1
|
Klabusayová E, Klučka J, Kratochvíl M, Musilová T, Vafek V, Skříšovská T, Djakow J, Kosinová M, Havránková P, Štourač P. Airway Management in Pediatric Patients: Cuff-Solved Problem? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1490. [PMID: 36291426 PMCID: PMC9600438 DOI: 10.3390/children9101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Traditionally, uncuffed tubes were used in pediatric patients under 8 years in pursuit of reducing the risk of postextubation stridor. Although computed tomography and magnetic resonance imaging studies confirmed that the subglottic area remains the narrowest part of pediatric airway, the use of uncuffed tubes failed to reduce the risk of subglottic swelling. Properly used cuffed tubes (correct size and correct cuff management) are currently recommended as the first option in emergency, anesthesiology and intensive care in all pediatric patients. Clinical practice particularly in the intensive care area remains variable. This review aims to analyze the current recommendation for airway management in children in emergency, anesthesiology and intensive care settings.
Collapse
Affiliation(s)
- Eva Klabusayová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Jozef Klučka
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Kratochvíl
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tereza Musilová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Václav Vafek
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tamara Skříšovská
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Jana Djakow
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Paediatric Intensive Care Unit, NH Hospital Inc., 268 31 Hořovice, Czech Republic
| | - Martina Kosinová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Pavla Havránková
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, The Donaustadt Clinic, Lango Bardenstraße 122, 1220 Vienna, Austria
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| |
Collapse
|
2
|
Saidie S, Modir H, Yazdi B, Moshiri E, Noori G, Mohammadbeigi A. The effect of dexmedetomidine on decrease of cough, hemodynamic parameters and Ramsay score versus lidocaine during general anesthesia: a randomized clinical trial. Med Gas Res 2021; 11:1-5. [PMID: 33642330 PMCID: PMC8103969 DOI: 10.4103/2045-9912.310052] [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] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/24/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
Physiological responses remain common during anesthesia emergence and endotracheal extubation, causing some complications. We aimed to address the effect of dexmedetomidine (DEX) on decrease of cough, hemodynamic parameters and Ramsay score in comparing to lidocaine (LID) during anesthesia. In this double-blinded randomized clinical trial 120 hospitalized patients undergoing general anesthesia were enrolled after obtaining written consent. Block random allocation was used to assign patients into three groups including DEX (intravenous injection; 0.5 μg/kg), LID (1.5 mg/kg), and PBO (10 mL normal saline) at 10 minutes before anesthesia. No statistical significance was uncovered among three groups in blood pressure, oxygen saturation, frequency of laryngospasm and duration of surgery amongst the groups (P > 0.05), but DEX having lower heart rate and cough frequency (P < 0.05). Moreover, the mean of Ramsay score was statistically higher in DEX and LID groups than PBO except at the 50th and 60th minutes after extubation (P < 0.05). Since the mean of Ramsay score was higher in DEX vs. LID groups and reduced heart rate and cough frequency demonstrates in DEX, it seems that DEX could be an appropriate drug on suppressing cough during anesthesia without side effects. The study protocol was approved by the Ethical Committee of Arak University of Medical Sciences by code IR.ARAKMU.REC.1397.140 on August 19, 2018, and the protocol was registered at Iranian Registry of Clinical Trials by code IRCT20141209020258N97 on February 22, 2019.
Collapse
Affiliation(s)
- Soheila Saidie
- Students Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Hesameddin Modir
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Gholamreza Noori
- Department of Surgery, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| |
Collapse
|
3
|
Lu IC, Wu SH, Wu CW. Neuromuscular blockade management for intraoperative neural monitoring. Kaohsiung J Med Sci 2019; 36:230-235. [PMID: 31713975 DOI: 10.1002/kjm2.12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022] Open
Abstract
This article reviews the literature on development of neuromuscular blockade management in thyroid surgery with intraoperative neural monitoring (IONM) in the past decade. Neuromuscular blockade management includes the choice of neuromuscular blocking agents (NMBAs) and reversal of neuromuscular blockade by sugammadex. A series of animal study and clinical trials showed NMBAs effect on IONM in thyroid surgery. We summarized five NMBA regimens for IONM: (a) relaxant-free regimen, (b) depolarizing NMBA-succinylcholine, (c) titration of nondepolarizing NMBA, and (d) rocuronium combined with sugammadex. The proper management of neuromuscular blockade during IONM has greatly developed over the past decade. The misuse of NMBAs is associated with false IONM interpretations to surgeons. A detailed understanding of NMBAs and neuromuscular blockade management by sugammadex may optimize IONM quality in patients receiving monitored thyroid surgery.
Collapse
Affiliation(s)
- I-Cheng Lu
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Sheng-Hua Wu
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otorhinolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Rustagi PS, Nellore SS, Kudalkar AG, Sawant R. Comparative evaluation of i-gel ® insertion conditions using dexmedetomidine-propofol versus fentanyl-propofol - A randomised double-blind study. Indian J Anaesth 2019; 63:900-907. [PMID: 31772398 PMCID: PMC6868666 DOI: 10.4103/ija.ija_313_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/24/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022] Open
Abstract
Background and Aims: i-gel® insertion necessitates adequate depth of anaesthesia to prevent laryngospasm, gagging or limb movements. We aimed to compare i-gel® insertion conditions with propofol induction after pre-treatment with dexmedetomidine or fentanyl. Methods: Eighty ASAI/II patients undergoing general anaesthesia were randomised into Groups D (n = 40) and F (n = 40). Group D received 1 μg/kg dexmedetomidine over 10 minutes followed by 5ml of 0.9%normal saline (NS) over 2 minutes. Group F received 10 ml of 0.9%NS over 10 minutes followed by fentanyl 1 μg/kg over 2 minutes. Thirty seconds after study drugs, propofol 2 mg/kg was given. Ninety seconds after propofol, i-gel® was inserted. Overall insertion conditions were assessed by Modified Scheme of Lund and Stovener. Heart-rate (HR) and mean arterial pressure (MAP) were noted at baseline, after study drug, propofol induction and 1,3,5,10 minutes after i-gel® insertion. Respiratory rate and apnoea times were recorded. Results: Insertion conditions were comparable between both groups. Moderately relaxed jaw, coughing and movement was observed in more patients of Group F. Incidence of apnoea was significantly higher (P < 0.0001) in group F (18/40) than group D (3/40).Mean duration of apnoea in group F (284.5 ± 11.19 sec) was significantly higher than group D (217.17 ± 16.48 sec). Percentage drop in MAP from baseline after propofol was more in group F (10.3%) than group D (5.6%). MAP after induction was significantly lower in group F compared to group D (P = 0.002), but similar after i-gel® insertion, 1,3,5 and 10 minutes after insertion. After propofol (P = 0.003) and i-gel® insertion (P < 0.001), HR was significantly lower with dexmedetomidine. Conclusion: Dexmedetomidine and fentanyl provide comparable conditions for i-gel® insertion with propofol.
Collapse
Affiliation(s)
- Preeti Sachin Rustagi
- Department of Anesthesia, Lokmanya Tilak Municipal Medical College and General Hospital College Building, 4 Floor, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Shalaka Sandeep Nellore
- Department of Anesthesia, Lokmanya Tilak Municipal Medical College and General Hospital College Building, 4 Floor, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Amala Guru Kudalkar
- Department of Anesthesia, Lokmanya Tilak Municipal Medical College and General Hospital College Building, 4 Floor, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Rashmi Sawant
- Department of Anesthesia, Lokmanya Tilak Municipal Medical College and General Hospital College Building, 4 Floor, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Wang CY, Chen F, Wu J, Fu SY, Xu XM, Chen J, Jiang YF, Lian Q, Liu HC. The association of the optimal bolus of dexmedetomidine with its favourable haemodynamic outcomes in adult surgical patients under general anaesthesia. Br J Clin Pharmacol 2019; 86:85-92. [PMID: 31656042 DOI: 10.1111/bcp.14137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS Dexmedetomidine is highly specific α2-adrenoceptor agonist. A single bolus of dexmedetomidine can achieve clinical therapeutic effect. Therefore, it is essential to know the safety margin between the clinical effectiveness dosages of dexmedetomidine and its side effect. METHODS A total of 42 patients who underwent elective thyroidectomy were enrolled in this study. Dexmedetomidine was given as a single bolus injection 30 min towards the end of surgery. The up-and-down sequential schedule was used in this study. The starting dose of dexmedetomidine was set at 0.1 μg/kg in the first patient and the next patient would then receive a dose of dexmedetomidine decremented by 0.05 μg/kg if the prior patient's baseline heart rate (HR) had a decrease of ≥20% and/or mean arterial blood pressure (MAP) increase or decrease of ≥20%, otherwise, the following patient would receive an incremental 0.05 μg/kg dose of dexmedetomidine. The analytic techniques of linear, linear-logarithmic, exponential regressions and centred isotonic regression were used to determine the ED50 of dexmedetomidine and the residual standard errors were calculated for the comparison of goodness of fit among the different models. RESULTS The median (interquartile range [range]) lowest HR was 57 beats/min (53-63.3[46-76]) with an average HR decrease of 8.0 beats/min (5-13 [4 to 23]). The median (interquartile range [range]) highest MAP was 98 mmHg (91.8-105 [83-126]) with a MAP increase of 10.0 mmHg (6.8-18.0 [2-24]). The ED50 (95% confidence interval) from 4 different statistical approaches (linear, linear-logarithmic, exponential regressions and centred isotonic regression) were 0.262 μg/kg (0.243, 0.306), 0.252 μg/kg (0.238, 0.307), 0.283 μg/kg (0.238, 0.307), and 0.278 μg/kg, respectively. Among the 4 models, the exponential regression had the least residual standard error (0.03618). CONCLUSION The ED50 derived from 4 statistical models for an intravenous bolus of dexmedetomidine without significant haemodynamic effects was distributed in a narrow range of 0.252-0.283 μg/kg, and the exponential regression was the model to best match the study data.
Collapse
Affiliation(s)
- Cheng-Yu Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Fang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Junzheng Wu
- Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Shu-Ying Fu
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Xi-Mou Xu
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Jia Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Yi-Fei Jiang
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Qingquan Lian
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Hua-Cheng Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| |
Collapse
|
6
|
Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol 2019; 33:353-360. [DOI: 10.1016/j.bpa.2019.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
|
7
|
Badawy AA, Mokhtar AM. Remifentanil vs dexmedetomidine for severely preeclamptic parturients scheduled for cesarean section under general anesthesia: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ahmed A. Badawy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ali M. Mokhtar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| |
Collapse
|
8
|
Mousa SA, Abd Elfatah Alsobky H. Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sherif Abdo Mousa
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Mansoura University, Egypt
| | | |
Collapse
|
9
|
Modir H, Saidie S, Yazdi B, Moshiri E, Mohammadbeigi A. Comparing the suppressing effect of dexmedetomidine versus lidocaine in cough during anesthesia emergence: A double-blinded randomized clinical trial. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2019. [DOI: 10.4103/jhnps.jhnps_32_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Lu IC, Lin IH, Wu CW, Chen HY, Lin YC, Chiang FY, Chang PY. Preoperative, intraoperative and postoperative anesthetic prospective for thyroid surgery: what's new. Gland Surg 2017; 6:469-475. [PMID: 29142836 DOI: 10.21037/gs.2017.05.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this review is to analyze what's new on anesthetic prospective to perioperative management for thyroid surgery. For recent decades intraoperative neuromonitoring (IONM) during thyroid and parathyroid surgery has obtained more and more popularity. New modality of anesthetic technique was also developed to incorporate into surgical teamwork. For example, the precise position of EMG tube and optimal use of neuromuscular blocking agents (NMBAs) play key roles in successful IONM system. Special focus is paid to following issues: (I) preoperative airway evaluation and pre-op preparation; (II) anesthetic managements including advanced intubation tools, NMBAs and sugammadex; and (III) post-op adverse events such as pain and postoperative nausea vomiting.
Collapse
Affiliation(s)
- I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Hua Lin
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ya Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Chu Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Yu Chiang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| |
Collapse
|
11
|
Singh RB, Ojha S, Choubey S. A Comparative Study of Dexmedetomidine and Diltiazem for Attenuating Pressor Responses to Laryngoscopy and Endotracheal Intubation: A Double-blind, Randomized Study. Anesth Essays Res 2017; 11:921-929. [PMID: 29284850 PMCID: PMC5735489 DOI: 10.4103/aer.aer_101_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT Endotracheal intubation has been suggested to be one of the most invasive stimuli in anesthesia, particularly during induction and after tracheal intubation. The present study aims to evaluate the efficacy of dexmedetomidine as compared to diltiazem on hemodynamic response to laryngoscopy and intubation. AIMS To assess and compare the hemodynamic response of dexmedetomidine as compared to diltiazem in patients undergoing laryngoscopy and intubation and rate and type of side effects of the drugs if any. SETTINGS AND DESIGN This study design was a prospective, randomized, and double-blind trial. SUBJECTS AND METHODS The patients were randomly allocated into three groups: Group I (control), Group II (dexmedetomidine), and Group III (diltiazem) of 45 patients each. Group I (n = 45): 0.9% NaCl 10 ml was given to the patients over 10 min before intubation in Group I (control). Group II (n = 45): injection dexmedetomidine (0.5 μg/kg) in 10 ml normal saline was given to the patients over 10 min before intubation. Group III (n = 45): injection diltiazem (0.3 mg/kg) in 10 ml normal saline was given to the patients over 10 min before intubation. STATISTICAL ANALYSIS USED The data so collected were subjected to statistical analysis using Statistical Package for the Social Sciences version 15.0. RESULTS Mean percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) following intubation was 17.90%, 19.96%, and 19.04%, respectively, in control group, 9.04%, 6.32%, and 7.53%, respectively, in dexmedetomidine group, and 12.30%, 10.32%, and 11.14%, respectively, in diltiazem groups. Statistically, there was a significant difference in postintubation SBP, DBP, and MAP of the three groups (P < 0.001). Dexmedetomidine at a dose of 0.5 μg/kg showed to have a better attenuation of pressor response as compared to diltiazem at a dose of 0.3 μg/kg. CONCLUSIONS Both dexmedetomidine and diltiazem were safe and effective in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation; however, between two trial drugs, dexmedetomidine had a better response.
Collapse
Affiliation(s)
- Raj Bahadur Singh
- Department of Anaesthesiology, Narayan Medical College and Hospital, Sasaram, Bihar, India
| | - Shivendu Ojha
- Department of Anaesthesiology, ELMCH, Lucknow, Uttar Pradesh, India
| | - Sanjay Choubey
- Department of Anaesthesiology, ELMCH, Lucknow, Uttar Pradesh, India
| |
Collapse
|
12
|
The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery. Kaohsiung J Med Sci 2017; 33:400-404. [DOI: 10.1016/j.kjms.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/19/2017] [Indexed: 12/17/2022] Open
|
13
|
Mo Y, Qiu S. Effects of dexmedetomidine in reducing post-cesarean adverse reactions. Exp Ther Med 2017; 14:2036-2039. [PMID: 28962122 PMCID: PMC5609173 DOI: 10.3892/etm.2017.4759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/30/2017] [Indexed: 11/23/2022] Open
Abstract
This study evaluated the analgesia effect and the effect on adverse reaction of using dexmedetomidine (Dex) in post-cesarean section. Eighty women who had been performed caesarean delivery with combined spinal and epidural anesthesia were selected. The experimental group (group D) included 40 random patients and the control group (group C) included the other 40 women. Patients in group D were given ropivacaine hydrochloride and Dex while patients in group C were given ropivacaine hydrochloride and morphine. We assessed and recorded the patient status at 2, 6, 12, 24 and 48 h using Ramsay sedation scale and visual analogue scale (VAS) in resting state and coughing state and we also recorded their adverse reactions. Except for the first 2 h after surgery, group D gets a lower VAS score than group C all the time in either resting state or coughing state (p<0.05); at 12 h, group D had a lower Ramsay score than group C (p<0.05) and no significant difference during the rest of the time was found; group D had a significantly lower rate of nausea, emesis and pruritus than group C (p<0.05). In conclusion, the usage of Dex in analgesia for post-cesarean can increase the analgesia effect produced by local anesthetics, increase puerpera sedation scores and decrease adverse reactions.
Collapse
Affiliation(s)
- Yanshuai Mo
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Shuang Qiu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| |
Collapse
|
14
|
Noh C, Ko YK, Kim YH, Lim CS, Chung WS, Lee JY, Song SH. Effect of dexmedetomidine on endotracheal intubating conditions during endotracheal intubation without neuromuscular blocker following propofol/remifentanil. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chan Noh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Young Kwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chae Seong Lim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Woo Suk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ji Yong Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Hyun Song
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
15
|
Hancı V, Özbilgin Ş, Özbal S, Kamacı G, Ateş H, Boztaş N, Ergür BU, Arıkanoğlu A, Yılmaz O, Yurtlu BS. Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study. Braz J Anesthesiol 2016; 66:456-64. [PMID: 27591458 DOI: 10.1016/j.bjane.2015.01.003] [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: 12/20/2014] [Accepted: 01/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. METHODS Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1μg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated. RESULTS There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. CONCLUSION Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.
Collapse
Affiliation(s)
- Volkan Hancı
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey.
| | - Şule Özbilgin
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Seda Özbal
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Gonca Kamacı
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Hasan Ateş
- Dokuz Eylül University, School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, İnciraltı, İzmir, Turkey
| | - Nilay Boztaş
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Bekir Uğur Ergür
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Ahmet Arıkanoğlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Osman Yılmaz
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Bülent Serhan Yurtlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| |
Collapse
|
16
|
Avaliação dos efeitos de sugamadex e dexmedetomidina intra‐arterial: estudo experimental. Braz J Anesthesiol 2016; 66:456-64. [DOI: 10.1016/j.bjan.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022] Open
|
17
|
Effectiveness of sugammadex for cerebral ischemia/reperfusion injury. Kaohsiung J Med Sci 2016; 32:292-301. [PMID: 27377841 DOI: 10.1016/j.kjms.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 01/17/2023] Open
Abstract
Cerebral ischemia may cause permanent brain damage and behavioral dysfunction. The efficacy and mechanisms of pharmacological treatments administered immediately after cerebral damage are not fully known. Sugammadex is a licensed medication. As other cyclodextrins have not passed the necessary phase tests, trade preparations are not available, whereas sugammadex is frequently used in clinical anesthetic practice. Previous studies have not clearly described the effects of the cyclodextrin family on cerebral ischemia/reperfusion (I/R) damage. The aim of this study was to determine whether sugammadex had a neuroprotective effect against transient global cerebral ischemia. Animals were assigned to control, sham-operated, S 16 and S 100 groups. Transient global cerebral ischemia was induced by 10-minute occlusion of the bilateral common carotid artery, followed by 24-hour reperfusion. At the end of the experiment, neurological behavior scoring was performed on the rats, followed by evaluation of histomorphological and biochemical measurements. Sugammadex 16 mg/kg and 100 mg/kg improved neurological outcome, which was associated with reductions in both histological and neurological scores. The hippocampus TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and caspase results in the S 16 and S 100 treatment groups were significantly lower than those of the I/R group. Neurological scores in the treated groups were significantly higher than those of the I/R group. The study showed that treatment with 16 mg/kg and 100 mg/kg sugammadex had a neuroprotective effect in a transient global cerebral I/R rat model. However, 100 mg/kg sugammadex was more neuroprotective in rats.
Collapse
|
18
|
Kakkar A, Tyagi A, Nabi N, Sethi AK, Verma UC. Comparision of clonidine and dexmedetomidine for attenuation of laryngoscopy and intubation response - A randomized controlled trial. J Clin Anesth 2016; 33:283-8. [PMID: 27555178 DOI: 10.1016/j.jclinane.2016.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 03/19/2016] [Accepted: 04/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clonidine and dexmedetomidine are alpha-2 agonists with beneficial effect on the hemodynamic response to laryngoscopy and intubation. The present study was designed to evaluate and compare the efficacy of intravenous clonidine 1 μg/kg, and dexmedetomidine in doses of 0.5 μg/kg and 1 μg/kg, for blunting the hemodynamic changes during laryngoscopy and intubation. METHOD Adult patients of ASA physical grade I/II scheduled for surgery under general anaesthesia with endotracheal tube were randomly divided into three groups using a computer generated random number table, each group receiving one of the following drugs prior to induction of anaesthesia, by a blinded anaesthesiologist in a volume of 100 mL infused intravenously over 20 minutes: clonidine 1 μg/kg, or dexmedetomidine 0.5 μg/kg, or dexmedetomidine 1 μg/kg. General anaesthesia was induced using standard technique and intubations performed by same anaesthesiologist. Heart rate and mean blood pressure were recorded in pre-operative room (baseline) and again at 1 minute, 3 minutes, 5 minutes and 10 minutes after intubation. An increase in heart rate and/or mean blood pressure by >20% above baseline values during observation period was taken to indicate a positive intubation response. RESULTS The incidence of intubation response was similar in all three groups (P>.05). The number of patients developing hypotension was significantly higher in group receiving dexmedetomidine1μg/kg group (P<.005) as compared to other two groups. Both the groups receiving dexmedetomidine had higher number of patients developing bradycardia as compared to patients receiving clonidine. DISCUSSION & CONCLUSION Dexmedetomidine 0.5 μg/kg, 1 μg/kg and clonidine 1 μg/kg attenuate the laryngoscopy and intubation response but Clonidine 1 μg/kg was associated with lesser side effects.
Collapse
Affiliation(s)
- Aanchal Kakkar
- Department of Anaesthesia & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
| | - Asha Tyagi
- Department of Anaesthesia & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
| | - Nazish Nabi
- Department of Anaesthesia & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
| | - A K Sethi
- Department of Anaesthesia & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
| | - U C Verma
- Department of Anaesthesia & Critical Care, Presently at Maulana Azad Medival College, Delhi, India.
| |
Collapse
|
19
|
Darlong V, Garg R, Pandey R, Khokhar S, Chandralekha, Sinha R, Punj J, Sinha R. Evaluation of minimal dose of atracurium for cataract surgery in children: A prospective randomized double-blind study. Saudi J Anaesth 2015; 9:283-8. [PMID: 26240547 PMCID: PMC4478821 DOI: 10.4103/1658-354x.154711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cataract surgery when performed under general anesthesia, especially without neuromuscular blocking agents, eccentric position of the eye has been reported. However, no evidence exists for the need and optimal dose of neuromuscular blocking agents for surgical reasons when the anesthetic management may be done without its need. We hypothesize that the minimal dose atracurium may accomplish the surgical requirement of cataract surgery in children. MATERIALS AND METHODS After ethical committee approval, this double-blind, prospective, randomized study was conducted in children scheduled for cataract surgery under general anesthesia. Anesthesia was induced in a standardized manner and using laryngeal mask airway. The patients were randomized into four groups of 55 patients each and atracurium was administered as per group allocation: Group 0: No atracurium was administered; Group 50: Received atracurium at 50% dose of ED95; Group 75: Received atracurium at 75% dose of ED95; Group 100: Received atracurium of 100% dose of ED95. Surgeon was asked to grade surgical condition just after the stab incision in the cornea. The primary outcome variable included the need of atracurium supplementation based on grading of surgical conditions by the operating surgeon who was blinded to the randomized group. RESULTS The need of atracurium due to unacceptable surgical conditions based on surgeon satisfaction score was statistically significant when compared among the groups being maximum in Group 0 (P < 0.001). Also, the surgeon satisfaction score was statistically significant among the groups (P < 0.0001) with the least satisfaction in Group 0. The laryngeal mask airway (LMA) insertion score was statistically significant in the four groups (P - 0.001). However, number of attempts for LMA placement was comparable among the four groups (P - 0.766). CONCLUSION We conclude that a balanced anesthetic technique including atracurium provided better surgical condition for cataract procedures in children. The surgical condition improved with increasing dose of atracurium from 25% to 100% ED95 dose.
Collapse
Affiliation(s)
- Vanlal Darlong
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravinder Pandey
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudarshan Khokhar
- Department of Opthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chandralekha
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Sinha
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Department of Opthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
20
|
Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: estudo prospectivo, randomizado e duplo‐cego. Braz J Anesthesiol 2015; 65:191-9. [DOI: 10.1016/j.bjan.2014.05.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022] Open
|
21
|
Hanci V, Gülle K, Karakaya K, Yurtlu S, Akpolat M, Yüce MF, Yüce FZ, Turan IÖ. Dexmedetomidina retal em ratos: avaliação dos efeitos sedativos e sobre a mucosa. Braz J Anesthesiol 2015; 65:1-6. [DOI: 10.1016/j.bjan.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/09/2013] [Indexed: 11/24/2022] Open
|
22
|
Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, Salihoglu Z. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol 2014; 65:191-9. [PMID: 25925031 DOI: 10.1016/j.bjane.2014.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/05/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 μg and 120 ± 94 μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.
Collapse
Affiliation(s)
- Mefkur Bakan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
| | - Tarik Umutoglu
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ufuk Topuz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Harun Uysal
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Pulmonary Medicine, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Kadioglu
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ziya Salihoglu
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
23
|
Hancı V, Yurdakan G, Yurtlu S, Turan IÖ, Sipahi EY. Protective effect of dexmedetomidine in a rat model of α-naphthylthiourea–induced acute lung injury. J Surg Res 2012; 178:424-30. [DOI: 10.1016/j.jss.2012.02.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 12/21/2022]
|
24
|
El-Tahan M, Mowafi H, Al Sheikh I, Khidr A, Al-Juhaiman R. Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose–response study. Int J Obstet Anesth 2012; 21:222-9. [DOI: 10.1016/j.ijoa.2012.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/16/2022]
|
25
|
The effects of dexmedetomidine on mesenteric arterial occlusion-associated gut ischemia and reperfusion-induced gut and kidney injury in rabbits. J Surg Res 2012; 178:223-32. [PMID: 22560540 DOI: 10.1016/j.jss.2012.03.073] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We assessed the antioxidant activity of dexmedetomidine (Dex) administered during the ischemic period in a rabbit model of mesenteric ischemia/reperfusion (I/R) injury using biochemical and histopathological methods. METHODS A total of 24 male New Zealand white rabbits weighing between 2.5 and 3.0 kg were randomly divided into three groups: the sham group (Group S, n = 8), the I/R group (Group I/R, n = 8), and the I/R plus Dex treatment group (Group Dex, n = 8). In the I/R group, ischemia was achieved with 60 min of mesenteric occlusion. The sham group provided normal basal values. The rabbits in Group I/R were operated to achieve I/R. Group Dex received intravenous Dex 30 min after the commencement of reperfusion (10 μg/kg Dex was infused within 10 min, and then a maintenance dose of 10 μg/kg/h Dex was infused intravenously). For the measurement of tissue malondialdehyde, total antioxidant status, total oxidant status, lipid hydroperoxide levels, superoxide dismutase, catalase, and myeloperoxidase activity levels in the renal tissue samples of animals, the rabbits in each group were sacrificed 3 h after reperfusion. The histopathological examination scores were determined using the intestinal and renal tissues. RESULTS The mean malondialdehyde, total oxidant status, myeloperoxidase, and lipid hydroperoxide levels were significantly higher in Group I/R than in Groups S and Dex (P < 0.05). There also were significant decreases in the mean total antioxidant status, catalase, and superoxide dismutase activities in Group I/R compared with Groups S and Dex (P < 0.05). The histopathological examination scores of the intestinal and renal tissues were significantly higher in Group I/R compared with Groups S and Dex (P < 0.05). CONCLUSION Dex treatment may have biochemical and histopathological benefits by preventing I/R-related cellular damage of intestinal and renal tissues as shown in an experimental mesenteric ischemia model. The preference to use Dex for anesthesia during the mesenteric ischemia procedure may attenuate I/R injury in intestinal and renal tissues.
Collapse
|
26
|
Tracheal Intubation Without Use of Muscle Relaxants: Comparison of Remifentanil and Alfentanil. Anesth Pain Med 2012. [DOI: 10.5812/aapm.3599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|