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Vitin AA, Egan TD. Remifentanil-induced hyperalgesia: the current state of affairs. Curr Opin Anaesthesiol 2024; 37:371-378. [PMID: 38841986 DOI: 10.1097/aco.0000000000001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Remifentanil-induced hyperalgesia (RIH) is a part of a general opioid-induced hyperalgesia (OIH) syndrome, seemingly resulting from abrupt cessation of continuous remifentanil infusion at rates equal or exceeding 0.3 mcg/kg/min. The intricate mechanisms of its development are still not completely understood. However, hyperactivation of the N -methyl d -aspartate receptor system, descending spinal facilitation and increased concentration of dynorphin (a κ-opioid ligand) are commonly proposed as possible mechanisms. Several ways of prevention and management have been suggested, such as slow withdrawal of remifentanil infusion, the addition of propofol, pretreatment with or concomitant administration of ketamine, buprenorphine, cyclooxygenase-2 inhibitors (NSAIDs), methadone, dexmedetomidine. In clinical and animal studies, these strategies exhibited varying success, and many are still being investigated.
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Affiliation(s)
| | - Talmage D Egan
- Department of Anesthesiology, Perioperative & Pain Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Hailu S, Abbabu S, Seifu A, Gorde N, Besha A. Effectiveness of different doses of dexmedetomidine on intraoperative haemodynamic profiles and postoperative pain in patients undergoing abdominal surgery at Dilla University Referral Hospital, Ethiopia, 2024: a double-blind randomized controlled trial. Ann Med Surg (Lond) 2024; 86:4495-4504. [PMID: 39118723 PMCID: PMC11305718 DOI: 10.1097/ms9.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 08/10/2024] Open
Abstract
Background and objective Abdominal surgery stands as one of the most frequently conducted procedures across surgical specialties, accounting for up to half of surgery-related expenses. Hemodynamic instability emerges as a significant concern during anaesthesia and surgery, provoked by the stress of intubation, surgical incision, and anaesthetic agents. Following abdominal surgery, pain is an inevitable consequence, typically managed with opioid-based analgesia. However, the adverse effects associated with opioids often overshadow their analgesic benefits, particularly in the context of abdominal surgery. Consequently, there exists a necessity to explore and assess alternative non-opioid pain management options post-abdominal surgery as part of a broader strategy to reduce opioid usage. The primary aim of this investigation is to assess the effectiveness of varying doses of dexmedetomidine in regulating intraoperative hemodynamics and alleviating postoperative pain in patients undergoing abdominal surgery. Methods Ethical clearance and institutional review board were obtained from the ethical clearance committee of Dilla University College of Medicine and Health Sciences with protocol unique number of duirb/008/22-01. Our trial has been prospectively registered on the Pan African Clinical Trial Registry with a unique identification number for the registry PACTR202208813896934. Statistical package and analysis were performed by using SPSS version 25. The distribution of data was checked by using Shapiro-Wilk test and the homogeneity of variance was checked by Levene's test. Analysis of variance (ANOVA) and Kruskal-Wallis H test were used for normally distributed continuous data and non-normally distributed or non-parametric data, respectively. P value less than 0.05 with a power of 90% was considered statistically significant. Result There was a statistically significant increase in mean SBP in the control group at the different critical time points (P<0.05), as compared to the baseline value, while there was no significant difference in mean systolic blood pressure (SBP) between the baseline and all other levels for group 2 and group 3. A statistically significant increase in mean arterial pressure (MAP) was detected in the control group at immediately after intubation (P=0.009) as compared to the baseline value, while a statistically significant reduction in mean heart rate (HR) was observed in group 3 at 15th min after infusion and at 30th 30 min after induction compared to baseline with a P value of 0.002 and 0.008, respectively.Conclusion:Perioperative low-dose infusion of dexmedetomidine at the rate of 0.4 mcg/kg/h is a useful anaesthesia adjuvant to control hemodynamic stress response to critical periods. It is wise to use this infusion dose as part of general anaesthesia to achieve better hemodynamic stability.
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Affiliation(s)
- Seyoum Hailu
- Department of Anesthesia, Dilla University, Dilla
| | | | - Ashenafi Seifu
- Department of Anesthesia, Addis Ababa University, Addis Ababa
| | - Naol Gorde
- Department of Anesthesia, Wolaita Sodo University, Soddo
| | - Aschalew Besha
- Department of Anesthesia, Hawassa University, Awasa, Ethiopia
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Gaiwal S, Palep JH, Mirkute R, Prasad N, Kush M. Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial. J Minim Access Surg 2024:01413045-990000000-00068. [PMID: 39095983 DOI: 10.4103/jmas.jmas_69_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/07/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) programs represent a shift in perioperative care, combining evidence-based interventions to reduce surgical stress to expedite recovery. ERAS requires cohesive team efforts to facilitate early discharge and reduce hospital stays. Anaesthesia and pneumoperitoneum management within ERAS play crucial roles in influencing postoperative outcomes. Laparoscopic cholecystectomy is widely acknowledged as the foremost approach for managing symptomatic gallstone disease due to its minimally invasive nature and favourable recovery. It has been demonstrated that increased abdominal pressures with prolonged CO2 exposure produce changes in cardio-vascular and pulmonary dynamics, which can be minimized by insufflating at minimum pressure required for adequate exposure, as advocated by European endoscopic guidelines. Dexmedetomidine, a highly selective alpha-2 adrenoreceptor agonist, has gained attention in anaesthesia armamentarium due to its sedative, analgesic, sympatholytic, and opioid-sparing properties. For multimodal opioid sparing postoperative pain management it's advantageous. AIM To evaluate combined effect of low-pressure pneumoperitoneum and intra-operative dexmedetomidine infusion in laparoscopic cholecystectomy for ERAS. PATIENTS AND METHODS 160 patients of American Society of Anaesthesiologists (ASA) score 1 and 2, undergoing elective laparoscopic cholecystectomy were randomized into low pressure pneumoperitoneum (10-12 mmHg) and standard pressure pneumoperitoneum (13-15 mmHg) groups. Each group is subdivided into, no Dexmedetomidine (ND) and with Dexmedetomidine (WD) infusion (0.7 mcg/kg/hr) intra-operatively. Thus, 40 patients in each of the 4 study arms. Perioperative variables were collected and analysed. RESULTS AND CONCLUSIONS Low pressure pneumoperitoneum with intra-operative Dexmedetomidine infusion (0.7 mcg/kg/hr) resulted in stable hemodynamics, reduced post-operative pain, no requirement of additional analgesics and early discharge. Thus, synergistic impact of these interventions significantly improved postoperative outcomes when used as part of ERAS protocols.
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Affiliation(s)
- Sucheta Gaiwal
- Department of Anaesthesiology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - J H Palep
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rohini Mirkute
- Department of Anaesthesiology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Nimitha Prasad
- Department of Anaesthesiology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Mehta Kush
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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Gupta K, Singh P, Singh V, Singh GP. Comparison of the Efficacies of Dexmedetomidine and Clonidine in Preventing Postoperative Nausea and Vomiting in Paediatric Patients Undergoing Abdominal Surgeries. Cureus 2024; 16:e64789. [PMID: 39156421 PMCID: PMC11329882 DOI: 10.7759/cureus.64789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is a common complication in paediatric patients undergoing abdominal surgeries. Dexmedetomidine and clonidine, both α2-adrenergic agonists, have been proposed as potential treatments for PONV due to their antiemetic properties. This study aimed to compare the efficacies of dexmedetomidine and clonidine in the prevention of PONV in paediatric patients following abdominal surgeries Methods Eighty patients, aged five to 12 years undergoing abdominal surgeries under general anaesthesia were enrolled in this study. Patients were randomly assigned to receive either a single intravenous dose of 0.5 µg/kg of dexmedetomidine (Group D; n=40) or 1 µg/kg of clonidine (Group C; n = 40) 10 minutes before extubation. PONV was recorded for the next 24 hours. Results The baseline characteristics of patients were comparable. A higher proportion of patients in the clonidine group developed PONV as compared to the dexmedetomidine group (27.5% vs 20.0%, p=0.189). The visual analogue scale (VAS) score of group C was higher than that of group D (1.38±1.55 vs 1.00±1.26) but was not statistically significant. The Paediatric Anaesthesia Emergence Delirium (PAED) scale score or emergence agitation (EA) score was higher in group C during recovery time. The mean arterial pressures and the heart rates were comparable in both groups. No significant side effects were reported. Conclusion Our study concludes that dexmedetomidine and clonidine effectively control PONV in paediatric abdominal surgery, with no significant difference in incidence or severity. Dexmedetomidine significantly reduced PAED scale scores during recovery, indicating better control of EA. The two treatments showed comparable mean arterial pressures and heart rates without significant side effects.
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Affiliation(s)
- Khooshabo Gupta
- Department of Anaesthesiology and Critical Care, King George's Medical University, Lucknow, IND
| | - Premraj Singh
- Department of Anaesthesiology and Critical Care, King George's Medical University, Lucknow, IND
| | - Vinita Singh
- Department of Anaesthesiology and Critical Care, King George's Medical University, Lucknow, IND
| | - Gyan Prakash Singh
- Department of Anaesthesiology and Critical Care, King George's Medical University, Lucknow, IND
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K R V, Singh K, Sahay N, Sinha C, Kumar A, Kumar N. Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Anesth Pain Med (Seoul) 2024; 19:109-116. [PMID: 38725165 PMCID: PMC11089293 DOI: 10.17085/apm.23097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and analgesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. METHODS Study included 88 patients aged 18-60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentanyl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. RESULTS Both groups had similar demographic characteristics. The opioid-free group required lesser analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 ± 28.2 vs. 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. CONCLUSIONS Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associated with decreased PONV.
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Affiliation(s)
- Vishnuraj K R
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
| | - Kunal Singh
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
| | - Nishant Sahay
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
| | - Chandni Sinha
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
| | - Amarjeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
| | - Neeraj Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, India
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Watson DJ, Nemecek E, Bongiovanni R, Merlin MA. Dexmedetomidine Utilization During Air Medical Transport for Agitated Patients. Air Med J 2024; 43:60-62. [PMID: 38154843 DOI: 10.1016/j.amj.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 12/30/2023]
Abstract
Fixed Wing Air Ambulance providers routinely transport patients agitated from traumatic brain injury sequelae across long distances in a unique environment. The current paradigm limits options available to air medical clinicians to those routinely found on ground based, short distance vehicles, plus whatever a sending facility might be willing to provide. We postulate that dexmedetomidine offers a safe, effective alternative to improve patient care and enhance the safe operation of aircraft.
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Affiliation(s)
- David J Watson
- Angel MedFlight Worldwide Air Ambulance Service, Scottsdale, AZ.
| | - Erik Nemecek
- Angel MedFlight Worldwide Air Ambulance Service, Scottsdale, AZ
| | | | - Mark A Merlin
- Angel MedFlight Worldwide Air Ambulance Service, Scottsdale, AZ
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Moon J, Chun DH, Kong HJ, Lee HS, Jeon S, Park J, Kim NY, Kim HI. The Intraoperative Administration of Dexmedetomidine Alleviates Postoperative Inflammatory Response in Patients Undergoing Laparoscopy-Assisted Gastrectomy: A Double-Blind Randomized Controlled Trial. Biomedicines 2023; 11:3253. [PMID: 38137474 PMCID: PMC10741238 DOI: 10.3390/biomedicines11123253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Surgical stress can compromise the immune system of patients with cancer, affecting susceptibility to perioperative infections, tumor progression, treatment responses, and postoperative recovery. Perioperatively reducing inflammatory responses could improve outcomes. We determined the impact of intraoperative dexmedetomidine administration on the inflammatory response and postoperative recovery in patients undergoing elective laparoscopy-assisted gastrectomy. These patients were randomly assigned to the dexmedetomidine or control group (n = 42 each). The primary endpoint was the C-reactive protein (CRP) level on postoperative day 1. The secondary endpoints included the perioperative interleukin (IL)-6 levels, postoperative numerical rating scale (NRS) scores, and rescue analgesic doses. There were no significant between-group differences in terms of CRP levels. The IL-6 levels at the end of the surgery, NRS scores in the post-anesthesia care unit, and rescue pethidine requirements within the first hour postoperatively were significantly lower in the dexmedetomidine group than in the control group. The bolus deliveries-to-attempts ratio (via patient-controlled analgesia) at 2 h differed significantly between the two groups. However, IL-6 reduction was confined to a single timepoint, and the postoperative analgesic effects lasted for the first 2 h postoperatively. Low-dose dexmedetomidine infusion (0.4 µg kg-1 h-1) during laparoscopy-assisted gastrectomy exerts minimal anti-inflammatory effects.
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Affiliation(s)
- Jiae Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Duk-Hee Chun
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea
| | - Hee Jung Kong
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Soyoung Jeon
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Jooeun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.M.); (H.J.K.); (J.P.)
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Farmawy MSE, Mowafy SMS, Wahdan RA. Epidural nalbuphine versus dexmedetomidine as adjuvants to bupivacaine in lower limb orthopedic surgeries for postoperative analgesia: a randomized controlled trial. BMC Anesthesiol 2023; 23:401. [PMID: 38057695 PMCID: PMC10699026 DOI: 10.1186/s12871-023-02348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Administration of adjuvant drugs epidurally in combination with local anesthetics offers new dimensions in the management of postoperative pain. This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative analgesia in lower limb orthopedic surgeries under combined spinal-epidural anesthesia. METHODS This prospective randomized double-blind study included 69 patients scheduled for lower limb orthopedic surgeries. Anesthesia was started with 15 mg hyperbaric bupivacaine 0.5% intrathecally, and then an epidural bolus dose of 12 ml (10 ml 0.25% bupivacaine with 2 ml normal saline in group C, 2 ml (10 mg) nalbuphine in group N or dexmedetomidine 2 ml (100 µg) in group D was administered when sensory regression to T10. Postoperatively, when visual analogue scale (VAS) was ≥ 3, an epidural top-up dose of 8 ml (6 ml 0.25% bupivacaine plus 2 ml normal saline in group C, 2 ml (2 mg) nalbuphine in group N or 20 µg dexmedetomidine (2 ml) in group D was given. The primary outcome was to evaluate the duration of postoperative analgesia and secondary outcomes were any side effects and patient satisfaction. RESULTS The onset of epidural analgesia was 17.83 ± 2.53 versus 13.39 ± 1.27 versus 12.17 ± 1.27 min in groups C, N and D, respectively (p value < 0.001). The mean duration of analgesia was 241.3 ± 14.24 versus 318.38 ± 22.54 versus 365.87 ± 18.01 min in groups C, N and D, respectively (p value < 0.001). The mean sedation score was less in group C than group N and D (P < 0.001). The patient satisfaction score showed the lowest degree of satisfaction in group C (p value < 0.001). Top-up doses consumed and total analgesic requirements were lower in groups N and D than in group C. There was a statistically significant difference between the studied groups regarding VAS over time (p value < 0.001), intraoperative bradycardia (p value 0.029), and shivering (p value 0.029). CONCLUSION The addition of either nalbuphine or dexmedetomidine to epidural bupivacaine was effective for postoperative analgesia in terms of onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine. TRIAL REGISTRATION Approval from the research ethics committee of the Faculty of Medicine, Zagazig University was obtained with the reference number (ZU-IRB#:7045-15-8-2021) and it was registered under clinicaltrials.gov (NCT05041270) on registration date 13/09/2021.
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Affiliation(s)
- Manal S E Farmawy
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif M S Mowafy
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Rehab A Wahdan
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Peršec J, Šribar A, Ilić M, Mamić I, Kifer D, Domijan AM, Maleš Ž, Turčić P. Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:691-708. [PMID: 38147472 DOI: 10.2478/acph-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
The aim of this study was to compare the effects of dexmedetomidine and dexamethasone as adjuvants to preoperative epidural administration of local anesthetic (ropivacaine) in thoracic surgery on the postoperative level of pain, use of analgesics, inflammation, and oxidative stress. The study enrolled 42 patients who underwent elective thoracic surgery in a one-year period at the University Hospital Dubrava (Zagreb, Croatia). Based on a computer-generated randomization list the patients were assigned to the dexmedetomidine (n = 18) or dexamethasone (n = 24) group. Postoperatively, patients of dexmedetomidine group reported lower pain (VAS value 1 h post surgery, 3.4 ± 2.7 vs. 5.4 ± 1.8, dexmedetomidine vs. dexamethasone, p < 0.01) and had lower anal-gesic requirements in comparison with dexamethasone group. Thus, dexmedetomidine in comparison with dexamethasone was more efficient in lowering pain and analgesia requirements 24 h after the surgery. On the contrary, dexamethasone had better anti-inflammatory properties (CRP level 24 h post surgery, 131.9 ± 90.7 vs. 26.0 ± 55.2 mg L-1, dexmedetomidine vs. dexamethasone, p < 0.01). Both dexmedetomidine and dexamethasone exhibited antioxidant effects, however, their antioxidant properties should be further explored. The results of this study improve current knowledge of pain control in thoracic surgery.
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Affiliation(s)
- Jasminka Peršec
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrej Šribar
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Monika Ilić
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
| | - Ivan Mamić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
| | - Domagoj Kifer
- 4University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Biophysics, Zagreb, Croatia
| | - Ana-Marija Domijan
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Željan Maleš
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Petra Turčić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
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Jin Z, Rismany J, Gidicsin C, Bergese SD. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. J Anesth 2023; 37:624-640. [PMID: 37311899 PMCID: PMC10263381 DOI: 10.1007/s00540-023-03206-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care. We will also discuss the different models of postoperative care, including enhanced recovery pathways, as well as elective critical care admission. With discoveries of new effective interventions, and advances in healthcare information technology, optimized pathways could be developed to provide the best care possible that meets the challenges of perioperative frailty.
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Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Joshua Rismany
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Christopher Gidicsin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA.
- Department of Neurosurgery, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Kim D, Lee C, Bae H, Kim J, Oh EJ, Jeong JS. Comparison of the perfusion index as an index of noxious stimulation in monitored anesthesia care of propofol/remifentanil and propofol/dexmedetomidine: a prospective, randomized, case-control, observational study. BMC Anesthesiol 2023; 23:183. [PMID: 37237353 DOI: 10.1186/s12871-023-02116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Dexmedetomidine, one of the sedatives, has an analgesic effect. We aimed to investigate postoperative analgesia with dexmedetomidine as adjuvants for procedural sedation using perfusion index (PI). METHODS In this prospective, randomized, case-control, observational study, 72 adult patients, 19-70 years, who were scheduled for chemoport insertion under monitored anesthesia care were performed. According to the group assignment, remifentanil or dexmedetomidine was simultaneously infused with propofol. The primary outcome was PI 30 min after admission to the post anesthesia care unit (PACU). And, pain severity using numerical rating scale (NRS) score and the relationship between NRS score and PI were investigated. RESULTS During PACU staying, PI values were significantly different between the two groups PI values at 30 min after admission to the PACU were 1.3 (0.9-2.0) in the remifentanil group and 4.5 (2.9-6.8) in the dexmedetomidine group (median difference, 3; 95% CI, 2.1 to 4.2; P < 0.001). The NRS scores at 30 min after admission to the PACU were significantly lower in the dexmedetomidine group (P = 0.002). However, there was a weak positive correlation between NRS score and PI in the PACU (correlation coefficient, 0.188; P = 0.01). CONCLUSION We could not find a significant correlation between PI and NRS score for postoperative pain control. Using PI as a single indicator of pain is insufficient. TRIAL REGISTRATION Clinical Trial Registry of Korea, https://cris.nih.go.kr : KCT0003501, the date of registration: 13/02/2019.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Changjin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - HanWool Bae
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University Scholl of Medicine, Gwangmyeong, Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, 06351, Gangnam, Seoul, Korea.
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Xie M, Deng Y, Wang Z, He Y, Wu X, Zhang M, He Y, Liang Y, Li T. Development and assessment of novel machine learning models to predict the probability of postoperative nausea and vomiting for patient-controlled analgesia. Sci Rep 2023; 13:6439. [PMID: 37081130 PMCID: PMC10119140 DOI: 10.1038/s41598-023-33807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/19/2023] [Indexed: 04/22/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) can lead to various postoperative complications. The risk assessment model of PONV is helpful in guiding treatment and reducing the incidence of PONV, whereas the published models of PONV do not have a high accuracy rate. This study aimed to collect data from patients in Sichuan Provincial People's Hospital to develop models for predicting PONV based on machine learning algorithms, and to evaluate the predictive performance of the models using the area under the receiver characteristic curve (AUC), accuracy, precision, recall rate, F1 value and area under the precision-recall curve (AUPRC). The AUC (0.947) of our best machine learning model was significantly higher than that of the past models. The best of these models was used for external validation on patients from Chengdu First People's Hospital, and the AUC was 0.821. The contributions of variables were also interpreted using SHapley Additive ExPlanation (SHAP). A history of motion sickness and/or PONV, sex, weight, history of surgery, infusion volume, intraoperative urine volume, age, BMI, height, and PCA_3.0 were the top ten most important variables for the model. The machine learning models of PONV provided a good preoperative prediction of PONV for intravenous patient-controlled analgesia.
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Affiliation(s)
- Min Xie
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yan Deng
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zuofeng Wang
- Department of Anesthesiology, Chengdu First People's Hospital, Chengdu, Sichuan, 610017, People's Republic of China
| | - Yanxia He
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Xingwei Wu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, 610072, People's Republic of China
| | - Meng Zhang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yao He
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yu Liang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Tao Li
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Ke HH, Liou JY, Teng WN, Hsu PK, Tsou MY, Chang WK, Ting CK. Opioid-sparing anesthesia with dexmedetomidine provides stable hemodynamic and short hospital stay in non-intubated video-assisted thoracoscopic surgery: a propensity score matching cohort study. BMC Anesthesiol 2023; 23:110. [PMID: 37013487 PMCID: PMC10069055 DOI: 10.1186/s12871-023-02032-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted thoracic surgery (VATS) may reduce opioid-related complications such as postoperative nausea and vomiting (PONV), dyspnea, constipation, dizziness, skin itching, and cause minimal respiratory depression, and stable hemodynamic status. METHODS Patients who underwent non-intubated VATS lung wedge resection with propofol combined with dexmedetomidine (group D) or alfentanil (group O) between December 2016 and May 2022 were enrolled in this retrospective propensity score matching cohort study. Intraoperative vital signs, arterial blood gas data, perioperative results and treatment outcomes were analyzed. Of 100 patients included in the study (group D, 50 and group O, 50 patients), group D had a significantly lower degree of decrement in the heart rate and the blood pressure than group O. Intraoperative one-lung arterial blood gas revealed lower pH and significant ETCO2. The common opioid-related side effects, including PONV, dyspnea, constipation, dizziness, and skin itching, all of which occurred more frequently in group O than in group D. Patients in group O had significantly longer postoperative hospital stay and total hospital stay than group D, which might be due to opioid-related side effects postoperatively. CONCLUSIONS The application of dexmedetomidine in non-intubated VATS resulted in a significant reduction in perioperative opioid-related complications and maintenance with acceptable hemodynamic performance. These clinical outcomes found in our retrospective study may enhance patient satisfaction and shorten the hospital stay.
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Affiliation(s)
- Hui-Hsuan Ke
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jing-Yang Liou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Nung Teng
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Hsu
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Kun Ting
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Jacob Y, Schneider B, Spies C, Heinrich M, von Haefen C, Kho W, Pohrt A, Müller A. In a secondary analysis from a randomised, double-blind placebo-controlled trial Dexmedetomidine blocks cholinergic dysregulation in delirium pathogenesis in patients with major surgery. Sci Rep 2023; 13:3971. [PMID: 36894596 PMCID: PMC9998872 DOI: 10.1038/s41598-023-30756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
Dexmedetomidine is an alpha-2 adrenoreceptor agonist with anti-inflammatory and anti-delirogenic properties. Pathogenesis of postoperative delirium (POD) includes cholinergic dysfunction and deregulated inflammatory response to surgical trauma. Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) are discussed as biomarkers for both POD and severity in acute inflammation. To show whether there is a link between blood cholinesterase activities and dexmedetomidine, we performed a secondary analysis of a randomised, double-blind, placebo-controlled trial that recently showed a lower incidence of POD in the dexmedetomidine group. Abdominal or cardiac surgical patients aged ≥ 60 years were randomised to receive dexmedetomidine or placebo intra- and postoperatively in addition to standard general anaesthesia. We analysed the course of perioperative cholinesterase activities of 56 patients, measured preoperatively and twice postoperatively. Dexmedetomidine resulted in no change in AChE activity and caused a rapid recovery of BChE activity after an initial decrease, while placebo showed a significant decrease in both cholinesterase activities. There were no significant between-group differences at any point in time. From these data it can be assumed that dexmedetomidine could alleviate POD via altering the cholinergic anti-inflammatory pathway (CAIP). We advocate for further investigations to show the direct connection between dexmedetomidine and cholinesterase activity.
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Affiliation(s)
- Yanite Jacob
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany
| | - Bill Schneider
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany
| | - Maria Heinrich
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - Clarissa von Haefen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany
| | - Widuri Kho
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Anika Müller
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Platz 1, 10117, Berlin, Germany.
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15
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Wang K, Cai J, Du R, Wu J. Global trends in research related to emergence delirium, 2012–2021: A bibliometric analysis. Front Psychol 2023; 14:1098020. [PMID: 36968713 PMCID: PMC10031052 DOI: 10.3389/fpsyg.2023.1098020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
IntroductionEmergence delirium is a kind of mental disorder during the early awakening period after general anesthesia, which is manifested as the combination of perceptual disturbance and psychomotor agitation. It is an independent risk factor for postoperative delirium and even long-term postoperative cognitive decline, which often affects the postoperative outcome and deserves the attention of clinical anesthesiologists. There are many studies on emergence delirium, but the quantity and quality of these studies are unclear. Therefore, we conducted a bibliometric analysis of studies on emergence delirium between January 2012 and December 2021. Through the analysis of relevant literature, the research hotspots and trends of emergence delirium are understood, which can provide a reference for future research.MethodsWe searched the Web of Science Core Collection (WoSCC) for original articles and reviews related to emergence delirium published between 2012 and 2021, and collected a variety of bibliographic elements, including annual publications, authors, countries/regions, institutions, journals, and keywords. Three different science-based tools (CiteSpace, VOSviewer and Bibliometrix) were used for this comprehensive analysis.ResultsFrom January 2012 to December 2021, a total of 912 emergence delirium (ED) related literature were published, including 766 original research articles and 146 review articles. The number of publications has increased every year except 2016. The United States published 203 articles, ranking first with China, followed by South Korea (95 articles). The United States is also the country with the most citations (4,508), and Yonsei Univ is the most productive institution. The most published journal was PEDIATRIC ANESTHESIA, with the highest h and g index. LEE JH is the most influential author in this field.Discussion“Children, emergence agitation, delirium, dexmedetomidine” are the hot topics in this field in recent years. The bibliometric analysis in this field will provide the future direction for the study of emergence delirium for clinicians.
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Affiliation(s)
- Kenru Wang
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiehui Cai
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Jiehui Cai,
| | - Ruiming Du
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Ruiming Du,
| | - Jiaxuan Wu
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Jiaxuan Wu,
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Hung TY, Lin YC, Wang YL, Lin MC. Efficacy and safety of intravenous dexmedetomidine as an adjuvant to general anesthesia in gynecological surgeries: A systematic review and meta-analysis of randomized controlled trials. Taiwan J Obstet Gynecol 2023; 62:239-251. [PMID: 36965890 DOI: 10.1016/j.tjog.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 03/27/2023] Open
Abstract
This study investigated the efficacy and safety of intravenous dexmedetomidine as an adjuvant to general anesthesia in patients undergoing gynecological surgery. We systemically searched for randomized controlled trials (RCTs), and performed a meta-analysis on studies that met the inclusion criteria. The primary outcomes were postoperative nausea and vomiting (PONV), bradycardia, hypotension, and 24 h opioid consumption. The secondary outcomes include postoperative shivering, postoperative pain score, intraoperative anesthetic consumption, extubation time, postoperative sedation, and the time to first flatus. Twenty-five RCTs were included in this study. Meta-analysis showed that intravenous dexmedetomidine significantly reduced the risk of PONV (RR, 0.57 [0.47, 0.68]) and postoperative shivering (RR: 0.31 [0.22, 0.42]), 24 h opioid consumption (Mean Difference: - 4.85 mg [-8.60, -1.11]) and postoperative pain score within 24 h. However, these benefits were at the cost of increased bradycardia (RR, 3.21 [2.41, 4.28]) and hypotension (RR, 2.17 [1.50, 3.14]). Notably, no serious adverse effects were reported in any of the included studies. Thus, our study showed that intravenous dexmedetomidine provided significant antiemetic and anti-shivering effects and moderate analgesic effects in patients that underwent gynecological surgery. However, its benefits should be weighed against the significantly increased risk of bradycardia and hypotension.
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Affiliation(s)
- Tsung-Yu Hung
- Department of Anesthesia, MacKay Memorial Hospital, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesia, MacKay Memorial Hospital, Taiwan; Mackay Medical College, Taiwan; Mackay Medicine, Nursing and Management College, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Yeou-Lih Wang
- Mackay Medical College, Taiwan; Mackay Medicine, Nursing and Management College, Taiwan; Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taiwan
| | - Mei-Chi Lin
- Department of Anesthesia, MacKay Memorial Hospital, Taiwan; Mackay Medical College, Taiwan; Mackay Medicine, Nursing and Management College, Taiwan.
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17
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Kong H, Li M, Deng CM, Wu YJ, He ST, Mu DL. A comprehensive overview of clinical research on dexmedetomidine in the past 2 decades: A bibliometric analysis. Front Pharmacol 2023; 14:1043956. [PMID: 36865921 PMCID: PMC9971591 DOI: 10.3389/fphar.2023.1043956] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction: Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, and opioid-sparing properties. A large number of dexmedetomidine-related publications have sprung out in the last 2 decades. However, no bibliometric analysis for clinical research on dexmedetomidine has been published to analyze hot spots, trends, and frontiers in this field. Methods: The clinical articles and reviews related to dexmedetomidine, published from 2002 to 2021 in the Web of Science Core Collection, were retrieved on 19 May 2022, using relevant search terms. VOSviewer and CiteSpace were used to conduct this bibliometric study. Results: The results showed that a total of 2,299 publications were retrieved from 656 academic journals with 48,549 co-cited references by 2,335 institutions from 65 countries/regions. The United States had the most publications among all the countries (n = 870, 37.8%) and the Harvard University contributed the most among all institutions (n = 57, 2.48%). The most productive academic journal on dexmedetomidine was Pediatric Anesthesia and the first co-cited journal was Anesthesiology. Mika Scheinin is the most productive author and Pratik P Pandharipande is the most co-cited author. Co-cited reference analysis and keyword analysis illustrated hot spots in the dexmedetomidine field including pharmacokinetics and pharmacodynamics, intensive care unit sedation and outcome, pain management and nerve block, and premedication and use in children. The effect of dexmedetomidine sedation on the outcomes of critically ill patients, the analgesic effect of dexmedetomidine, and its organ protective property are the frontiers in future research. Conclusion: This bibliometric analysis provided us with concise information about the development trend and provided an important reference for researchers to guide future research.
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Affiliation(s)
| | | | - Chun-Mei Deng
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yu-Jia Wu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shu-Ting He
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Liang Mu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
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18
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Zarfoss EL, Garavaglia J, Hayanga JWA, Kabulski G. Comparison of Standard-Dose Versus High-Dose Dexmedetomidine in Extracorporeal Membrane Oxygenation. Ann Pharmacother 2023; 57:121-126. [PMID: 35678713 DOI: 10.1177/10600280221102474] [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: 01/05/2023] Open
Abstract
BACKGROUND Dexmedetomidine is commonly used to achieve light sedation in patients on extracorporeal membrane oxygenation (ECMO) despite minimal evidence. In vivo studies have shown dexmedetomidine sequestration in ECMO circuits, and higher doses may be used to overcome sequestration. OBJECTIVE The purpose of this study was to compare safety and efficacy of dexmedetomidine at standard versus high doses in ECMO. METHODS A retrospective analysis of adult ECMO patients was performed. Patients were compared as receiving either standard-dose (≤1.5 µg/kg/h) or high-dose (>1.5 µg/kg/h) dexmedetomidine. Safety outcomes included new onset bradycardia or hypotension. Efficacy was compared by the addition of concomitant sedative and analgesic agents. RESULTS One hundred five patients were evaluated, with 20% of patients in the high-dose group. Comparing standard and high dosing, no significant differences were seen in primary safety outcomes including bradycardia (49% vs 38%, P = 0.46), hypotension (79% vs 71%, P = 0.56), or addition of vasopressors (75% vs 71%, P = 0.78). Need for concomitant analgesic agents and propofol was similar between groups. CONCLUSION AND RELEVANCE This represents the first evaluation of use of high-dose dexmedetomidine in ECMO. Rates of dexmedetomidine higher than 1.5 µg/kg/h were commonly used in patients on ECMO, with similar rates of adverse effects and need for concomitant propofol and analgesic agents. While high-dose dexmedetomidine may be as safe as standard dose, no additional efficacy was found.
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Affiliation(s)
- Erika L Zarfoss
- Department of Pharmacy, WVU Medicine - West Virginia University Hospitals, Morgantown, WV, USA
| | - Jeffrey Garavaglia
- Department of Pharmacy, WVU Medicine - West Virginia University Hospitals, Morgantown, WV, USA
| | - J W Awori Hayanga
- Department of Medicine, WVU Medicine - West Virginia University Hospitals, Morgantown, WV, USA
| | - Galen Kabulski
- Department of Pharmacy, WVU Medicine - West Virginia University Hospitals, Morgantown, WV, USA
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ELHoshy HS, ELBardan IM. Comparison between different anaesthesia techniques for protecting renal function in children undergoing radical nephrectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2092301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Hassan Saeed ELHoshy
- Lecturer of Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Islam Mohamed ELBardan
- Lecturer of Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Zeng L, Liu J, Zhang T, Liu Y, Liao L, Chen X, Dong S. Study on the protective mechanism of dexmedetomidine on the liver of perioperative diabetic patients: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e30899. [PMID: 36254014 PMCID: PMC9575753 DOI: 10.1097/md.0000000000030899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although several studies have reported that dexmedetomidine is a highly selective α2-adrenergic receptor agonist that protects liver function in perioperative patients by inhibiting oxidative stress (OS) and inflammatory response, patients with type 2 diabetes mellitus (T2DM) have not been included in the previous studies. The purpose of this study was to investigate the effects of perioperative low-dose dexmedetomidine on perioperative liver function in T2DM patients. METHODS This was a single-center, placebo-controlled randomized trial. Fifty-four T2DM patients scheduled for debridement of lower extremity ulcers were included in this study and randomly divided into 2 groups (n = 27 per group): the dexmedetomidine group (DEX group) and the control group (CON group). Continuous intravenous infusion of dexmedetomidine (DEX group) or normal saline (CON group) was administered from the completion of monitoring to the end of surgery. All participants received femoral and sciatic nerve block with 0.33% ropivacaine. The main result was the activity of liver enzymes (AST, ALT) reflecting liver function. The secondary results included variables reflecting blood glucose (Glu), blood lipids (TG, HDL, LDL, total cholesterol), biomarkers of OS (MDA, SOD), and systemic inflammatory response (TNF-α, IL-6). RESULTS Compared with CON group, DEX group exhibited a reduction in hemodynamic parameters, Glu, systemic inflammatory response, and liver injury indicators. OS response MDA activity was lower in DEX group than in CON group, while SOD was higher than that in CON group. The variables reflecting lipid metabolism function showed no differences between the groups. CONCLUSION SUBSECTIONS Dexmedetomidine administered perioperatively can reduce Glu levels and protect the liver by attenuating OS injury and inflammatory response in T2DM patients without any potential risk.
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Affiliation(s)
- Lin Zeng
- Shifang People’s Hospital, Shifang, Sichuan Province, China
| | - Juan Liu
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Tianyao Zhang
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yusong Liu
- Shifang People’s Hospital, Shifang, Sichuan Province, China
| | - Lumiu Liao
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xuelian Chen
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Shuhua Dong
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- * Correspondence: Shuhua Dong, Department of Anesthesiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China (e-mail: dong. )
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21
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Li B, Zhao Y, Liu X, Liu Y, Zhang J, Zhang W. The Optimal Dose of Intraoperative Dexmedetomidine for Antiemetic Effects of Post-operative Nausea and Vomiting in Patients Undergoing Elective Thoracic Surgery: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:891096. [PMID: 35559335 PMCID: PMC9090336 DOI: 10.3389/fmed.2022.891096] [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: 03/07/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dexmedetomidine (DEX) administration decreases post-operative nausea and vomiting (PONV), but it is a lack of large-scale retrospective cohort study and is unclear whether there is a dose-relationship and optimal dose for antiemetic effects between DEX and PONV. We performed a large-scale retrospective cohort study to explore the optimal dose of intraoperative DEX for antiemetic effects of PONV. Methods A total of 5,310 patients aged ≥18 who underwent elective thoracic surgery from January 2016 to March 2020 under total intravenous anesthesia (TIVA) or combined intravenous and inhalation anesthesia in Henan Provincial People's Hospital. Patients were divided into two groups, those who received DEX intraoperatively and those who did not receive DEX. Patients who received DEX after surgery were excluded. Our primary outcomes were the association, the dose-response relationship, and the optimal dose for antiemetic effects between intraoperative DEX and PONV. Results Among the 3,878 patients enrolled, 2,553 patients received DEX and 1,325 patients did not receive DEX. The incidence of PONV in patients who received DEX was 21.3%, and the incidence of PONV in patients who did not receive DEX was 46.5% (P = 0.001). After the matched-pairs cohort consisted of 1,325 patients, the incidence of PONV in patients who received DEX was 23.6%, and the incidence of PONV in patients who did not receive DEX was 46.5% (P = 0.001). We analyzed three different models after propensity matching to validate the stability of the prediction model between intraoperative DEX and PONV. A dose-response relationship between intraoperative DEX and PONV was observed. The optimal dose range of intraoperative DEX for antiemetic effects of PONV is 50–100 μg in elective thoracic surgery. Conclusions Intraoperative DEX was associated with a decreased incidence of PONV in the large-scale retrospective cohort study. A dose-response relationship between intraoperative DEX and PONV was observed. The optimal dose range of intraoperative DEX for antiemetic effects of PONV is 50–100 μg in elective thoracic surgery.
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Affiliation(s)
- Bing Li
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Zhao
- Department of Anesthesiology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinmin Liu
- Department of Anesthesiology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Liu
- Department of Anesthesiology, People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jiaqiang Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China
- *Correspondence: Jiaqiang Zhang
| | - Wei Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China
- Wei Zhang
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Zhang W, Wang R, Li B, Zhao Y, Liu X, Yuan J. The Effect of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients Undergoing Thoracic Surgery-A Meta-Analysis of a Randomized Controlled Trial. Front Surg 2022; 9:863249. [PMID: 35433815 PMCID: PMC9008250 DOI: 10.3389/fsurg.2022.863249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dexmedetomidine reduces the occurrence of postoperative nausea and vomiting (PONV); however, the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery remains inconclusive. In addition, the effect of different dexmedetomidine application methods, anesthetics, and surgical procedures on the effects of dexmedetomidine on PONV remains unclear. Therefore, the purpose of this meta-analysis was to study the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery. Methods Electronic databases were searched to identify randomized controlled trials studying the effects of dexmedetomidine on nausea and vomiting after thoracic surgery. In total, 12 articles that met the inclusion criteria were obtained. The primary outcome of this comprehensive analysis was the incidence of PONV; secondary outcomes included the incidence of postoperative nausea, the incidence of postoperative vomiting, postoperative visual analog score (VAS), the amount of intraoperative sufentanil, and the number of times postoperative salvage analgesia was administered. Results Twelve trials involving 905 participants undergoing thoracic surgery were included. Compared with placebo, dexmedetomidine reduced the incidence of nausea and vomiting after thoracic surgery [12 trials; 905 participants; risk ratio (RR) = 0.32; 95% CI (0.23, 0.44); P < 0.00001, I2 = 0%]. The subgroup analysis revealed that dexmedetomidine reduces the occurrence of PONV in both thoracotomy and thoracoscopic surgery. In addition, both intravenous and local infusion of dexmedetomidine can reduce the occurrence of PONV, and intravenous or inhaled anesthetics do not affect the effect of dexmedetomidine on reducing PONV. Dexmedetomidine can reduce the postoperative resting VAS of patients, and no statistically significant differences in the amount of intraoperative sufentanil and the number of salvage analgesia procedures after surgery were noted. Conclusion Compared with placebo, dexmedetomidine can reduce the occurrence of PONV in patients undergoing thoracic surgery, and this effect is not affected by the method of dexmedetomidine administration, use of minimally invasive surgery, and use of a combination of intravenous or inhalation anesthetics. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, PROSPERO, identifier: CRD42021269358.
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Affiliation(s)
- Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ruohan Wang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Zhao
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinmin Liu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingli Yuan
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Kardash K, Harvey E, Payne S, Yang SS. Single-dose premedication enhances multimodal analgesia after knee arthroplasty. J Perioper Pract 2022:17504589211049292. [PMID: 35322698 DOI: 10.1177/17504589211049292] [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]
Abstract
BACKGROUND With the current trend to reduce postoperative opioid use to enhance recovery and address perioperative opioid addiction concerns, the challenge of managing pain after total knee arthroplasty has increased. This study examined the effect of adding a preoperative medication regime to a multimodal postoperative analgesia protocol that included regional anaesthesia. MATERIALS AND METHODS Sixty patients undergoing elective first-time unilateral knee arthroplasty received celecoxib 100mg, gabapentin 600mg and dexamethasone 10mg po one hour before skin incision. They were compared to a sequential retrospective cohort of 49 patients. All patients routinely received acetaminophen 650mg po q6h, ibuprofen 400mg po q8h, patient-controlled opioid analgesia and continuous adductor canal blocks postoperatively. Pain scores and opioid consumption were recorded at 4, 8, 12, 24 and 48h. RESULTS Pain scores and cumulative opioid use were statistically and clinically significantly reduced at all time points up to 48h. CONCLUSIONS Combining preoperative oral celecoxib, gabapentin and dexamethasone had a clinically significantly effect in reducing pain scores and opioid use for at least 48h. Most of this effect is probably due to dexamethasone.
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Affiliation(s)
- Kenneth Kardash
- Department of Anesthesia, Jewish General Hospital and McGill University, Montreal, Canada
| | - Eric Harvey
- Department of Anesthesia, Jewish General Hospital and McGill University, Montreal, Canada
| | - Stacey Payne
- Department of Nursing, Jewish General Hospital and McGill University, Montreal, Canada
| | - Stephen Su Yang
- Department of Anesthesia, Jewish General Hospital and McGill University, Montreal, Canada
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Efe Mercanoglu E, Girgin Kelebek N, Turker G, Aksu H, Ozgur M, Karakuzu Z, Turkcan S, Ozcan B. Comparison of the Effect of Ketamine and Dexmedetomidine Combined with Total Intravenous Anesthesia in Laparoscopic Cholecystectomy Procedures: A Prospective Randomized Controlled Study. Int J Clin Pract 2022; 2022:1878705. [PMID: 35936068 PMCID: PMC9334052 DOI: 10.1155/2022/1878705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
This randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 μg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 μg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.
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Affiliation(s)
| | | | - G. Turker
- Uludag University, School of Medicine, Bursa, Turkey
| | - H. Aksu
- Uludag University, School of Medicine, Bursa, Turkey
| | - M. Ozgur
- Uludag University, School of Medicine, Bursa, Turkey
| | - Z. Karakuzu
- Uludag University, School of Medicine, Bursa, Turkey
| | - S. Turkcan
- Uludag University, School of Medicine, Bursa, Turkey
| | - B. Ozcan
- Uludag University, School of Medicine, Bursa, Turkey
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25
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Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial. Braz J Anesthesiol 2021; 72:593-598. [PMID: 34848312 PMCID: PMC9515666 DOI: 10.1016/j.bjane.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/22/2021] [Accepted: 10/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. Results: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.
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Abstract
Adequate pain management is important for successful postoperative recovery after any surgical procedure. Unfortunately, the USA and many other parts of the world are in the midst of an opioid epidemic, and healthcare providers are thus tasked with balancing the comfort and recovery of their patients after an operation against the individual and societal harms of the over-prescription of opioids. The goal of this article is to discuss the range of opioid formulations currently in use, examine why this may be problematic, and explore alternatives that provide similar efficacy and may improve overall safety in the pediatric population after urologic surgery. Improving the way opioids are prescribed through clinical practice guidelines as well as considering alternatives to opioids can ensure patients have access to safer and more effective pain treatments and potentially reduce opioid misuse.
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Oh C, Hong B, Jo Y, Jeon S, Park S, Chung W, Ko Y, Lee SY, Lim C. Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial. J Clin Med 2021; 10:jcm10122579. [PMID: 34208055 PMCID: PMC8230569 DOI: 10.3390/jcm10122579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during dexmedetomidine infusion. Methods: Patients scheduled for upper extremity surgery were randomly allocated into a control and an epinephrine group. All patients received brachial plexus blockade, consisting of 25 mL of a 1:1 mixture of 1% lidocaine and 0.75% ropivacaine, with patients in the epinephrine group also receiving 125 μg epinephrine. Intraoperative sedation was induced using dexmedetomidine at a loading dose of 1 µg/kg and maintenance dose of 0.4 µg/kg/hr. The primary outcome was the incidence of intraoperative hypotension or hypotension in the post-anesthesia care unit (PACU). Results: One hundred and thirty patients were included (65 per group). The incidence of hypotension was significantly higher in the epinephrine than in the control group (80.6% vs. 56.9%, p = 0.009). The duration of hypotension and the maximal change in blood pressure were also greater in the epinephrine group. Conclusions: Perineural epinephrine for brachial plexus blockade does not reduce hypotension due to dexmedetomidine infusion and may actually augment the occurrence of hypotensive events.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Seungbin Jeon
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
| | - Sooyong Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Sun Yeul Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
- Correspondence: (S.Y.L.); (C.L.)
| | - Chaeseong Lim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea; (C.O.); (B.H.); (Y.J.); (S.J.); (S.P.); (W.C.); (Y.K.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
- Correspondence: (S.Y.L.); (C.L.)
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Mason KP, Park RS, Sullivan CA, Lukovits K, Halpin EM, Imbrescia ST, Cavanaugh D, Prescilla R, Fox VL. The synergistic effect of dexmedetomidine on propofol for paediatric deep sedation: A randomised trial. Eur J Anaesthesiol 2021; 38:541-547. [PMID: 33009191 DOI: 10.1097/eja.0000000000001350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Propofol and dexmedetomidine are used separately, and sometimes together, for paediatric deep sedation. Although their combination has been described in adults, the effect of dexmedetomidine as a potential synergist in children has not been studied before. OBJECTIVES The primary objective was to compare the propofol requirements of children who receive propofol alone with those who receive it in combination with dexmedetomidine for deep sedation for upper and lower endoscopic gastrointestinal procedures. DESIGN This was a prospective, open-label, randomised study comparing patients who received propofol alone (group P) with those who received dexmedetomidine and propofol (group DP). The depth of sedation was titrated to a target bispectral (BIS) index. SETTING A Gastroenterology Procedure Unit at a single, tertiary care academic medical centre from April 2018 until December 2019. PATIENTS Eligible patients were scheduled for upper endoscopy, lower endoscopy or both. A total of 39 patients were enrolled (20 DP) and (19 P). INTERVENTIONS Patients in Group DP received dexmedetomidine 0.5 μg kg-1 administered over 1 min followed by an infusion of 0.15 μg kg-1 h-1. In both groups, intravenous propofol was given in bolus increments titrated to a BIS index of 40 to 50 and then a continuous infusion of propofol to maintain BIS at 40 to 50. MAIN OUTCOME MEASURES The primary outcome measure was propofol requirement in each group. Secondary outcome measures were time to achieve the targeted sedation depth, time to achieve an Aldrete recovery score of 9, duration of sedation, mean BIS values, adverse events, 'PAED' scores and time to discharge from the postanaesthesia care unit (PACU). RESULTS The median (range) total dose of propofol was 0.23 (0.10 to 0.50) mg kg-1 min-1 in group DP and 0.40 (0.20 to 0.50) mg kg-1 min-1 in group P (P = 0.0004). Time of discharge from the PACU was 60 (20 to 121) min in group DP and 63 (46 to 91) min in group P (P = 0.0409). CONCLUSION The combination of dexmedetomidine and propofol for paediatric procedural sedation achieved a significant reduction in median propofol dose and a slightly shorter median time to discharge from PACU. Large-scale studies may determine whether this reduction decreases the risk of significant adverse events. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02952222.
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Affiliation(s)
- Keira P Mason
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston (KPM, RSP, CAS), Special Care Nursery, Winchester Hospital,Winchester (EMH), Department of Experimental Therapeutics/Interventional Trials, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston (STI), Boston Biostatistical Consulting, North Reading (DC), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital (KL, RP) and Division of Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA (VLF)
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De Cassai A, Boscolo A, Geraldini F, Zarantonello F, Pettenuzzo T, Pasin L, Iuzzolino M, Rossini N, Pesenti E, Zecchino G, Sella N, Munari M, Navalesi P. Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis. J Clin Anesth 2021; 72:110287. [PMID: 33873003 DOI: 10.1016/j.jclinane.2021.110287] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE An uncontrolled adrenergic response during tracheal intubation may lead to life-threatening complications. Dexmedetomidine binds to α2-receptors and may attenuate this response. The primary aim of our meta-analysis is to investigate dexmedetomidine efficacy in attenuating sympathetic response to tracheal intubation, compared with placebo or no dexmedetomidine, in terms of heart rate and blood pressure at intubation. DESIGN Meta-analysis with meta-regression and trial sequential analysis. SETTING Systematic search from inception until December 1, 2020 in the following databases: Pubmed, Scopus, the Cochrane Central Register of Controlled Trials, EMBASE and Google Scholar. INTERVENTIONS All randomized controlled trials investigating intravenous dexmedetomidine as premedication in adult patients undergoing tracheal intubation were included in our study. Studies were included without any language or publication date restriction. A trial sequential analysis and a post-hoc meta-regression were performed on the main outcomes. MEASUREMENTS Hemodynamic parameters and heart rate at tracheal intubation, dose of anesthetic needed for induction of anesthesia, total anesthetic requirement throughout the operative procedure, postoperative pain and percentage of patients requiring analgesics at 24 postoperative hours, postoperative nausea and vomiting, intraoperative and postoperative bradycardia, hypotension, dizziness, shivering and/or respiratory depression. MAIN RESULTS Ninety-nine included studies randomized 6833 patients. During laryngoscopy, all hemodynamic parameters were significantly greater in the no dexmedetomidine group. In particular, in the dexmedetomidine group, systolic blood pressure differed by -21.8 mm Hg (95% CI -26.6 to -17.1, p-value < 0.001, I2 97%), mean arterial pressure by -12.8 mm Hg (95% CI -15.6 to -10.0, p-value < 0.001, I2 98%), and heart rate by -16.9 bpm (95% CI -19.8 to -13.9, p-value < 0.001, I2 98%). CONCLUSIONS Patients receiving premedication with dexmedetomidine for tracheal intubation, compared with no dexmedetomidine, have a lower blood pressure and heart rate, however, the risk of bradycardia and hypotension is relevant and its use during daily practice should be cautiously evaluated for each patient.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Laura Pasin
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Margherita Iuzzolino
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Nicolò Rossini
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Elisa Pesenti
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giovanni Zecchino
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy; UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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Zhang X, Bai Y, Shi M, Ming S, Jin X, Xie Y. Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis. Transl Pediatr 2021; 10:929-957. [PMID: 34012842 PMCID: PMC8107879 DOI: 10.21037/tp-21-105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Beneficial effects of dexmedetomidine (DEX) against emergence agitation (EA) in children remain controversial. We performed a more comprehensive meta-analysis to evaluate the protective effect of different administration routes, timing, patterns, and doses of DEX on EA in children. METHODS The randomized controlled trials about DEX preventing EA in children were searched in PubMed, Cochrane Library, Embase, and Web of Sciences up to October 7, 2020. The traditional meta-analysis and subgroup analysis were performed to study the influence of DEX on EA in children. The sequential trial analysis (TSA) further analyzed the pooled results to evaluate meta-analyses' robustness. Grading of recommendation, assessment, development, and evaluation (GRADE) was used to assess evidence quality. RESULTS Sixty-seven studies with 5,688 pediatric patients were included. DEX significantly decreased EA in children compared to placebo [RR 0.29, 95% confidence intervals (CI): 0.25-0.34] and midazolam (RR 0.34, 95% CI: 0.25-0.45), with firm evidence from TSA. Notably, using DEX significantly reduced severe EA incidence (RR 0.23, 95% CI: 0.16-0.32), with firm evidence by TSA and high quality of GRADE. Pre-specified subgroup analyses revealed firm and high-quality evidence for a reduction of EA, only if the perineural route administers DEX (RR 0.24, 95% CI: 0.14-0.41), as premedication (RR 0.27, 95% CI: 0.20-0.36), as continuous dosage (RR 0.25, 95% CI: 0.18-0.33), at high dose (RR 0.24, 95% CI: 0.18-0.31). The pooled results also showed that DEX reduced the incidence of PONV compared to placebo (RR 0.43, 95% CI: 0.33-0.55). Evidence for DEX's influence on other secondary outcomes (emergence time, time in PACU, rescue analgesia, hypotension, and bradycardia) is insufficient to draw any conclusion. CONCLUSIONS Our findings confirm the beneficial effects of DEX on EA, severe EA, and PONV in children. There was firm and high-quality evidence for the efficacy of DEX in preventing EA in children when perineural routes administered DEX, as premedication, as continuous dosage, and at a high dose. The best dose, route, patterns, and timing of DEX and influence on other outcomes call for further studies.
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Affiliation(s)
- Xu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Bai
- Department of Anesthesiology, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Min Shi
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shaopeng Ming
- Department of Anesthesiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaogao Jin
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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van Hoorn CE, Flint RB, Skowno J, Davies P, Engelhardt T, Lalwani K, Olutoye O, Ista E, de Graaff JC. Off-label use of dexmedetomidine in paediatric anaesthesiology: an international survey of 791 (paediatric) anaesthesiologists. Eur J Clin Pharmacol 2021; 77:625-635. [PMID: 33119787 PMCID: PMC7935836 DOI: 10.1007/s00228-020-03028-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/15/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this international study was to investigate prescribing practices of dexmedetomidine by paediatric anaesthesiologists. METHODS We performed an online survey on the prescription rate of dexmedetomidine, route of administration and dosage, adverse drug reactions, education on the drug and overall experience. Members of specialist paediatric anaesthesia societies of Europe (ESPA), New Zealand and Australia (SPANZA), Great Britain and Ireland (APAGBI) and the USA (SPA) were consulted. Responses were collected in July and August 2019. RESULTS Data from 791 responders (17% of 5171 invitees) were included in the analyses. Dexmedetomidine was prescribed by 70% of the respondents (ESPA 53%; SPANZA 69%; APAGBI 34% and SPA 96%), mostly for procedural sedation (68%), premedication (46%) and/or ICU sedation (46%). Seventy-three percent had access to local or national protocols, although lack of education was the main reason cited by 26% of the respondents not to prescribe dexmedetomidine. The main difference in dexmedetomidine use concerned the age of patients (SPA primarily < 1 year, others primarily > 1 year). The dosage varied widely ranging from 0.2-5 μg kg-1 for nasal premedication, 0.2-8 μg kg-1 for nasal procedural sedation and 0-4 μg kg-1 intravenously as adjuvant for anaesthesia. Only ESPA members (61%) had noted an adverse drug reaction, namely bradycardia. CONCLUSION The majority of anaesthesiologists use dexmedetomidine in paediatrics for premedication, procedural sedation, ICU sedation and anaesthesia, despite the off-label use and sparse evidence. The large intercontinental differences in prescribing dexmedetomidine call for consensus and worldwide education on the optimal use in paediatric practice.
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Affiliation(s)
- Camille E van Hoorn
- Department of Anaesthesiology, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Paediatric Surgery, Erasmus University Medical Centre -Sophia Children's Hospital, PO Box: 2060, 3000 CB, Rotterdam, The Netherlands.
| | - Robert B Flint
- Division of Neonatology, Department of Paediatrics, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Justin Skowno
- Department of Anaesthesiology, Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Paul Davies
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia
| | - Thomas Engelhardt
- Department of Anaesthesia, Royal Children's Hospital Aberdeen and School of Medicine, University of Aberdeen, Aberdeen, UK
- Department of Anaesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada
| | - Kirk Lalwani
- Department of Anaesthesiology and Paediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Olutoyin Olutoye
- Department of Anaesthesiology, Peri-operative and Pain Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Erwin Ista
- Department of Internal Medicine - Nursing Science, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Paediatric Surgery, Paediatric Intensive Care, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
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Siddiqui TH, Choudhary N, Kumar A, Kohli A, Wadhawan S, Bhadoria P. Comparative evaluation of dexmedetomidine and fentanyl in total intravenous anesthesia for laparoscopic cholecystectomy: A randomised controlled study. J Anaesthesiol Clin Pharmacol 2021; 37:255-260. [PMID: 34349376 PMCID: PMC8289637 DOI: 10.4103/joacp.joacp_253_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/11/2018] [Accepted: 05/12/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Laparoscopic cholecystectomy is one of the commonly performed ambulatory surgeries. The selection of anesthetic agents for ambulatory surgeries should be done bearing in mind the need for early discharge. Opioids form an integral component of total intravenous anesthesia (TIVA) but their associated side effects may result in an increased hospital stay. Hence, we planned a study to compare the opioid (fentanyl) and non-opioid (dexmedetomidine) based technique of TIVA for laparoscopic surgery. MATERIAL AND METHODS Ninety ASA I and II patients between 18-60 years of either sex posted for laparoscopic cholecystectomy were randomly allocated into two groups namely group D (Dexmedetomidine) and group F (Fentanyl). Patients received propofol infusion along with group specific drug infusion, after which an appropriate size proseal laryngeal mask airway was placed. The patients were assessed for discharge time from post-anesthesia care unit (PACU), on table recovery time, time to first rescue analgesia, hemodynamic parameters, incidence of postoperative nausea and vomiting (PONV) and any other complication. RESULTS Demographic profile of both the groups was comparable. Group D had longer on table recovery time (13.00 ± 2.34 min vs 6.29 ± 2.46 min; P < 0.001) and time to discharge from PACU (6.80 ± 3.96 min vs 2.36 ± 1.67 min; P < 0.001) compared to group F. Group F had better hemodynamic stability compared to group D. In group D, 77% patients required rescue analgesia in first one hour post surgery, unlike 22% in group F. No patient in group D had PONV. CONCLUSION Opioid based technique (Fentanyl) of TIVA is superior over non-opioid based (dexmedetomidine) technique with faster recovery, early discharge, decreased postoperative pain scores and better hemodynamic stability. PONV is observed with opioids which can be treated successfully with antiemetics.
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Affiliation(s)
- Tabish Husnain Siddiqui
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Nitin Choudhary
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Abhijit Kumar
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Amit Kohli
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Sonia Wadhawan
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Poonam Bhadoria
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
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Xu D, Zhou C, Lin J, Cai W, Lin W. Dexmedetomidine provides protection to neurons against OGD/R-induced oxidative stress and neuronal apoptosis. Toxicol Mech Methods 2021; 31:374-382. [PMID: 33648426 DOI: 10.1080/15376516.2021.1888363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dexmedetomidine, a potent α2-adrenoceptor (α2-AR) agonist, is extensively used in the operating room (OR) and intensive care unit (ICU) and has been applied for the treatment of several diseases. Western blotting has been routinely used to investigate the protein levels of α-adrenergic receptor (α-AR), apoptosis related proteins (Bcl-2, Bax and Cleaved Caspase 3) and a range of proteins associated with the Nrf2/ARE pathway (Nrf2, HO-1, NQO-1, SOD) in neurons. The CCK-8 assay was used to determine cell survival rates while the Co-IP assay was used to investigate the binding ability between α2-AR and Nrf2. The TUNEL assay was used to detect cell apoptosis in neurons. OGD/R treatment reduced the level of α2-AR protein in neurons and reduced neuronal survival in a time-dependent manner. However, treatment with dexmedetomidine led to the increased protein expression of α2-AR in OGD/R-treated neurons and enhanced survival rate of OGD/R-treated neurons. From a mechanistic point-of-view, Nrf2 can effectively bind with α2-AR. Silencing Nrf2 reversed the effects of dexmedetomidine on cell viability, oxidative stress, and neuronal apoptosis in OGD/R-treated neurons. The activation of α2-AR by dexmedetomidine had a protective effect in neurons against OGD/R-triggered oxidative stress and neuronal apoptosis by modulating the Nrf2/ARE pathway.
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Affiliation(s)
- Deming Xu
- Department of Anesthesiology, The Affiliated Hospital (Group) of Putian University, Putian City, China
| | - Changbi Zhou
- Department of Anesthesiology, The Affiliated Hospital (Group) of Putian University, Putian City, China
| | - Juanyun Lin
- Department of Anesthesiology, The Affiliated Hospital (Group) of Putian University, Putian City, China
| | - Wenhui Cai
- Department of Anesthesiology, The Affiliated Hospital (Group) of Putian University, Putian City, China
| | - Wei Lin
- Department of General Surgery, The Affiliated Hospital (Group) of Putian University, Putian City, China
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Effects of dexmedetomidine on immune function, renal function and inflammatory factors of patients undergoing percutaneous nephrolithotomy under general anesthesia. Exp Ther Med 2021; 21:406. [PMID: 33692837 PMCID: PMC7938444 DOI: 10.3892/etm.2021.9837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
The present study was designed to determine the effects of dexmedetomidine on immune function, renal function and inflammatory factors in patients undergoing percutaneous nephrolithotomy under general anesthesia. A total of 177 patients with kidney calculi who underwent percutaneous nephrolithotomy in The Second Affiliated Hospital of Fujian Medical University were enrolled, in which 91 patients were treated with dexmedetomidine during surgery (research group) and 86 patients were not sedated during surgery (control group). The vital signs, renal function, inflammatory factors and immune function during surgery between the two groups were compared. Patients in the research group showed improved vital signs, renal function, inflammatory factors and immune function compared with the control group (P<0.05), and also experienced a significantly shorter hospitalization time (P<0.001). Therefore, the present results suggested that with a relatively high safety profile, use of dexmedetomidine for sedation can effectively protect renal and immune functions, and reduce the inflammatory response of patients during percutaneous nephrolithotomy. Thus, dexmedetomidine may have be potentially applied in clinical practice.
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J N S, Kumar S, Vijay T. To Compare the Efficacy of Dexmedetomidine Versus Labetalol in Providing Controlled Hypotension in Functional Endoscopic Sinus Surgery. Anesth Pain Med 2021; 11:e108915. [PMID: 34221935 PMCID: PMC8241463 DOI: 10.5812/aapm.108915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Functional endoscopic sinus surgery (FESS) is a surgical intervention for sinus diseases. Bleeding is a common concern during FESS. Hemodynamic stability and quality surgical field visibility help to achieve the best outcomes. Objectives The present study primarily intended to compare the effectiveness of dexmedetomidine versus labetalol in providing controlled hypotension during FESS and then to assess the quality of the surgical field. Methods The current research was conducted as a prospective randomized double-blinded clinical study. Sixty patients of the American Society of Anesthesiologists grade I or II status undergoing FESS under general anesthesia were divided into two groups, each with 30 members. Patients receiving dexmedetomidine and labetalol were named as group D and L, respectively. The study intended to manage mean arterial pressure (MAP) between 65 - 75 mmHg. The visibility of the operative field was evaluated using Fromme and Boezaart scoring system. Total intraoperative fentanyl consumption and postoperative first analgesic request time were recorded. Results The MAP target was achieved in both groups. Intergroup differences concerning MAP were observed in both D (75.0 ± 2.0) and L (82.4 ± 5.2) groups (P-value < 0.05). Scores for blood loss were significantly lower in the D group (1.3 ± 0.3) compared to the L group (2.1 ± 0.3) (P-value < 0.05). There was no intergroup difference concerning the mean heart rate (group D; 70.8 ± 4.2, and group L; 73.4 ± 4.4). The total dose of fentanyl consumed was found to be significantly lower in the group D (41.9 ± 5.8) compared to group L (59.9 ± 5.3) (P-value < 0.05). The first analgesic request time was significantly longer in the group D (50.2 ± 9.1) compared to group L (24.8 ± 5.1) (P-value < 0.05). Conclusions Dexmedetomidine provided better hemodynamic stability and operative field visibility as compared to labetalol during FESS.
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Affiliation(s)
- Sujay J N
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
| | - Shiva Kumar
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
- Corresponding Author: Department of Anesthesiology Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India.
| | - Tanushree Vijay
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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Han DS, Brockel MA, Boxley PJ, Dönmez Mİ, Saltzman AF, Wilcox DT, Rove KO. Enhanced recovery after surgery and anesthetic outcomes in pediatric reconstructive urologic surgery. Pediatr Surg Int 2021; 37:151-159. [PMID: 33161476 DOI: 10.1007/s00383-020-04775-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) is a perioperative management strategy to hasten postoperative recovery. We examined the effects of a pilot implementation of ERAS for pediatric patients on anesthetic outcomes. METHODS We performed a prospective case-control study utilizing an ERAS protocol in patients aged < 18 years undergoing urologic reconstruction that included a bowel anastomosis. Protocol elements included: multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis. ERAS patients were propensity-matched with historical controls. Outcomes of interest included maximum PACU pain score, time to first opioid, opioid-free days, and need for opioids on day of discharge. RESULTS A total of 13 ERAS patients and 26 historical controls were included, with median ages 9.9 years (IQR 9.1-11) and 10.4 years (IQR 8.0-12.4), respectively. ERAS increased the percentage of patients who did not receive any intraoperative or postoperative opioids (0% vs 15%, p = 0.046 for both) and reduced maximum PACU pain score (3 vs 0, p < 0.001). The use of postoperative supplemental oxygen was decreased in the ERAS group (85% vs 38%, p = 0.013). CONCLUSIONS The implementation of an ERAS protocol appears to decrease postoperative pain, opioid usage, and positively impact other anesthetic outcomes in children undergoing urologic reconstructive surgery utilizing a bowel anastomosis.
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Affiliation(s)
- Daniel S Han
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, B-463, Aurora, CO, 80045, USA.
| | - Megan A Brockel
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Peter J Boxley
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, B-463, Aurora, CO, 80045, USA
| | - M İ Dönmez
- Department of Urology, Division of Pediatric Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, B-463, Aurora, CO, 80045, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, B-463, Aurora, CO, 80045, USA
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Dexmedetomidine suppresses bupivacaine-induced parthanatos in human SH-SY5Y cells via the miR-7-5p/PARP1 axis-mediated ROS. Naunyn Schmiedebergs Arch Pharmacol 2020; 394:783-796. [PMID: 32989562 DOI: 10.1007/s00210-020-01971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
This study aims to explore the regulatory mechanisms of dexmedetomidine in parthanatos. MTT assay was applied to reveal cell viability; JC-1 staining assay was utilized to reveal mitochondrial membrane potential. Reactive oxygen species (ROS) probe, DCFH-DA, was used to detect intracellular ROS production. Luciferase activity assay was applied to measure the binding between miR-7-5p and PARP1. We first identified that bupivacaine inhibited the viability and induced the parthanatos of human neuroblastoma SH-SY5Y cells. In addition, dexmedetomidine, a potent α2-adrenoceptor agonist, reversed the regulatory effect of bupivacaine on parthanatos of SH-SY5Y. More importantly, dexmedetomidine counteracted bupivacaine-induced changes of mitochondrial membrane potential and ROS production in SH-SY5Y cells. Hyper-activation of PARP1 plays a vital role in parthanatos. Further exploration of our study identified that bupivacaine triggered overexpression of PARP1 in SH-SY5Y cells. Bioinformatics analysis revealed that miR-7-5p targeted the 3' untranslated region (3' UTR) of PARP1 to inhibit PARP1 expression. In addition, dexmedetomidine recovered the suppressive effects of bupivacaine on miR-7-5p expression. Dexmedetomidine suppressed bupivacaine-induced parthanatos in SH-SY5Y cells via the miR-7-5p/PARP1 axis, which may shed a new insight into parthanatos-dependent neuronal injury.
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Ochroch J, Usman A, Kiefer J, Pulton D, Shah R, Grosh T, Patel S, Vernick W, Gutsche JT, Raiten J. Reducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative, Intraoperative, and Critical Care Strategies. J Cardiothorac Vasc Anesth 2020; 35:2155-2165. [PMID: 33069556 DOI: 10.1053/j.jvca.2020.09.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 02/08/2023]
Abstract
Patients undergoing cardiothoracic surgery are exposed to opioids in the operating room and intensive care unit and after hospital discharge. Opportunities exist to reduce perioperative opioid use at all stages of care and include alternative oral and intravenous medications, novel intraoperative regional anesthetic techniques, and postoperative opioid-sparing sedative and analgesic strategies. In this review, currently used and investigational strategies to reduce the opioid burden for cardiothoracic surgical patients are explored.
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Affiliation(s)
- Jason Ochroch
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Asad Usman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jesse Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ro Shah
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Taras Grosh
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jesse Raiten
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Wang XX, Dai J, Dai L, Guo HJ, Zhou AG, Pan DB. Caudal dexmedetomidine in pediatric caudal anesthesia: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21397. [PMID: 32756133 PMCID: PMC7402903 DOI: 10.1097/md.0000000000021397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of caudal dexmedetomidine in pediatric caudal anesthesia (CA). METHODS We searched PubMed, Embased, and Cochrane Library (from inception to June 2019) for eligible studies. The primary outcomes were the time to first analgesia, time of postoperative eye opening, intraoperative endtidal sevoflurane concentration, and postoperative sedation score. We calculated pooled risk ratios (RR) and 95% CIs using random- or fixed-effects models. RESULTS Thirteen trials involving 793 patients were found. Meta-analysis showed that the time to first rescue pain medication and the time from the end of anesthesia to eye opening in the CA+dexmedetomidine group were significantly longer than in the CA group (P < .00001). The intraoperative end-tidal sevoflurane concentration in the CA+dexmedetomidine group was significantly decreased (P < .00001). Dexmedetomidine appeared to increase the rate of bradycardia in the CA+dexmedetomidine group (P = .04). Additionally, the sedation score in the CA+ dexmedetomidine group was significantly higher at 2 hours after the operation compared with the CA group (P < .00001 at 2 hours). CONCLUSIONS Caudally administered dexmedetomidine is a good alternative for prolonging postoperative analgesia with less pain, decreased intraoperative end-tidal sevoflurane concentration, and full postoperative sedation.
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Reddy SK, Jones JJ, Gordish-Dressman H, Pestieau SR. Dexmedetomidine as an Opioid-Sparing Agent in Pediatric Craniofacial Surgery. CHILDREN-BASEL 2020; 7:children7070068. [PMID: 32630167 PMCID: PMC7401866 DOI: 10.3390/children7070068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings.
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Affiliation(s)
- Srijaya K. Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology—Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, 2200 Children’s Way Suite 3116, Nashville, TN 37232, USA
- Correspondence:
| | - Jacob J. Jones
- Division of Anesthesiology, Pain and Perioperative Medicine—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA; (J.J.J.); (S.R.P.)
| | - Heather Gordish-Dressman
- Center for Translational Research—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA;
| | - Sophie R. Pestieau
- Division of Anesthesiology, Pain and Perioperative Medicine—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA; (J.J.J.); (S.R.P.)
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Perioperative Dexmedetomidine Fails to Improve Postoperative Analgesic Consumption and Postoperative Recovery in Patients Undergoing Lateral Thoracotomy for Thoracic Esophageal Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial. Pain Res Manag 2020; 2020:4145893. [PMID: 32454920 PMCID: PMC7229565 DOI: 10.1155/2020/4145893] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
Objectives Dexmedetomidine is widely used as an adjunct to general anesthesia. In this study, we evaluated the effects of perioperative dexmedetomidine infusion on postoperative analgesia in patients undergoing lateral thoracotomy for thoracic esophageal cancer. Methods A total of 62 patients undergoing lateral thoracotomy for thoracic esophageal cancer were randomized to receive adjuvant therapy with either dexmedetomidine (0.5 μg/kg intravenous bolus injection for 10 min before induction of anesthesia, followed by continuous infusion of 0.2-0.4 μg/kg/h until the end of surgery, and 0.06 μg/kg/h for 5 days after surgery) or equal volumes of saline. Acute postoperative pain was treated with patient-controlled intravenous sufentanil and flurbiprofen axetil. The primary outcomes of this study were the numbers of analgesic requirements in the first postoperative 72 h. Results Perioperative dexmedetomidine did not decrease the numbers of analgesic requirements in the first postoperative 72 h (dexmedetomidine group: 12.14 ± 4.76, saline group: 10.89 ± 5.66; p=0.367). Likewise, the groups did not differ with respect to total postoperative analgesic requirements, postoperative pain, perioperative inflammation, blood cell count, incidence of adverse events, surgical recovery (assessed at postoperative days 2 and 5 using the surgical recovery scale), length of hospital stay, hospital cost, incidence of chronic pain, or quality of life. Notably, dexmedetomidine had beneficial effects on decreasing intraoperative opioid consumption and improving postoperative sleep quality. Discussion. Perioperative dexmedetomidine has limited analgesic benefits in lateral thoracotomy for esophageal cancer when added to an opioid-based multimodal anesthetic regimen but can reduce opioid consumption.
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Pan J, Hei Z, Li L, Zhu D, Hou H, Wu H, Gong C, Zhou S. The Advantage of Implementation of Enhanced Recovery After Surgery (ERAS) in Acute Pain Management During Elective Cesarean Delivery: A Prospective Randomized Controlled Trial. Ther Clin Risk Manag 2020; 16:369-378. [PMID: 32440135 PMCID: PMC7210449 DOI: 10.2147/tcrm.s244039] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/02/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to test whether the implementation of an enhanced recovery after surgery (ERAS) protocol for patients undergoing elective cesarean delivery has a positive impact on the postoperative status of the patients in terms of pain management, hospital stay, hospitalization costs, and adverse reactions. METHODS Patients who underwent elective cesarean delivery were randomized into two groups - ERAS group and control group - and the groups were managed with the ERAS protocol and traditional protocol, respectively. RESULTS Compared to the control group, the ERAS group had significantly fewer patients with intraoperative nausea, pain of visual analog scale (VAS) scores, and VAS grade >3 during rest in the first 24 h and during motion in the first 24 and 48 h after surgery. There were no intergroup differences in the requirement of extra analgesics, the incidence of vomiting, shivering, hypotension, postoperative nausea, and pruritus. None of the patients in either group had postoperative vomiting. Patient satisfaction rated as per the VAS was significantly higher in the ERAS group than in the control group. The total length of stay, postoperative length of stay, and the cost of anesthesia in both groups were comparable. Further, the average daily hospitalization cost was significantly lower in the ERAS group than in the control group. CONCLUSION The ERAS protocol shows promise and appears to be worthwhile for widespread implementation among patients undergoing elective cesarean delivery; it was found to be beneficial in reducing the postoperative pain, incidence of intraoperative nausea, and average cost of hospitalization and also improved patient satisfaction.
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Affiliation(s)
- Jingru Pan
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Liping Li
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Dan Zhu
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hongying Hou
- Department of Obstetrics, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Huizhen Wu
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Chulian Gong
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Shaoli Zhou
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
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Ju JY, Kim KM, Lee S. Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis. Anesth Pain Med (Seoul) 2020; 15:157-166. [PMID: 33329808 PMCID: PMC7713826 DOI: 10.17085/apm.2020.15.2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Alpha-2 agonists have sedative, analgesic, and opioid-sparing effects. Moreover, intraoperative or postoperative systemic administration of alpha-2 adrenergic agonists is known to reduce postoperative pain and opioid consumption. This meta-analysis investigated whether preoperative administration of alpha-2 agonists can affect postoperative pain and opioid consumption. Methods We searched the MEDLINE, EMBASE, Cochrane Library (CENTRAL), KoreaMed, and KMbase databases through March 2019 to identify relevant randomized controlled trials (RCTs) on the effect of preoperative systemic administration of alpha-2 agonists on postoperative pain and opioid consumption. We conducted a meta-analysis according to the Cochrane Collaboration guidelines. Standardized mean differences (SMDs) of postoperative pain intensity or dose of opioid consumption in the alpha-2 agonist group were extracted and combined using a random-effect model and were compared to those of the control group. Results Eleven RCTs involving 748 participants were included in this meta-analysis. Preoperative administration of systemic alpha-2 agonists significantly reduced cumulative opioid consumption up to 6 h (SMD, –0.52; 95% confidence interval [–0.90 to –0.14]) and 24 h (SMD, –0.68 [–1.27 to –0.09]) after surgery. Moreover, preoperative administration of alpha-2 agonists significantly reduced postoperative pain intensity at 6 h (SMD, –0.50 [–0.78 to –0.21]) and 24 h (SMD, –0.44 [–0.86 to –0.03]). Conclusions In this meta-analysis, high degree of heterogeneity limits the preoperative administration of alpha-2 agonists in reducing postoperative opioid consumption and pain intensity. Future powered large RCTs are required to increase the certainty of evidence on the effect in reducing postoperative opioid consumption and pain intensity.
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Affiliation(s)
- Ji Youn Ju
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Zoroufchi BH, Zangian H, Abdollahpour A. Examination of the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy surgery: A randomized controlled trial. J Family Med Prim Care 2020; 9:1042-1047. [PMID: 32318464 PMCID: PMC7113976 DOI: 10.4103/jfmpc.jfmpc_890_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: At present, laparoscopic surgery is a very common method, especially for the removal of the gallbladder, because pain and anxiety following surgery is a major problem in surgical operations. Various studies have demonstrated the effectiveness of gabapentin and dexmedetomidine in reducing pain intensity after surgery. The present study is aimed at examining the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy. Methods: This was a double-blinded clinical trial involving 40 patients who were candidates for laparoscopic cholecystectomy. The patients were randomly allotted in two groups of dexmedetomidine (n = 20) and gabapentin (n = 20). Then, pain intensity based on the visual analog scale (VAS) and sedation level based on the Ramsay Sedation Scale (RSS) were measured at the curtained times. As the data were not normally distributed, the Mann–Whitney U test was used to analyze the data, and the significance level was set at 0.05. Results: Across the follow-up points, more reduction in pain intensity was observed in the dexmedetomidine group as compared with the gabapentin group. The available dissimilarities between these two groups in pain decrement at the recovery room and 3 h after being discharged from the recovery room were not significant (P ≥ 0.414). In addition, across all the time points, there was considerable growth in sedation in the dexmedetomidine group in comparison with the gabapentin group (P < 0.024). This finding indicated that dexmedetomidine was more effective than gabapentin in creating sedation. Conclusion: Compared with gabapentin, dexmedetomidine leads to more pain reduction after surgery and better sedation during and after surgery.
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Affiliation(s)
- Babak H Zoroufchi
- Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Hoda Zangian
- Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Abolfazl Abdollahpour
- Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
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Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, Harbell MW, Lajaunie J, Cornett EM. Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain. Curr Pain Headache Rep 2020; 24:21. [PMID: 32240402 PMCID: PMC7223065 DOI: 10.1007/s11916-020-00853-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). RECENT FINDINGS Dexmedetomidine, a selective alpha2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA USA
| | | | - Pankaj Thakur
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103 USA
| | - Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103 USA
| | - Rachel J. Kaye
- Medical University of South Carolina, Charleston, SC 29425 USA
| | - Lauren K. Eng
- Tulane University School of Medicine, New Orleans, LA 70112 USA
| | - Monica W. Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054 USA
| | - Jared Lajaunie
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA 70112 USA
| | - Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103 USA
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Li S, Liu T, Xia J, Jia J, Li W. Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: a randomized controlled study. BMC Ophthalmol 2020; 20:86. [PMID: 32138784 PMCID: PMC7059381 DOI: 10.1186/s12886-020-01359-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. METHODS In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 μg/kg dexmedetomidine, and DEX2 group, 0.5 μg/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 h in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. RESULTS Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p = 0.0146). During the first 24 h post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p = 0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. CONCLUSION Dexmedetomidine (0.5 μg/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery. TRIAL REGISTRATION The trial was prospectively registered before patient enrollment at Chinese Clinical Trial Registry (Clinical Trial Number: ChiCTR1800020176, Date: 12/19/2018).
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Affiliation(s)
- Shuangshuang Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Tingjie Liu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Junming Xia
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jie Jia
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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Kruthiventi SC, Hofer RE, Warner ME, Sprung J, Kellogg TA, Weingarten TN. Postoperative nausea and vomiting after bariatric surgery and dexmedetomidine anesthetic: a propensity-weighted analysis. Surg Obes Relat Dis 2020; 16:545-553. [PMID: 32063491 DOI: 10.1016/j.soard.2020.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/27/2019] [Accepted: 01/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing laparoscopic bariatric surgery have high rates of postoperative nausea and vomiting (PONV). Dexmedetomidine based anesthetic could reduce PONV rates. OBJECTIVES To determine if PONV rates differ in patients undergoing laparoscopic bariatric surgery with anesthesia primarily based on dexmedetomidine or standard anesthetic management with inhalational agents and opioids. SETTING University hospital. METHODS From January 2014 to April 2018, 487 patients underwent laparoscopic bariatric surgery and met inclusion criteria (dexmedetomidine, n = 174 and standard anesthetic, n = 313 patients). In both groups, patients received preoperative PONV prophylaxis. We analyzed rates of PONV and moderate-to-deep sedation. A propensity score was calculated and outcomes were assessed using generalized estimating equations with inverse probability of treatment weighting. RESULTS Perioperative opioids and volatile anesthetics were reduced in dexmedetomidine patients. During anesthesia recovery the incidence of PONV was similar between dexmedetomidine and standard anesthetic patients (n = 37 [21.3%] versus n = 61 [19.5%], respectively; inverse probability of treatment weighting odds ratio = 1.35; 95% confidence interval .78-2.32, P = .281), and the incidence of sedation higher in dexmedetomidine patients (n = 86 [49.4%] versus n = 75 [24.0%]; inverse probability of treatment weighting odds ratio = 2.43; 95% confidence interval 1.47-4.03, P < 0.001). Rates of PONV and sedation were similar during the remainder of the hospital stay. A secondary sensitivity analysis was performed limited to dexmedetomidine patients who did not receive volatile and results were similar. CONCLUSIONS While dexmedetomidine-based anesthesia was associated with reduced opioid and volatile agents use, it was not associated with a reduction of PONV. The higher rates of moderate-to-deep sedation during anesthesia recovery observed with dexmedetomidine may be undesirable in morbidly obese patients.
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Affiliation(s)
| | | | | | - Juraj Sprung
- Department of Anesthesiology, Rochester, Minnesota
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Li HJ, Liu S, Geng ZY, Li XY. Adding dexmedetomidine to morphine-based analgesia reduces early postoperative nausea in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol 2020; 20:11. [PMID: 31914930 PMCID: PMC6950793 DOI: 10.1186/s12871-019-0928-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Few studies have investigated the effect of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients underwent gynecological laparoscopic surgery. We investigated if adding dexmedetomidine to a morphine-based patient-controlled analgesia (PCA) could decrease the incidence of PONV in this high-risk patient population. METHODS In this prospective, randomized, double-blind and placebo-controlled study, 122 patients underwent gynecological laparoscopic surgery were assigned into two groups. Patients in the dexmedetomidine group (Group Dex) received a loading dose of dexmedetomidine 0.4 μg/kg before the end of surgery, followed by morphine 0.5 mg/ml plus dexmedetomidine 1 μg/ml for postoperative i.v. PCA. Patients in the control group (Group Ctrl) received normal saline before the end of surgery, followed by morphine 0.5 mg/ml alone for postoperative i.v. PCA. PCA pump was programmed as followed: bolus dose 2 ml, lockout interval 8 min and background infusion at a rate of 1 ml/h. The primary outcome was the incidence of nausea and vomiting within the first postoperative 24 h. RESULTS Although there were no significant differences in regard to the total incidence of PONV (41.0% vs 52.5%, P = 0.204), PONV score, time to first onset of PONV, or the need for rescue antiemetics within the first postoperative 24 h between the two groups, the incidence of nausea and total PONV during the first 2 h period was significantly lower in the Group Dex than in the Group Ctrl (9.8% vs 24.6%, P = 0.031 and 0.031, respectively). More patients in Group Dex were over sedated or had bradycardia during the PACU compared with Group Ctrl (P = 0.040 and 0.036, respectively). CONCLUSION Our protocol in which dexmedetomidine was administered postoperatively - after a loading dose - to intravenous PCA morphine in patients undergoing gynecological laparoscopic surgery, had only early antiemetic effects, while no clinically meaningful antiemetic effect could be evidenced within the first 24 h after surgery. TRIAL REGISTRATION Current control trial registered at Chictr.org.cn: ChiCTR1800017172. Date registered: 07/16/2018.
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Affiliation(s)
- Huai Jin Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Shan Liu
- Department of Anesthesiology, Beijing Shangdi Hospital, Beijing, China
| | - Zhi Yu Geng
- Department of Anesthesiology, Peking University First Hospital, Beijing, China.
| | - Xue Ying Li
- Department of Biostatics, Peking University First Hospital, Beijing, China
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