group of patients.
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Affiliation(s)
- Malik Rameez Rashid
- Department of Anaesthesia and Critical Care, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rukhsana Najeeb
- Department of Anaesthesia and Critical Care, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Saima Mushtaq
- Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rizwana Habib
- Department of Obstretrics and Gynecology, Government Medical College, Srinagar, Jammu and Kashmir, India
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191
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Rudiger A, Singer M. Decatecholaminisation during sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:309. [PMID: 27716402 PMCID: PMC5048664 DOI: 10.1186/s13054-016-1488-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alain Rudiger
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, CH 8091, Zurich, Switzerland.
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, WC1E 6BT, UK
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192
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Zhao J, Zhou C. The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period. Exp Ther Med 2016; 12:2903-2908. [PMID: 27882094 PMCID: PMC5103723 DOI: 10.3892/etm.2016.3711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of the present study was to analyze the protective and hemodynamic effects of dexmedetomidine in hypertensive cerebral hemorrhage (HCH) patients during perioperative period. In total, 50 HCH patients were selected and randomly divided into two groups, one group was administered with dexmedetomidine and the other groups with midazolam. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were monitored in the two groups of patients before and during the operation. The MAP, HR, SpO2 and PETCO2 recorded 5 min after admission into the operation room was considered T1, the same parameters recorded 10 min after drug administration were considered T2, just after starting the operation were considered T3 and 30 min after start of operation were considered T4. The preoperative sedation and analgesia were evaluated by the Ramsay scoring method and the neuron-specific enolase (NSE) and S100 protein (S100β) were estimated using ELISA. The patients of the midazolam group experienced mild respiratory depression during the period of sedation. Levels of, MAP, HR and PETCO2 were significantly increased whereas SPO2 was decreased (P<0.05). The MAP, HR, SPO2 and PETCO2 were stable during the period of sedation (P>0.05). The plasma concentrations of epinephrine and norepinephrine at T1 were similar in the two groups (P>0.05), but decreased after drug administration. This decrease was more prominent in the dexmedetomidine group patients (P<0.05) than midazolam group patients. The epinephrine and norepinephrine concentrations just after starting operation (T3) were higher than the basal level (T1) in the midazolam group, but close to the basal level in the dexmedetomidine group (P<0.05). The serum concentration of NSE and S100β in the two groups showed no difference (P>0.05) at the end of operation (T5), but after 24 h of operation (T7) NSE and S100β in the dexmedetomidine group were significantly lower compared to the midazolam group (P<0.05). In conclusion, the administration of dexmedetomidine for patients with HCH during perioperative period is safe and serves as an effective sedative, without causing respiratory depression and does not influence stable haemodynamics with certain brain protective effect.
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Affiliation(s)
- Junhui Zhao
- Department of Anesthesiology, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Chuixian Zhou
- Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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Schickli MA, Eberwein KA, Short MR, Ratliff PD. Pharmacy-Driven Dexmedetomidine Stewardship and Appropriate Use Guidelines in a Community Hospital Setting. Ann Pharmacother 2016; 51:27-32. [PMID: 27543645 DOI: 10.1177/1060028016666100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dexmedetomidine is a widely utilized agent in the intensive care unit (ICU) because it does not suppress respiratory drive and may be associated with less delirium than midazolam or propofol. Cost of dexmedetomidine therapy and debate as to the proper duration of use has brought its use to the forefront of discussion. OBJECTIVE To validate the efficacy and cost savings associated with pharmacy-driven dexmedetomidine appropriate use guidelines and stewardship in mechanically ventilated patients. METHODS This was a retrospective cohort study of adult patients who received dexmedetomidine for ICU sedation while on mechanical ventilation at a 433-bed not-for-profit community hospital. Included patients were divided into pre-enactment (PRE) and postenactment (POST) of dexmedetomidine guideline groups. RESULTS A total of 100 patients (50 PRE and 50 POST) were included in the analysis. A significant difference in duration of mechanical ventilation (11.1 vs 6.2 days, P = 0.006) and incidence of reintubation (36% vs 18% of patients, P = 0.043) was seen in the POST group. Aggregate use of dexmedetomidine 200-µg vials (37.1 vs 18.4 vials, P = 0.010) and infusion days (5.4 vs 2.5 days, P = 0.006) were significantly lower in the POST group. Dexmedetomidine acquisition cost savings were calculated at $374 456.15 in the POST group. There was no difference between the PRE and POST groups with regard to ICU length of stay, expected mortality, and observed mortality. CONCLUSIONS Pharmacy-driven dexmedetomidine appropriate use guidelines decreased the use of dexmedetomidine and increased cost savings at a community hospital without adversely affecting clinical outcomes.
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Dexmedetomidine as an adjunct for sedation in patients with traumatic brain injury. J Trauma Acute Care Surg 2016; 81:345-51. [DOI: 10.1097/ta.0000000000001069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McLaughlin M, Marik PE. Dexmedetomidine and delirium in the ICU. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:224. [PMID: 27385042 DOI: 10.21037/atm.2016.05.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew McLaughlin
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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196
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Fang G, Wan L, Mei W, Yu HH, Luo AL. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Anaesthesia 2016; 71:700-5. [PMID: 26945818 DOI: 10.1111/anae.13445] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 12/31/2022]
Affiliation(s)
- G. Fang
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - L. Wan
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - W. Mei
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - H. H. Yu
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - A. L. Luo
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Ohmori T, Shiota N, Haramo A, Masuda T, Maruyama F, Wakabayashi K, Adachi YU, Nakazawa K. Post-operative cardiac arrest induced by co-administration of amiodarone and dexmedetomidine: a case report. J Intensive Care 2015; 3:43. [PMID: 26500779 PMCID: PMC4618359 DOI: 10.1186/s40560-015-0109-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
We firstly report a postoperative hemodialysis patient who was co-administered with amiodarone and dexmedetomidine and developed severe bradycardia followed by cardiac arrest. A 79-year-old male patient underwent an amputation of the right lower extremity. The electrocardiogram of the patient showed a complete right bundle branch block with left anterior fascicular block before the anesthesia, and paroxysmal atrial tachycardia over 200 beats/min lasting 15 min was observed during surgery. After admission to the intensive care unit, the intensivist and the consultant cardiologist decided to treat tachycardia using amiodarone. The initial dosing of amiodarone and the maintenance infusion succeeded to decrease the heart rate. Approximately 2 h and a half after the start of dexmedetomidine infusion for sedation, the heart rate gradually declined and severe bradycardia suddenly followed by cardiac arrest was observed. Resuscitation was promptly initiated and the patient regained sinus rhythm without delay. In retrospective analysis, the monitoring record of the electrocardiogram revealed the marked atrioventricular conduction abnormalities. This is the first case report concerning a cardiac arrest induced by amiodarone and dexmedetomidine.
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Affiliation(s)
- Takafumi Ohmori
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Nobuhiro Shiota
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Akihiro Haramo
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Takahiro Masuda
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Fumi Maruyama
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Kenji Wakabayashi
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Yushi U Adachi
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
| | - Koichi Nakazawa
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Medical Hospital, M&D Tower 15th floor, 1-5-45 Yushima, Bunkyo-ku, 1138519 Tokyo Japan
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