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Huang C, Yang R, Xie X, Dai H, Pan L. Effects of dexmedetomidine on early postoperative cognitive function and postoperative inflammatory response: a systematic review and network meta-analysis. Front Neurol 2024; 15:1422049. [PMID: 39188709 PMCID: PMC11346340 DOI: 10.3389/fneur.2024.1422049] [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] [Received: 04/23/2024] [Accepted: 07/15/2024] [Indexed: 08/28/2024] Open
Abstract
Background Dexmedetomidine (DEX) has demonstrated potential as an effective agent for enhancing early postoperative cognitive function. However, there is ongoing debate regarding its optimal dosage and impact on early postoperative inflammatory response. This study aimed to assess and prioritize the effects of varying doses of DEX on early postoperative cognitive function and inflammatory response, in order to identify the most effective intervention dosage. Methods Randomised controlled trials (RCTs) and retrospective cohort studies (RCS) from PubMed, Embase, and Cochrane Library up to January 28, 2024, were included. The Mini-Mental State Examination (MMSE) was utilized to assess the impact of varying doses of DEX on cognitive function during the early postoperative period as the primary outcome, peripheral blood levels of IL-6 and TNF-α were considered as secondary outcomes. Meta-analysis and Bayesian Network Meta-Analysis (NMA) were conducted using R. Funnel plots were generated using Stata 15.0. Results A total of 29 studies involving 2,807 patients and 25 different doses of DEX were included. DEX was given at a loading dose of 0.3-1.0 μg/kg followed by a maintenance dose of 0.1-0.5 μg/kg/h, or at a uniform intraoperative dose of 0.4-0.7 μg/kg/h. Network meta-analysis revealed most doses of DEX were significantly more effective than normal saline (NS) in improving postoperative MMSE scores (on days 1, 3, and 7) and lowering IL-6 and TNF-α levels. Probability results showed that a 1 μg/kg loading dose followed by a 0.6 μg/kg/h maintenance dose was the best dosing regimen for improving MMSE scores on postoperative days 1 (97.3%), 3 (100%), and 7 (99.9%), as well as for reducing postoperative blood IL-6 levels (1.3%). On the other hand, 0.3 μg/kg followed by 0.2 μg/kg/h was the optimal dosing regimen for reducing postoperative blood TNF-α levels (6.6%). Conclusion Compared with NS, intraoperative intravenous DEX improved early postoperative cognitive function and postoperative inflammatory response in patients undergoing elective surgery. In particular, a 1 μg/kg loading dose and a 0.6 μg/kg/h maintenance dose resulted in the best improvement in postoperative MMSE scores and blood IL-6 levels, while a 0.3 μg/kg loading dose followed by a 0.2 μg/kg/h maintenance dose is the optimal regimen for lowering postoperative blood TNF-α levels.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=433932, identifier CRD42023433932.
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Affiliation(s)
- Cuifang Huang
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Clinical Research Center for Anesthesiology (GKAD22035214), Nanning, China
- Guangxi Engineering Research Center for Tissue and Organ Injury and Repair Medicine, Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Dysfunction, Nanning, China
| | - Ruimin Yang
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xianlong Xie
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Clinical Research Center for Anesthesiology (GKAD22035214), Nanning, China
- Guangxi Engineering Research Center for Tissue and Organ Injury and Repair Medicine, Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Dysfunction, Nanning, China
| | - Huijun Dai
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Clinical Research Center for Anesthesiology (GKAD22035214), Nanning, China
- Guangxi Engineering Research Center for Tissue and Organ Injury and Repair Medicine, Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Dysfunction, Nanning, China
| | - Linghui Pan
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Clinical Research Center for Anesthesiology (GKAD22035214), Nanning, China
- Guangxi Engineering Research Center for Tissue and Organ Injury and Repair Medicine, Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Dysfunction, Nanning, China
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Lopez-Lopez D, Mato-Bua R, Neira-Somoza P, Turrado-Blanco E. Postoperative hypotension: Is intraoperative use of dexmedetomidine safe in frail patients? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:557-558. [PMID: 38754552 DOI: 10.1016/j.redare.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 05/18/2024]
Affiliation(s)
- D Lopez-Lopez
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - R Mato-Bua
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - P Neira-Somoza
- Departamento de Enfermería de Anestesia y Cirugía, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - E Turrado-Blanco
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Zeng S, Li X, Xu H, Ye Q, Li Z, Wang F. The optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia in great saphenous varicose vein surgery, based on hemodynamics and anesthesia efficacy: a randomized, controlled, double-blind clinical trial. Front Med (Lausanne) 2024; 11:1426512. [PMID: 39114828 PMCID: PMC11303176 DOI: 10.3389/fmed.2024.1426512] [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] [Received: 05/20/2024] [Accepted: 07/05/2024] [Indexed: 08/10/2024] Open
Abstract
Objective This study aimed to explore the optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia on perioperative hemodynamics and anesthesia efficacy in patients undergoing great saphenous varicose vein surgery. Methods A total of 90 patients were randomly divided into three groups: 0.25 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED1 group), 0.5 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED2 group), and 0.75 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED3 group). Hemodynamics, anesthesia efficiency, and adverse reactions were recorded. Main results Compared with the ED1 group, the ED2 group had lower systolic blood pressure at T1-3 (T1, 95%CIs, 6.52-21.93, p < 0.001; T2, 95%CIs, 2.88-18.21, p = 0.004; T3, 95%CIs, 0.49-18.17, p = 0.035), and the diastolic blood pressure at T1-2 was decreased (T1, 95%CIs, 4.55-14.36, p < 0.001; T2, 95%CIs, 0.37-12.17, p = 0.033). Compared with the ED2 group, the ED3 group had higher systolic blood pressure at T1-2 (T1, 95%CIs, 5.90-21.46, p < 0.001; T2, 95%CIs, 2.07-17.55, p = 0.008) and higher diastolic blood pressure at T1-3 (T1, 95%CIs, 2.91-12.81, p = 0.001; T2, 95%CIs, 1.32-13.23, p = 0.011; T3, 95%CIs, 0.14-11.52, p = 0.043). Compared with the ED2 group, the heart rate was significantly decreased at T1-4 in the ED3 group (T1, 95%CIs, 2.25-15.72, p = 0.005; T2, 95%CIs, 2.35-13.82, p = 0.003; T3, 95%CIs, 0.50-9.79, p = 0.025; T4, 95%CIs, 1.46-10.36, p = 0.005). The myocardial oxygen consumption in all three groups was significantly decreased at each time point compared to T0 (p < 0.05 or < 0.001), and no significant between-group differences were detected (P>0.05). Compared with the ED1 group, the anesthesia efficiency of ED2 and ED3 groups was markedly enhanced, but the risk of bradycardia in ED2 and ED3 groups was dramatically increased (6 of 28 [21.4%] vs. 14 of 30 [46.7%] and 14 of 27 [51.9%], p = 0.023), one patient in the ED3 group experienced difficulty urinating, and remaining adverse reactions were mild in all three groups. Conclusion A measure of 0.5 μg/kg dexmedetomidine is the optimal dose as a 0.59% ropivacaine adjuvant for epidural anesthesia in patients undergoing great saphenous varicose vein surgery. Clinical trial registration http://www.chictr.org.cn/, registration number: ChiCTR2200060619.
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Affiliation(s)
- Sisi Zeng
- Department of Anesthesiology, Xinqiao Hospital, Chongqing, China
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- First People’s Hospital of Chongqing Liangjiang New District, Chongqing, China
| | - Xuechao Li
- First People’s Hospital of Chongqing Liangjiang New District, Chongqing, China
| | - Hongchun Xu
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qin Ye
- Zigong Fourth People's Hospital, Zigong, China
| | - Zhaogang Li
- The People's Hospital of Leshan, Leshan, China
| | - Fangjun Wang
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Sancheti S, Uppal V. Is remimazolam the future of sedation for regional anesthesia? Can J Anaesth 2024; 71:731-736. [PMID: 38378938 DOI: 10.1007/s12630-024-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Affiliation(s)
- Sushil Sancheti
- Discipline of Anesthesia, Memorial University of Newfoundland, 300 Prince Philip Dr., St. John's, NL, A1B 3V6, Canada.
| | - Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Kim H, Kim Y, Bae J, Yoo S, Lim YJ, Kim JT. Comparison of remimazolam and dexmedetomidine for intraoperative sedation in patients undergoing lower extremity surgery under spinal anesthesia: a randomized clinical trial. Reg Anesth Pain Med 2024; 49:110-116. [PMID: 37280081 DOI: 10.1136/rapm-2023-104415] [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] [Received: 02/07/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dexmedetomidine sedation has advantages, such as low incidence of respiratory depression and prolonged block duration, but also significant disadvantages, such as slow onset, high rate of sedation failure, and a long context-sensitive half-life. Remimazolam provides rapid sedation and recovery, high sedation efficacy and has minimal hemodynamic effects. We hypothesized that patients who received remimazolam would require less rescue midazolam than dexmedetomidine. METHODS Patients (n=103) scheduled for surgery under spinal anesthesia were randomized to receive dexmedetomidine (DEX group) or remimazolam (RMZ group) targeting a Modified Observer's Assessment of Alertness/Sedation score of 3 or 4. Rescue midazolam was administered if the patient failed to be sedated after the initial loading dose or despite infusion rate adjustment. RESULTS Rescue midazolam administration was significantly higher in the DEX group (0% vs 39.2%; p<0.001). Patients in the RMZ group reached the target sedation level more rapidly. The incidences of bradycardia (0% vs 25.5%; p<0.001) and hypertension (0% vs 21.6%; p<0.001) were higher in the DEX group. Respiratory depression occurred at a higher rate in the RMZ group (21.2% vs 2.0%; p=0.002), but no patients required manual ventilation. Patients in the RMZ group recovered faster, had a shorter PACU stay and higher satisfaction scores. Hypotensive episodes in the PACU were more frequent in the DEX group (1.9% vs 29.4%; p<0.001). CONCLUSIONS Remimazolam showed excellent sedation efficacy, minimal hemodynamic effects, and fewer adverse events in the PACU than dexmedetomidine. However, it is important to note that respiratory depression was more frequent with the use of remimazolam. TRIAL REGISTRATION NUMBER NCT05447507.
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Affiliation(s)
- Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon, Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Baek S, Lee J, Shin YS, Jo Y, Park J, Shin M, Oh C, Hong B. Perioperative Hypotension in Patients Undergoing Orthopedic Upper Extremity Surgery with Dexmedetomidine Sedation: A Retrospective Study. J Pers Med 2023; 13:1658. [PMID: 38138885 PMCID: PMC10744607 DOI: 10.3390/jpm13121658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: limited data exist regarding the occurrence of hypotension associated with dexmedetomidine use and its risk factors in the context of intraoperative sedation for patients receiving peripheral nerve blocks. (2) Method: This single-center retrospective study assessed the incidence of hypotension in patients undergoing orthopedic upper extremity surgery with brachial plexus blockade. Patients were classified into three groups: group N (non-sedated), group M (midazolam), and group D (dexmedetomidine), based on their primary intraoperative sedative use. The primary outcome was the incidence of perioperative hypotension, defined as systolic blood pressure (SBP) < 90 mmHg or mean blood pressure (MBP) < 60 mmHg, at a minimum of two recorded time points during the intraoperative period and post-anesthesia care unit stay. Multivariable logistic models for the occurrence of hypotension were constructed for the entire cohort and group D. (3) Results: A total of 2152 cases (group N = 445, group M = 678, group D = 1029) were included in the analysis. The odds ratio for the occurrence of hypotension in group D was 5.68 (95% CI, 2.86 to 11.28) compared with group N. Concurrent use of a beta blocker, longer duration of surgery, and lower preoperative SBP and higher preoperative heart rate were identified as significant risk factors. (4) Conclusions: the increased risk of hypotension and the associated factors should be taken into account before using dexmedetomidine in these cases.
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Affiliation(s)
- Sujin Baek
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Jiyong Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Yong Sup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Juyeon Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
| | - Myungjong Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea (J.L.); (Y.S.S.); (J.P.); (M.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
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King GA, Le A, Nickol M, Sarkis B, van der Merwe JM. Periarticular infiltration used in total joint replacements: an update and review article. J Orthop Surg Res 2023; 18:859. [PMID: 37957753 PMCID: PMC10641975 DOI: 10.1186/s13018-023-04333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Periarticular infiltration following total knee and hip arthroplasty has been demonstrated to be equivalent to peripheral nerve blocks for postoperative pain management. The ideal cocktail has not been established yet. We have conducted a literature search on PubMed and Embase. Our search criteria included randomized controlled trials (RCTs) and systematic reviews (SRs). We tried to only include the most recent studies to keep the information current. The included research focused at Dexmedetomidine, Liposomal Bupivacaine, Ropivacaine, Epinephrine, Ketorolac, Morphine, Ketamine and Glucocorticosteroids. Each medication's mode of action, duration, ideal dosage, contraindications, side effects and effectiveness have been summarized in the review article. This article will help the clinician to make an informed evidence-based decision about which medications to include in their ideal cocktail.
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Affiliation(s)
- Gavin Anthony King
- College of Medicine - Department of Orthopaedic Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Alexander Le
- College of Medicine - Department of Orthopaedic Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Michaela Nickol
- College of Medicine - Department of Orthopaedic Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Bianca Sarkis
- College of Medicine - Department of Orthopaedic Surgery, University of Saskatchewan, Saskatoon, Canada
- Faculty of Medicine - Division of Orthopaedic Surgery, University of Montreal, Montreal, Canada
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Pardessus P, Loiselle M, Silins V, Horlin AL, Brouns K, Marsac L, Fait C, Ilharreborde B, Julien-Marsollier F, Dahmani S. The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery. Paediatr Anaesth 2023; 33:829-836. [PMID: 37386846 DOI: 10.1111/pan.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Bleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis. METHODS This prospective study included all cases of adolescent idiopathic scoliosis operated in a single center during 2 years (2018-2020). Predictors analyzed were as follows: body mass index, preoperative hemoglobin concentration, thoracoplasty, preoperative halo-gravity, volume of intraoperative crystalloid administration, use of esophageal Doppler (for goal-directed fluid therapy), and duration of surgery. Statistical analyses were performed using a multivariable logistic regression model. RESULTS Two hundred patients were included in the analysis. Multivariable analysis found: an increased volume of intraoperative crystalloid administration as a significant predictor of allogenic blood transfusion. Receiving operator characteristics analysis found the model exhibiting an area under the curve of 0.85 (95% confidence interval: 0.75-0.95). Optimizing stroke volume using esophageal Doppler was associated with a decrease in intraoperative crystalloid intake. CONCLUSION These results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion.
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Affiliation(s)
- Pierre Pardessus
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Vilnis Silins
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Anne-Laure Horlin
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Lucile Marsac
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Charlotte Fait
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Brice Ilharreborde
- Université de Paris-Cité, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
- Department of orthopedic surgery, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
| | - Souhayl Dahmani
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
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Sedation during regional anesthesia: less is more. Can J Anaesth 2022; 69:1453-1458. [PMID: 36289152 DOI: 10.1007/s12630-022-02338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
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