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Joy JJ, Bidkar PU, Swaminathan S, Balasubramanian M, Dey A, Chinnarasan VC, Gunasekaran A. Comparison of Dexmedetomidine Versus Fentanyl-Based Anesthetic Protocols Under Patient State Index Guidance in Patients Undergoing Elective Neurosurgical Procedures with Intraoperative Neurophysiological Monitoring. Cureus 2023; 15:e35864. [PMID: 37033575 PMCID: PMC10078854 DOI: 10.7759/cureus.35864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Objectives The study was designed to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol in total intravenous anesthesia (TIVA) on anesthetic dose reduction, the quality of intraoperative neurophysiological monitoring (IONM) recordings, analgesic requirements, and recovery parameters in patients undergoing neurosurgical procedures with neurophysiological monitoring. Methods A total of 54 patients for elective neurosurgical procedures with IONM were randomized to group D (dexmedetomidine) and group F (fentanyl). A loading dose of the study drug of 1µg/kg followed by 0.5 µg/kg/h infusion was used in two groups. Propofol-based TIVA with a Schneider target-controlled infusion model was used for induction and maintenance with effect site concentration of 4-5 and 2.5-4 µg/mL, respectively, titrated to a Patient State Index (PSI) of 25-40. Baseline IONM recordings were obtained after induction. The mean propofol consumption, number of patient movements, quality of IONM recordings, number of fentanyl boluses, hemodynamic characteristics, and recovery parameters were recorded. Results The mean propofol consumption was significantly lower in group D when compared to group F (101.4 ± 13.5 µg/kg/min vs 148.0 ± 29.8 µg/kg/min). Baseline IONM recordings were acquired in all patients without any difficulty. The two groups were comparable with respect to the number of additional boluses of fentanyl, patient movements, and recovery characteristics. Conclusion Dexmedetomidine as an adjuvant to propofol in TIVA reduces the requirement of the latter, without affecting the IONM recordings. The addition of dexmedetomidine also ensures stable hemodynamics and decreases the requirement of opioids with similar recovery characteristics.
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Li H, Zhao Q, Yu Y, Li W. Clinical observation of different dosages of dexmedetomidine combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy. Front Surg 2023; 9:1025592. [PMID: 36684220 PMCID: PMC9852038 DOI: 10.3389/fsurg.2022.1025592] [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: 08/23/2022] [Accepted: 10/21/2022] [Indexed: 01/07/2023] Open
Abstract
Objective This study aimed to explore the clinical effects of different dosages of dexmedetomidine (Dex) combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy. Methods Ninety patients who underwent hysteroscopic submucosal myomectomy between September 2021 and March 2022 were enrolled and randomly divided into three groups, with 30 patients in each group. Patients in Groups A, B, and C received injections of 0.25, 0.5, or 0.75 µg/kg of Dex, respectively, by intravenous pump over 10 min. After this time, a maintenance dosage of 0.5 µg/kg/h was administered by intravenous infusion until the end of the surgery. Anesthesia was induced using 1.5 mg/kg of propofol and 0.3 µg/kg of sufentanil that were introduced through a laryngeal mask. The plasma concentration of propofol was maintained at 3 µg/ml by target-controlled infusion until the end of the surgery. The mean arterial pressure (MAP), heart rate (HR), and electroencephalographic bispectral index (BIS) were observed when the patient entered the operating room (T0), after catheter indwelling for anesthesia (T1), at the time of cervical dilation (T2), at the time of hysteroscopic surgery (T3), and at the end of the surgery (T4) in all three groups. The total dosage of propofol for induction and maintenance, anesthesia awakening time, orientation recovery time, Visual Analog Scale (VAS) score of the post-awakening uterine contraction pain, and adverse reactions were recorded. Results The intraoperative reductions of MAP and HR in patients were significant in Group C when compared with those in Groups A and B (P < 0.05), and BIS was significantly lower in Group C at T2 and T3 when compared with the baseline measurement at T0 (P < 0.05). The dosage of propofol was significantly higher for Group A than for Groups B and C (P < 0.05). The anesthesia awakening time and orientation recovery time were significantly longer for patients in Group C when compared with patients in Groups A and B (P < 0.05). Within 5-30 min after awakening, the VAS scores in Groups B and C were significantly lower than those for Group A (P < 0.05). The incidence of adverse reactions in Group B was significantly less than that for Groups A and C (P < 0.05). Conclusion The continuous pumping of 0.5 µg/kg of Dex combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy resulted in positive anesthetic and analgesia effects and fewer adverse reactions. It therefore has high clinical significance.
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Ramji R, Carlson E, Kottorp A, Shleev S, Awad E, Rämgård M. Development and evaluation of a physical activity intervention informed by participatory research- a feasibility study. BMC Public Health 2020; 20:112. [PMID: 31992285 PMCID: PMC6988255 DOI: 10.1186/s12889-020-8202-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Despite numerous interventions aiming to improve physical activity in socially disadvantaged populations, physical inactivity remains to be a rising challenge to public health globally, as well as, in Sweden. In an effort to address this challenge, a community-based participatory intervention was developed through active community engagement and implemented in a socially disadvantaged neighborhood in Sweden. The current study aims to present the development and initial evaluation of a participatory research driven physical activity intervention. Methods Fifteen participants (11 females and 4 males) aged 17–59 years volunteered to participate in the physical activity intervention program. The intervention program was evaluated using a longitudinal mixed methods design measuring health impact changes over time through focus group discussions and quality of life surveys. Further additional biomedical health parameters such as levels of glycosylated hemoglobin, blood pressure, levels of oxygen saturation and body mass index were monitored before and after the intervention. Focus group data were analyzed using content analysis with an inductive approach. The pre-and post-test scores from the survey-based quality of life domains, as well as the health parameters were compared using non-parametric and parametric statistics. Results Four themes emerged from the analysis of the focus group discussions including sense of fellowship, striving for inclusion and equity, changing the learner perspective and health beyond illness. The scores for the domains Physical Health, Psychological Health, Social Relationships and Health Satisfaction where significantly higher after participation in the physical activity intervention program compared to the pre-test scores (p < .05)s. There were however, no significant changes in the scores for the environmental domain and overall quality of life after intervention compared to that prior to intervention start. Overall, the biomedical health parameters remained stable within the normal ranges during intervention. Conclusion The focus group discussions and results from the surveys and biomedical measures reveal important findings to understand and further develop the intervention program to promote health equity among citizens in disadvantaged areas. Evaluating the feasibility of such an intervention using multiple approaches contributes to effective implementation of it for larger communities in need.
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Affiliation(s)
- Rathi Ramji
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden.
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden
| | - Anders Kottorp
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden
| | - Sergey Shleev
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden
| | - Eman Awad
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, SE-20506, Malmö, Sweden
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Chakrabarti D, Kamath S, Madhusudan Reddy KR, Srinivas DB, Manohar N, Masapu D. Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2018; 34:496-502. [PMID: 30774230 PMCID: PMC6360882 DOI: 10.4103/joacp.joacp_55_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims The study was conceived to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol (total intravenous anesthesia) on anesthetic dose reduction and anesthesia recovery parameters in cerebello-pontine angle (CPA) surgeries. Material and Methods This prospective randomized study was conducted on 49 patients (25 with dexmedetomidine, 24 without). After standardized anesthetic induction, anesthesia was maintained using propofol (via target controlled infusion, titrated to maintain BIS between 40 and 60), fentanyl (0.5 μg/kg/hour) and either dexmedetomidine (0.5 μg/kg/hour) or a sham infusion. Neuromuscular blocking agents were excluded to allow cranial nerve EMG monitoring. Adverse hemodynamic events, recovery parameters (time to opening eyes, obeying commands, and extubation) and postoperative sedation score, shivering score, nausea, and vomiting score were recorded. Results Propofol and fentanyl utilization (as total dose, adjusted for duration of surgery and body weight, and number of extra boluses) was significantly lower in the dexmedetomidine group. There was no difference in any of the recovery parameters between the two groups. Incidence of bradycardia was significantly higher with dexmedetomidine, while no difference was found for hypotension, hypertension, and tachycardia. Conclusion Dexmedetomidine-fentanyl-propofol anesthesia compares favorably with fentanyl-propofol anesthesia during CPA neurosurgical procedures with regard to anesthesia recovery times, but with lower intraoperative opioid and hypnotic utilization rates.
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Affiliation(s)
- Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sriganesh Kamath
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K R Madhusudan Reddy
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Deepti B Srinivas
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Nitin Manohar
- Department of Neuroanaesthesia, Yashoda Hospitals, Secunderabad, Telengana, India
| | - Dheeraj Masapu
- Department of Neuroanaesthesia, Sakra World Hospital, Bengaluru, Karnataka, India
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Wu X, Hang LH, Wang H, Shao DH, Xu YG, Cui W, Chen Z. Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia. Yonsei Med J 2016; 57:998-1005. [PMID: 27189297 PMCID: PMC4951480 DOI: 10.3349/ymj.2016.57.4.998] [Citation(s) in RCA: 12] [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] [Received: 09/17/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Intranasal dexmedetomidine is an effective sedative for premedication and is regularly used to reduce preoperative tension and anxiety in children. This study aimed to assess the effect of intranasally adjunctive dexmedetomidine on perioperative sedative and analgesic requirements in adults. MATERIALS AND METHODS Patients were randomly divided into four groups to receive preoperative administration of saline, intranasal dexmedetomidine 1 μg/kg and 2 μg/kg, and intravenous dexmedetomidine 1 μg/kg, respectively. Propofol and remifentanil were target-controlled infused to maintain intraoperative bispectral index at 45-55 and blood pressure at baseline value±20%. Sufentanil was administered to maintain postoperative visual analogue scale ≤3. Perioperative anesthetics requirements were compared using nonparametric tests. RESULTS Intranasal dexmedetomidine significantly attenuated propofol requirements for anesthesia induction and maintenance in a dose-dependent manner. Patients given intranasal dexmedetomidine 2 μg/kg required less remifentanil for anesthesia maintenance. The first postoperative request for sufentanil analgesia was delayed in patients given intranasal dexmedetomidine 2 μg/kg. The anesthetics-sparing effect of intranasal dexmedetomidine was significantly weaker than intravenous dexmedetomidine at the same dose of 1 μg/kg. The incidences of adverse events, including hemodynamic instability and delayed recovery, were comparable with and without intranasal dexmedetomidine. CONCLUSION Intranasal administration of dexmedetomidine can reduce perioperative anesthetic requirements, and a dose of dexmedetomidine 2 μg/kg produces a better effect in adults. The anesthetics-sparing effect of intranasal dexmedetomidine 1 μg/kg is less than that with the same intravenous dose of dexmedetomidine.
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Affiliation(s)
- Xiang Wu
- Department of Anesthesiology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, Zhejiang, China
| | - Li Hua Hang
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hong Wang
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dong Hua Shao
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yi Guo Xu
- Department of Anesthesiology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, Zhejiang, China
| | - Wei Cui
- Department of Anesthesiology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, Zhejiang, China
| | - Zheng Chen
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
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Park HY, Kim JY, Cho SH, Lee D, Kwak HJ. The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia. J Clin Monit Comput 2015; 30:429-35. [DOI: 10.1007/s10877-015-9735-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
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Affiliation(s)
- Joseph P Cravero
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
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