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Guzzetti L, Inversini D, Bacuzzi A. Anaesthesia for thyroid and parathyroid surgery. BJA Educ 2024; 24:270-276. [PMID: 39099753 PMCID: PMC11293567 DOI: 10.1016/j.bjae.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 03/08/2024] [Accepted: 04/23/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- L. Guzzetti
- University Hospital Varese ASST Settelaghi, Varese, Italy
| | - D. Inversini
- University Hospital Varese ASST Settelaghi, Varese, Italy
| | - A. Bacuzzi
- University Hospital Varese ASST Settelaghi, Varese, Italy
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Hailu S, Abbabu S, Seifu A, Gorde N, Besha A. Effectiveness of different doses of dexmedetomidine on intraoperative haemodynamic profiles and postoperative pain in patients undergoing abdominal surgery at Dilla University Referral Hospital, Ethiopia, 2024: a double-blind randomized controlled trial. Ann Med Surg (Lond) 2024; 86:4495-4504. [PMID: 39118723 PMCID: PMC11305718 DOI: 10.1097/ms9.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 08/10/2024] Open
Abstract
Background and objective Abdominal surgery stands as one of the most frequently conducted procedures across surgical specialties, accounting for up to half of surgery-related expenses. Hemodynamic instability emerges as a significant concern during anaesthesia and surgery, provoked by the stress of intubation, surgical incision, and anaesthetic agents. Following abdominal surgery, pain is an inevitable consequence, typically managed with opioid-based analgesia. However, the adverse effects associated with opioids often overshadow their analgesic benefits, particularly in the context of abdominal surgery. Consequently, there exists a necessity to explore and assess alternative non-opioid pain management options post-abdominal surgery as part of a broader strategy to reduce opioid usage. The primary aim of this investigation is to assess the effectiveness of varying doses of dexmedetomidine in regulating intraoperative hemodynamics and alleviating postoperative pain in patients undergoing abdominal surgery. Methods Ethical clearance and institutional review board were obtained from the ethical clearance committee of Dilla University College of Medicine and Health Sciences with protocol unique number of duirb/008/22-01. Our trial has been prospectively registered on the Pan African Clinical Trial Registry with a unique identification number for the registry PACTR202208813896934. Statistical package and analysis were performed by using SPSS version 25. The distribution of data was checked by using Shapiro-Wilk test and the homogeneity of variance was checked by Levene's test. Analysis of variance (ANOVA) and Kruskal-Wallis H test were used for normally distributed continuous data and non-normally distributed or non-parametric data, respectively. P value less than 0.05 with a power of 90% was considered statistically significant. Result There was a statistically significant increase in mean SBP in the control group at the different critical time points (P<0.05), as compared to the baseline value, while there was no significant difference in mean systolic blood pressure (SBP) between the baseline and all other levels for group 2 and group 3. A statistically significant increase in mean arterial pressure (MAP) was detected in the control group at immediately after intubation (P=0.009) as compared to the baseline value, while a statistically significant reduction in mean heart rate (HR) was observed in group 3 at 15th min after infusion and at 30th 30 min after induction compared to baseline with a P value of 0.002 and 0.008, respectively.Conclusion:Perioperative low-dose infusion of dexmedetomidine at the rate of 0.4 mcg/kg/h is a useful anaesthesia adjuvant to control hemodynamic stress response to critical periods. It is wise to use this infusion dose as part of general anaesthesia to achieve better hemodynamic stability.
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Affiliation(s)
- Seyoum Hailu
- Department of Anesthesia, Dilla University, Dilla
| | | | - Ashenafi Seifu
- Department of Anesthesia, Addis Ababa University, Addis Ababa
| | - Naol Gorde
- Department of Anesthesia, Wolaita Sodo University, Soddo
| | - Aschalew Besha
- Department of Anesthesia, Hawassa University, Awasa, Ethiopia
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Purohit A, Kumar M, Kumar N, Bindra A, Pathak S, Yadav A. Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis. Indian J Anaesth 2024; 68:415-425. [PMID: 38764958 PMCID: PMC11100647 DOI: 10.4103/ija.ija_790_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/21/2024] Open
Abstract
Background and Aims Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. Methods A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. Results In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. Conclusion This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.
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Affiliation(s)
- Aanchal Purohit
- Department of Neuroanaesthesiology and Critical Care, AIIMS, Delhi, India
| | - Mohan Kumar
- Department of Neuroanaesthesiology and Critical Care, AIIMS, Delhi, India
| | - Niraj Kumar
- Department of Neuroanaesthesiology and Critical Care, AIIMS, Delhi, India
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, AIIMS, Delhi, India
| | - Sharmishtha Pathak
- Department of Anaesthesiology Pain Medicine and Critical Care, JPNATC, AIIMS, Delhi, India
| | - Anuradha Yadav
- Department of Oral Medicine and Radiology, ITS College, India
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de Queiroz MN, Mendonça FT, de Matos MV, Lino RS, de Carvalho LSF. Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744455. [PMID: 37541486 DOI: 10.1016/j.bjane.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation. METHODS Randomized, double-blinded, placebo-controlled trial. SETTING Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. SAMPLE 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I-III aged 18-80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels. RESULTS Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51-0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08-0.43, p < 0.001). CONCLUSION Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo.
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Affiliation(s)
- Murilo Neves de Queiroz
- Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil; TSA, Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil.
| | - Fabrício Tavares Mendonça
- Hospital de Base do Distrito Federal, Brasília, DF, Brazil; TSA, Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil
| | | | | | - Luiz Sérgio Fernandes de Carvalho
- Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil; Clarity Healthcare Intelligence, Jundiaí, SP, Brazil
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Zheng L, Fang T, Zhang W, Zhang X, Ren Z, Qin W, Liang W, Ma Q, Yin N. Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:443-452. [PMID: 38370564 PMCID: PMC10874235 DOI: 10.2147/dddt.s452077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Dexmedetomidine (Dex) is a potent and highly selective α2-adrenergic receptor agonist. Within an appropriate dose range, Dex can effectively attenuate the surgical stress response, provide intraoperative hemodynamic stability, and improve the patient recovery quality. High-dose Dex can delay patient awakening from anesthesia and increase the incidence of bradycardia. This randomized controlled trial aimed to investigate the effects of low-dose intravenous Dex premedication in patients undergoing laparoscopic cholecystectomy (LC). Material and Methods In total, 100 patients undergoing LC were equally randomized into Group C (premedication with saline) and Group D (premedication with 0.5 µg/kg Dex). The patients were premedicated with saline or Dex, depending on the group, before anesthesia induction. Following this, anesthesia induction and endotracheal intubation was performed, and anesthesia was maintained during surgery. Following the completion of the surgery, the patients were transferred the post-anesthesia care unit (PACU) and stayed there until they met the PACU discharge criteria. The hemodynamic parameters, consumption of anesthetics, surgical duration, postoperative awakening time, extubation time, postoperative pain, and complications were recorded. Results No significant differences were observed in the heart rate (HR) and mean arterial pressure (MAP) between the two groups before premedication (P>0.05). The MAP and HR immediately after endotracheal intubation and immediately after extubation were significantly lower in Group D than in Group C (P<0.05 for both). The incidence of bradycardia was significantly higher in Group D than in Group C (P<0.05), while atropine was used in neither group. Propofol and remifentanil consumption was significantly lower in Group D than in Group C (P<0.05). The postoperative awakening and extubation times were significantly shorter in Group D than in Group C (P<0.05). The postoperative visual analog scale scores for pain and incidence of nausea, vomiting, and cough were significantly lower in Group D than in Group C (P<0.05 for all). Conclusion Our data suggest that premedication with dexmedetomidine (0.5 µg/kg) before general anesthesia induction can effectively attenuate intraoperative stress response and postoperative pain, maintain perioperative hemodynamic stability, and decrease the incidence of adverse events, which might be an effective and safe anesthetic protocol during LC worthy of further clinical application.
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Affiliation(s)
- Longbin Zheng
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Tao Fang
- Department of Anesthesiology, Xinchang County People’s Hospital, Xinchang, Zhejiang Province, People’s Republic of China
| | - Wei Zhang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xiaojing Zhang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Zhiqiang Ren
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Weimin Qin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Wenbo Liang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Qing Ma
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Ning Yin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
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Xu J, Sun P, Ma JH, Wang DX. Multimodal prevention of emergence cough following nasal endoscopic surgery under general anesthesia: a double-blind randomized trial. Front Med (Lausanne) 2024; 11:1288978. [PMID: 38327707 PMCID: PMC10847355 DOI: 10.3389/fmed.2024.1288978] [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: 09/05/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose Cough during emergence from anesthesia is a common problem and may cause adverse events. Monotherapy faces uncertainty in preventing emergence cough due to individual differences. We aimed to evaluate the efficacy and safety of multimodal intervention for preventing emergence cough in patients following nasal endoscopic surgery. Methods In this double-blind randomized trial, 150 adult patients undergoing nasal endoscopic surgery were randomly allocated into three groups. For the control group (n = 50), anesthesia was performed according to clinical routine, no intervention was provided. For the double intervention group (n = 50), normal saline 3 mL was sprayed endotracheally before intubation, 0.4 μg/kg dexmedetomidine was infused over 10 min after intubation, and target-controlled remifentanil infusion was maintained at an effect-site concentration of 1.5 ng/mL before extubation after surgery. For the multimodal intervention group (n = 50), 0.5% ropivacaine 3 mL was sprayed endotracheally before intubation, dexmedetomidine and remifentanil were administered as those in the double intervention group. The primary endpoint was the incidence of emergence cough, defined as single cough or more from end of surgery to 5 min after extubation. Results The incidences of emergence cough were 98% (49/50) in the control group, 90% (45/50) in the double group, and 70% (35/50) in the multimodal group, respectively. The incidence was significantly lower in the multimodal group than those in the control (relative risk 0.71; 95% CI 0.59 to 0.86; p < 0.001) and double (relative risk 0.78; 95% CI 0.63 to 0.95; p = 0.012) groups; the difference between the double and control groups was not statistically significant (relative risk 0.92; 95% CI 0.83 to 1.02; p = 0.20). The severity of sore throat was significantly lower in the multimodal group than that in the control group (median difference-1; 95% CI -2 to 0; p = 0.016). Adverse events did not differ among the three groups. Conclusion For adult patients undergoing endonasal surgery, multimodal intervention including ropivacaine topical anesthesia before intubation, dexmedetomidine administration after intubation, and remifentanil infusion before extubation after surgery significantly reduced emergence cough and was safe.
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Affiliation(s)
- Jing Xu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Pei Sun
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
- Outcomes Research Consortium, Cleveland, OH, United States
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Shetabi H, Karimian S. Efficacy of two doses of dexmedetomidine on attenuating cardiovascular response and safety of respiratory tract to extubation. J Cardiovasc Thorac Res 2023; 15:73-79. [PMID: 37654813 PMCID: PMC10466467 DOI: 10.34172/jcvtr.2023.31647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/21/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Extubation can be associated with an adverse hemodynamic or respiratory response, which may be serious in cardiovascular written or in the elderly. The present study was conducted with the aim of investigating the effect of two different doses of dexmedetomidine in the prevention of extubation complications. Methods This randomized clinical trial was conducted in Isfahan in 2020-2021 on 174 patients undergoing elective surgery. Patients were randomly divided into 3 groups receiving dexmedetomidine 1 μg/kg (D1), dexmedetomidine 0.5 μg/kg (D2), and normal saline (S). Hemodynamic variables include heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation (Spo2) was measured and recorded before removing the endotracheal tube and at 1, 3, 5 and 10 minutes after extubation. Also, airway responses to extubation such as cough, hoarseness, and laryngospasm were investigated. Results SBP, MAP, and HR in the D1 group were significantly lower than in other groups. In the D2 group, these measurements were lower than the control group at 3, 5, and 10 minutes after extubation (P<0.05 for all). In placebo group, SBP, MAP, and HR increased significantly after extubation (P=0.01). In group D1, cough (P=0.007) and its intensity (P=0.013), nausea and vomiting (P=0.04) and chills (P=0.001) were less than in other groups. Conclusion In the D1 group, attenuation of autonomic response to extubation was more than other groups and side effects were less than D2 group, and in both groups, these side effects were less than the saline group.
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Affiliation(s)
- Hamidreza Shetabi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Karimian
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Shao C, Lin L, Chen M, Wang N, Shangguan W. The effect of lidocaine intraoperative infusion on quality of postoperative sleep in patients undergoing thyroidectomy: a randomized controlled trial. BMC Anesthesiol 2023; 23:158. [PMID: 37161304 PMCID: PMC10169303 DOI: 10.1186/s12871-023-02109-w] [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: 11/28/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The incidence of thyroid nodules has increased significantly in recent years, and surgical removal is a common treatment. Postoperative sleep disturbance is still a serious problem in the current surgical environment. In this study, we explored whether intraoperative lidocaine infusion could improve the quality of sleep over 7 days and 30 days after surgery and postoperative recovery for patients undergoing thyroid surgery. METHODS Seventy patients who underwent thyroid surgery from October 2020 to June 2021 were randomly assigned to the lidocaine or the normal saline group, 35 cases in each group. Patients enrolled in this study were randomized to receive either system lidocaine (a bolus of 1.5 mg·kg- 1, followed by an infusion of 2 mg·kg- 1·h- 1 until the end of the surgical procedure) or identical volumes and rates of normal saline. The primary endpoint was the Pittsburgh Sleep Quality Index (PSQI) scores. Secondary endpoints included intraoperative remifentanil consumption, whether there was a cough within 5 min after extubation and the cough scores, postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV). RESULTS Totally seventy cases were enrolled and eventually sixty-eight cases were analyzed. PSQI scores did not change significantly over time (F = 2.799, P = 0.069); also, there was no significant difference in PSQI scores between two groups in the entire 30 days follow-up period (F = 0.174, P = 0.678). Further, there was no interaction between the time points and the intervention (F = 0.649, P = 0.513). Similarly, intraoperative remifentanil consumption, the incidence of cough and postoperative pain scores, were comparable between the two groups (all P > 0.05); while patients in the lidocaine group showed significantly lower cough scores (P = 0.042) and lower incidence of PONV (P = 0.015). CONCLUSIONS Systemic lidocaine infusion might not improve the sleep quality and reduce postoperative pain over 7 days or 30 days after the operation of patients who underwent thyroid surgery, but it can reduce postoperative complications and improve the quality of recovery. Furthermore, sleep quality of patients wasn't impaired significantly in the entire 30 days follow-up period after thyroid surgery compared with baseline values. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , identifier: ChiCTR2000039764, date: 08/11/2020).
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Affiliation(s)
- Caiqun Shao
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Longxiang Lin
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Mengmeng Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Ning Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Wangning Shangguan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.
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Wasinwong W, Thongkhachok S, Kitsiripant C, Nimmaanrat S, Suwannachot A, Thinkan N. Comparison of 40 and 100 mg of laryngotracheal lidocaine instillation to prevent cough during emergence from general anesthesia: A randomized controlled trial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Nahar AR, Gopinath V, Ruth MS. Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial. Saudi J Anaesth 2023; 17:39-44. [PMID: 37032667 PMCID: PMC10077806 DOI: 10.4103/sja.sja_619_22] [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: 08/31/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peri-extubation cough is an undesirable event during extubation, prevention of which has been studied with multiple drugs, amongst which intravenous dexmedetomidine has emerged as one of the favourable drugs. Intratracheal route is attractive because of its ease of administration, provided it avoids the hypotension and bradycardia that occurs during intravenous bolus administration. There is a paucity of data exploring the utility, doses, and adverse effect of intratracheal dexmedetomidine. Methods After obtaining ethical committee approval, 60 eligible, consenting adult patients undergoing surgery under general anesthesia in a tertiary teaching hospital were recruited and randomised into three groups-DEX0.3, DEX0.5, and NS. The plan of general anesthesia was standardized. Half an hour prior to extubation, study drug was instilled intratracheally-dexmedetomidine 0.3 mic/kg, 0.5 mic/kg, and NS in groups DEX0.3, DEX0.5, and NS, respectively. 4-point cough score was used to assess extubation response. Hemodynamic response and time to Ramsay sedation score 3 was also recorded. Results Majority of patients in DEX0.3 (60%) and DEX0.5 (85%) group had no cough (cough score 0), while majority of the patients in the NS group (70%) had either mild or moderate cough (cough score 1, 2). Kruskal Wallis test followed by post-hoc pairwise comparison showed statistically significant difference in 4-point cough score between GroupDEX0.3 and GroupNS (P < 0.001) and between GroupDEX0.5 and GroupNS (P = 0.038). DEX0.5 group, compared to DEX0.3 group, had significantly higher time from reversal to extubation (P < 0.001) and time to achieve Ramsay sedation score of 3 (P < 0.001). Conclusion We conclude that both 0.3 mic/kg and 0.5 mic/kg of dexmedetomidine when given intratracheally are effective in preventing peri-extubation cough. Further, 0.3 mic/kg dexmedetomidine showed a better recovery profile compared to 0.5 mic/kg dexmedetomidine when administered intratracheally.
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Affiliation(s)
- Afreen R. Nahar
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - V Gopinath
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Merlin Shalini Ruth
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
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Fernstrum C, Deichmann P, Duncan F, Humphries L, Hoppe I. A standardized approach to airway management during Abbé flap reconstruction. Paediatr Anaesth 2022; 32:1305-1309. [PMID: 36086897 DOI: 10.1111/pan.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Abbé flap is a two-staged procedure to address upper lip tightness, creating a surgically closed mouth during the first stage. Airway manipulation and management in the setting of a surgically closed mouth presents a challenge from an anesthetic standpoint. AIMS This study aims to describe the authors' standardized approach to airway management in cleft lip patients undergoing Abbé flap reconstruction. METHODS A retrospective review was performed including consecutive patients who underwent Abbe flap reconstruction at a single institution from 2019 to 2021. Five patients were included, and information regarding airway, intubation sequence, and emergence was gathered. RESULTS During the initial surgery, the airway was secured via nasotracheal intubation to allow for adequate surgical exposure. On emergence, with a newly constructed surgically closed mouth, the anesthesiologist forfeits the ability to reintubate should the patient fail extubation without the use of nasal fiberoptic guided intubation or flap deinset. In addition, any coughing or tension on the surgical site could cause inadvertent disruption to the integrity of the new flap. Dexmedetomidine titrated to effect was used to allow for smooth emergence, with the surgeon present. During the second stage, the patient was kept spontaneously breathing while local anesthetic and intravenous anxiolytic allowed for pedicle division. The patient was then orally intubated, and the flap was inset. All five patients had successful reconstruction with no airway concerns or events. CONCLUSIONS The proposed standardized approach to airway management during Abbé flap reconstruction was safe and effective in this limited series of patients.
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Affiliation(s)
- Colton Fernstrum
- Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paige Deichmann
- Pediatric Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Forrest Duncan
- Pediatric Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Laura Humphries
- Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ian Hoppe
- Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Fan X, Cai H, Pan B, Xie Y. Comparison of dexmedetomidine and remifentanil on reducing coughing during emergence from anesthesia with tracheal intubation: A meta-analysis. Front Pharmacol 2022; 13:993239. [PMID: 36249748 PMCID: PMC9561905 DOI: 10.3389/fphar.2022.993239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Dexmedetomidine and remifentanil are well known to suppress airway reflex during emergence from anesthesia, but which one is more effective is unclear. We conducted a meta-analysis to compare the effect of dexmedetomidine and remifentanil on reducing the occurrence of coughing.Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (published between 1 January 1950, and 30 December 2021; no language restrictions) comparing dexmedetomidine infusion with remifentanil infusion. The primary endpoint was the incidence of moderate to severe coughing during the recovery period. The secondary endpoints were the time of recovery and extubation, and residual sedation. We assessed pooled data by using a random-effects model.Results: Eight studies with 502 participants were included. The meta-analysis showed no statistically difference between dexmedetomidine and remifentanil in the occurrence of moderate to severe coughing during emergence from anesthesia (OR 1.45,95%CI 0.62–3.38), the extubation time (MD 0.93 min, 95%CI -0.28–2.14), and the residual sedation (OR 2.52, 95%CI 0.92–6.91). Compared with dexmedetomidine, the average recovery time of remifentanil was shorter (MD 3.88 min, 95%CI 1.01–6.75).Conclusion: Dexmedetomidine and remifentanil infusion had no difference in the occurrence of moderate to severe coughing during emergence from anesthesia.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021239710
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Affiliation(s)
- Xing Fan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hai Cai
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Pan
- Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Yubo Xie,
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13
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Yang L, He T, Liu MX, Han SQ, Wu ZA, Hao W, Lu ZX. The effect of intravenous lidocaine on propofol dosage in painless bronchoscopy of patients with COPD. Front Surg 2022; 9:872916. [PMID: 36189388 PMCID: PMC9520192 DOI: 10.3389/fsurg.2022.872916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWe tested the hypothesis that intravenous (IV) lidocaine reduces propofol requirements in painless bronchoscopy in patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 93 patients who underwent bronchoscopy were included in this randomized placebo-controlled study. The patients were randomly divided into two groups. After the IV doses of nalbuphine, patients were given a bolus of propofol, which was titrated if necessary until loss of consciousness. Then patients were given IV lidocaine (2 mg/kg then 4 mg/kg/h) or the same volume of saline. The primary endpoint was the propofol requirements. Secondary endpoints were the incidence of hypoxemia, the incidence of cough during glottis examination, the systolic blood pressure (SBP) and heart rate (HR) during bronchoscopy procedures, the bronchoscopist's comforts, and the time for wakefulness before recovery.ResultsLidocaine infusion resulted in a significant reduction in propofol requirements (p < .0001), and the incidence of hypoxemia (p = .001) and cough (p = .003) during examination decreased significantly in the lidocaine group. During the examination, the fluctuation of SBP and HR was significantly lower than that in the control group, and the difference was statistically significant (p < .05). Bronchoscopist's comforts were higher in the lidocaine group (p < .001), and time for wakefulness (p < .001) were significantly lower in the lidocaine group.ConclusionIn painless bronchoscopy in patients with COPD, IV infusion of lidocaine resulted in a reduction in propofol dose requirements and reduce the incidence of adverse events.
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Affiliation(s)
- Li Yang
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Tao He
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Min-Xiao Liu
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Shi-Qiang Han
- Department of Radiotherapy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhi-Ang Wu
- Department of Anesthesiology, Luquan Second People's Hospital, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- Correspondence: Zhi-Xia Lu Wei Hao
| | - Zhi-Xia Lu
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- Correspondence: Zhi-Xia Lu Wei Hao
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14
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Chungsamarnyart Y, Pairart J, Munjupong S. Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial. J Perioper Pract 2022; 32:53-58. [PMID: 32301388 DOI: 10.1177/1750458920912636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Coughing and laryngospasm are undesirable consequences occurring when patients awaken from general anaesthesia. The objective of the study aimed to compare the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm. METHODS In all, 120 patients scheduled surgery under general anaesthesia were randomly assigned into three groups. Patients in the control group (C-group) received intravenous 0.9% NaCl, while patients in the propofol group (P-group) received intravenous 0.25mg/kg propofol and patients in the propofol combined with ketamine group (PK-group) received intravenous 0.25mg/kg of propofol plus 0.15mg/kg of ketamine. Drugs were administered before extubation. Incidence and severity of coughing and laryngospasm were recorded by a blinded anaesthesiologist. RESULTS Subjects of the PK-group (25%) experienced significantly reduced incidence of postoperative cough than that in the P-group (55%) and C-group (72.5%) (all P < 0.05). The severity of cough in the PK-group was significantly less than that in the P-group and C-group (P = 0.039 and P < 0.001, respectively). No significant difference was found in the incidence and severity of laryngospasm between comparison groups. CONCLUSION Intravenous combination of propofol and low-dose ketamine significantly reduced the incidence and severity among patients awakening from general anaesthesia.
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Affiliation(s)
- Yanipan Chungsamarnyart
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
| | - Jiranun Pairart
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
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15
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Guo H, Ao T, Wang J, Zhang X, Zheng J, Xiao Y, Xue R, Kalika P, Ran R. Clinical Efficacy of Perioperative Intravenous Dexmedetomidine and Lidocaine Combined Infusion for Thyroidectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Clin J Pain 2022; 38:264-270. [PMID: 35125385 DOI: 10.1097/ajp.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of perioperative dexmedetomidine (DEX) combined with lidocaine intravenous infusion on relieving postoperative pain and improving recovery for patients undergoing thyroidectomy. MATERIALS AND METHODS A total of 138 patients undergoing thyroidectomy with general anesthesia were randomly divided into 4 groups: lidocaine (1.5 mg/kg bolus followed by 2 mg/kg/h infusion) in the group L, DEX (0.5 µg/kg) in the group D, lidocaine (same as the group L) with DEX (0.5 µg/kg) in the group L+D, and placebo as normal saline in the group C. All drugs were infused until the end of the surgery. The visual analog scale (VAS) scores of patients at 1, 4, 8, 12, and 24 hours following surgery, opioid requirement, propofol consumption, incidence of postoperative nausea and vomiting, awaking time, hemodynamic variables, and any adverse effects were assessed. RESULTS Compared with the group C, the VAS scores in the group L+D were significantly lower until 8 hours after surgery (P<0.05), while the VAS scores were significantly decreased just until 4 hours in the group L and 1 hour in the group D after surgery (P<0.05). There was no significant difference in opioid consumption between 4 groups. Propofol consumption in the group L+D was significantly lower than other groups (P<0.05). Compared with the group C, the incidence of postoperative nausea and vomiting in the group L+D was lower (P<0.05), and awaking time in the group L+D and the group L was shorter (P<0.05). CONCLUSION DEX combined with lidocaine infusion can effectively attenuate the postoperative pain without any serious adverse events, which may improve postoperative recovery in patients undergoing thyroidectomy.
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Affiliation(s)
- Hao Guo
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Tingting Ao
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jiagao Wang
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xi Zhang
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Junwei Zheng
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yun Xiao
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Rui Xue
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Prakash Kalika
- Department of Critical Care Medicine, Om Hospital and Research Center, Kathmandu, Nepal
| | - Ran Ran
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Stéphane H, Marianne G, Julie N, Patrizia L, Jean C, Patrice F, Pierre L. Opioid-free versus opioid-based anesthesia in pancreatic surgery. BMC Anesthesiol 2022; 22:9. [PMID: 34983396 PMCID: PMC8725294 DOI: 10.1186/s12871-021-01551-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Opioid-free anesthesia (OFA) is associated with significantly reduced cumulative postoperative morphine consumption in comparison with opioid-based anesthesia (OBA). Whether OFA is feasible and may improve outcomes in pancreatic surgery remains unclear. METHODS Perioperative data from 77 consecutive patients who underwent pancreatic resection were included and retrospectively reviewed. Patients received either an OBA with intraoperative remifentanil (n = 42) or an OFA (n = 35). OFA included a combination of continuous infusions of dexmedetomidine, lidocaine, and esketamine. In OBA, patients also received a single bolus of intrathecal morphine. All patients received intraoperative propofol, sevoflurane, dexamethasone, diclofenac, neuromuscular blockade. Postoperative pain management was achieved by continuous wound infiltration and patient-controlled morphine. The primary outcome was postoperative pain (Numerical Rating Scale, NRS). Opioid consumption within 48 h after extubation, length of stay, adverse events within 90 days, and 30-day mortality were included as secondary outcomes. Episodes of bradycardia and hypotension requiring rescue medication were considered as safety outcomes. RESULTS Compared to OBA, NRS (3 [2-4] vs 0 [0-2], P < 0.001) and opioid consumption (36 [24-52] vs 10 [2-24], P = 0.005) were both less in the OFA group. Length of stay was shorter by 4 days with OFA (14 [7-46] vs 10 [6-16], P < 0.001). OFA (P = 0.03), with postoperative pancreatic fistula (P = 0.0002) and delayed gastric emptying (P < 0.0001) were identified as only independent factors for length of stay. The comprehensive complication index (CCI) was the lowest with OFA (24.9 ± 25.5 vs 14.1 ± 23.4, P = 0.03). There were no differences in demographics, operative time, blood loss, bradycardia, vasopressors administration or time to extubation among groups. CONCLUSIONS In this series, OFA during pancreatic resection is feasible and independently associated with a better outcome, in particular pain outcomes. The lower rate of postoperative complications may justify future randomized trials to test the hypothesis that OFA may improve outcomes and shorten length of stay.
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Affiliation(s)
- Hublet Stéphane
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Galland Marianne
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Navez Julie
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Loi Patrizia
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Closset Jean
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Forget Patrice
- Clinical Chair in Anaesthesia, University of Aberdeen, Aberdeen, UK
| | - Lafère Pierre
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium.
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Modir H, Jafarzadeh E, Moshiri E, Zamani Barsari F, Almasi-Hashiani A. Comparison of dexmedetomidine, lidocaine, magnesium sulfate, and remifentanil in cough suppression during endotracheal extubation: A double-blind, randomized clinical trial. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_47_22] [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
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18
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Artawan IM, Sagita S, Dedi ME. Intratracheal Lidocaine Reduces Incidence of Cough During Extubation and Sore Throat After Tonsillectomy Surgery: A Randomized, Single-blind Clinical Trial. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_49_22] [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
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Wang YC, Lu MC, Yang SF, Bien MY, Chen YF, Li YT. Respiratory care for the critical patients with 2019 novel coronavirus. Respir Med 2021; 186:106516. [PMID: 34218168 PMCID: PMC8215880 DOI: 10.1016/j.rmed.2021.106516] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 01/25/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through respiratory droplets, aerosols and close contact. Cross infections occur because viruses spread rapidly among humans. Nineteen percent (19%) of the infected patients developed severe pneumonia and acute respiratory distress syndrome (ARDS). Hypoxemia usually occurs and patients may require oxygen therapy or mechanical ventilation (MV) support. In this article, recently published clinical experience and observational studies were reviewed. Corresponding respiratory therapy regarding different stages of infection is proposed. Infection control principles and respiratory strategies including oxygen therapy, non-invasive respiratory support (NIRS), intubation evaluation, equipment preparation, ventilator settings, special maneuvers comprise of the prone position (PP), recruitment maneuver (RM), extracorporeal membrane oxygenation (ECMO), weaning and extubation are summarized. Respiratory equipment and device disinfection recommendations are worked up. We expect this review article could be used as a reference by healthcare workers in patient care while minimizing the risk of environmental contamination.
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Affiliation(s)
- Yao-Chen Wang
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 402306, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, 402306, Taiwan.
| | - Min-Chi Lu
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, 404332, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, 406040, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung San Medical University, Taichung, 402306, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, 402306, Taiwan.
| | - Mauo-Ying Bien
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei, 116081, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, 110301, Taiwan.
| | - Yi-Fang Chen
- Division of Respiratory Therapy, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 402306, Taiwan.
| | - Yia-Ting Li
- Institute of Medicine, Chung San Medical University, Taichung, 402306, Taiwan; Division of Respiratory Therapy, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 402306, Taiwan.
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20
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De Cassai A, Boscolo A, Geraldini F, Zarantonello F, Pettenuzzo T, Pasin L, Iuzzolino M, Rossini N, Pesenti E, Zecchino G, Sella N, Munari M, Navalesi P. Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis. J Clin Anesth 2021; 72:110287. [PMID: 33873003 DOI: 10.1016/j.jclinane.2021.110287] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE An uncontrolled adrenergic response during tracheal intubation may lead to life-threatening complications. Dexmedetomidine binds to α2-receptors and may attenuate this response. The primary aim of our meta-analysis is to investigate dexmedetomidine efficacy in attenuating sympathetic response to tracheal intubation, compared with placebo or no dexmedetomidine, in terms of heart rate and blood pressure at intubation. DESIGN Meta-analysis with meta-regression and trial sequential analysis. SETTING Systematic search from inception until December 1, 2020 in the following databases: Pubmed, Scopus, the Cochrane Central Register of Controlled Trials, EMBASE and Google Scholar. INTERVENTIONS All randomized controlled trials investigating intravenous dexmedetomidine as premedication in adult patients undergoing tracheal intubation were included in our study. Studies were included without any language or publication date restriction. A trial sequential analysis and a post-hoc meta-regression were performed on the main outcomes. MEASUREMENTS Hemodynamic parameters and heart rate at tracheal intubation, dose of anesthetic needed for induction of anesthesia, total anesthetic requirement throughout the operative procedure, postoperative pain and percentage of patients requiring analgesics at 24 postoperative hours, postoperative nausea and vomiting, intraoperative and postoperative bradycardia, hypotension, dizziness, shivering and/or respiratory depression. MAIN RESULTS Ninety-nine included studies randomized 6833 patients. During laryngoscopy, all hemodynamic parameters were significantly greater in the no dexmedetomidine group. In particular, in the dexmedetomidine group, systolic blood pressure differed by -21.8 mm Hg (95% CI -26.6 to -17.1, p-value < 0.001, I2 97%), mean arterial pressure by -12.8 mm Hg (95% CI -15.6 to -10.0, p-value < 0.001, I2 98%), and heart rate by -16.9 bpm (95% CI -19.8 to -13.9, p-value < 0.001, I2 98%). CONCLUSIONS Patients receiving premedication with dexmedetomidine for tracheal intubation, compared with no dexmedetomidine, have a lower blood pressure and heart rate, however, the risk of bradycardia and hypotension is relevant and its use during daily practice should be cautiously evaluated for each patient.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Laura Pasin
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Margherita Iuzzolino
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Nicolò Rossini
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Elisa Pesenti
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giovanni Zecchino
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy; UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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van den Hoogen MWF, Seghers L, Manintveld OC, Roest S, Bekkers JA, den Hoed CM, Minnee RC, de Geus HRH, van Thiel RJ, Hesselink DA. Care for the organ transplant recipient on the intensive care unit. J Crit Care 2021; 64:37-44. [PMID: 33784577 DOI: 10.1016/j.jcrc.2021.03.003] [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: 12/28/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
All transplant recipients receive tacrolimus, mycophenolate and glucocorticoids and these drugs have many side-effects and drug-drug interactions. Common complications include surgical complications, infections, rejection and acute kidney injury. Infections as CMV and PJP can be prevented with prophylactic treatment. Given the complexity of organ transplant recipients a multi-disciplinary team of intensivists, surgeons, pharmacists and transplant specialists is essential. After heart transplantation a temporary pacemaker is required until the conduction system recovers. Stiffening of the heart and increased cardiac markers indicate rejection. An endomyocardial biopsy is performed via the right jugular vein, necessitating its preservation. For lung transplant patients, early intervention for aspiration is warranted to prevent chronic rejection. Risk of any infection is high, requiring active surveillance and intensive treatment, mainly of fungal infections. The liver is immunotolerant requiring lower immunosuppression. Transplantation surgery is often accompanied by massive blood loss and coagulopathy. Other complications include portal vein or hepatic artery thrombosis and biliary leakage or stenosis. Kidney transplant recipients have a high risk of cardiovascular disease and posttransplant anemia should be treated liberally. After postmortal transplantation, delayed graft function is common and dialysis is continued. Ureteral anastomosis complications can be diagnosed with ultrasound.
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Affiliation(s)
- M W F van den Hoogen
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - L Seghers
- Department of Pulmonology, Thorax Center, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - O C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S Roest
- Department of Cardiology, Thorax Center, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A Bekkers
- Department of Thorax Surgery, Thorax Center, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C M den Hoed
- Department of Gastroenterology, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R C Minnee
- Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H R H de Geus
- Department of Intensive Care, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R J van Thiel
- Department of Intensive Care, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - D A Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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22
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Ye Q, Wang F, Xu H, Wu L, Gao X. Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiol 2021; 21:63. [PMID: 33648441 PMCID: PMC7919082 DOI: 10.1186/s12871-021-01283-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the optimal dose of dexmedetomidine to maintain hemodynamic stability, prevent of cough and minimize postoperative pain for patients undergoing laparoscopic cholecystectomy. METHODS One hundred twenty patients were randomly divided into D1, D2, D3 and NS groups, and dexmedetomidine 0.4, 0.6, 0.8μg/kg and normal saline were administrated respectively. Patients' heart rate, systolic blood pressure and diastolic blood pressure were measured at T1-T7. The incidence of cough was recorded. Other parameters were noted, the time of spontaneous respiratory recovery and extubation, visual analogue scale scores and dosage of tramadol. RESULTS The heart rate, systolic blood pressure and diastolic blood pressure of D2 and D3 groups has smaller fluctuations at T2-3 and T7 compared with NS and D1 groups (P < 0.05). The incidence of cough was lower in D2 and D3 groups than NS group (P < 0.05). The visual analogue scale scores and tramadol dosage of D2 and D3 groups were lower than NS group (P < 0.05). The time of spontaneous respiratory recovery and extubation in D3 group was longer than that in D1 and D2 groups (P < 0.05). CONCLUSIONS Intravenous infusion of 0.6μg/kg dexmedetomidine before induction can maintain hemodynamic stability, decrease cough during emergence, relieve postoperative pain of patients undergoing laparoscopic cholecystectomy. TRIAL REGISTRATION ChiCTR1900024801 , registered at the Chinese Clinical Trial Registry, principal investigator: Qin Ye, date of registration: July 28, 2019.
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Affiliation(s)
- Qin Ye
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Fangjun Wang
- Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Shunqing District, Nanchong City, Sichuan Province, China.
| | - Hongchun Xu
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Le Wu
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Xiaopei Gao
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
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23
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Smooth Extubation and Smooth Emergence Techniques: A Narrative Review. Anesthesiol Res Pract 2021; 2021:8883257. [PMID: 33510786 PMCID: PMC7822686 DOI: 10.1155/2021/8883257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022] Open
Abstract
There is a paucity of literature on extubation technique and a lack of consensus regarding the definition of smooth extubation. This narrative review paper defines an ideal extubation, otherwise known as a “smooth extubation,” reviews perioperative criteria for extubation and risks and adverse events related to extubation, and explores various perioperative techniques that can be used to achieve a smooth extubation while caring for an uncomplicated patient without significant risk factors for extubation failure. In light of the evolving practice during the SARS CoV2 (COVID-19) pandemic to minimize aerosol generation and infection transmission, smooth extubation is particularly important.
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24
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Zhu Q, Huang Z, Ma Q, Wu Z, Kang Y, Zhang M, Gan T, Wang M, Huang F. Supine versus semi-Fowler's positions for tracheal extubation in abdominal surgery-a randomized clinical trial. BMC Anesthesiol 2020; 20:185. [PMID: 32738878 PMCID: PMC7395215 DOI: 10.1186/s12871-020-01108-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tracheal extubation is commonly performed in the supine position. However, in patients undergoing abdominal surgery, the supine position increases abdominal wall tension, especially during coughing and deep breathing, which may aggravate pain and lead to abdominal wound dehiscence. The semi-Fowler's position may reduce abdominal wall tension, but its safety and comfort in tracheal extubation have not been reported. We aimed to evaluate the safety and comfort of different extubation positions in patients undergoing abdominal surgery. METHODS We enrolled 141 patients with an American Society of Anesthesiologists grade of I-III who underwent abdominal surgery. All patients were anesthetized with propofol, fentanyl, cisatracurium, and sevoflurane. After surgery, all patients were transferred to the post-anesthesia care unit (PACU). Patients were then randomly put into the semi-Fowler's (n = 70) or supine (n = 71) position while 100% oxygen was administered. The endotracheal tube was removed after the patients opened their eyes and regained consciousness. Vital signs, coughing, and pain and comfort scores before and/or after extubation were recorded until the patients left the PACU. RESULTS In comparison with the supine position, the semi-Fowler's position significantly decreased the wound pain scores at all intervals after extubation (3.51 ± 2.50 vs. 4.58 ± 2.26, 2.23 ± 1.68 vs. 3.11 ± 2.00, 1.81 ± 1.32 vs. 2.59 ± 1.88, P = 0.009, 0.005 and 0.005, respectively), reduced severe coughing (8[11.43%] vs. 21[29.58%], P = 0.008) and bucking after extubation (3[4.29%] vs. 18[25.35%], P < 0.001), and improved the comfort scores 5 min after extubation (6.11 ± 2.30 vs. 5.17 ± 1.78, P = 0.007) and when leaving from post-anesthesia care unit (7.17 ± 2.27 vs. 6.44 ± 1.79, P = 0.034). The incidences of vomiting, emergence agitation, and respiratory complications were of no significant difference. CONCLUSION Tracheal extubation in the semi-Fowler's position is associated with less coughing, sputum suction, and pain, and more comfort, without specific adverse effects when compared to the conventional supine position. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900025566 . Registered on 1st September 2019.
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Affiliation(s)
- Qiongfang Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zheyan Huang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiaomei Ma
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zehui Wu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yubo Kang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miaoyin Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiantian Gan
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minxue Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, China
| | - Fei Huang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, China.
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25
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Sibert KS, Long JL, Haddy SM. Extubation and the Risks of Coughing and Laryngospasm in the Era of Coronavirus Disease-19 (COVID-19). Cureus 2020; 12:e8196. [PMID: 32440387 PMCID: PMC7237060 DOI: 10.7759/cureus.8196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has prompted new interest among anesthesiologists and intensivists in controlling coughing and expectoration of potentially infectious aerosolized secretions during intubation and extubation. However, the fear of provoking laryngospasm may cause avoidance of deep or sedated extubation techniques which could reduce coughing and infection risk. This fear may be alleviated with clear understanding of the mechanisms and effective management of post-extubation airway obstruction including laryngospasm. We review the dynamic function of the larynx from the vantage point of head-and-neck surgery, highlighting two key concepts: 1. The larynx is a complex organ that may occlude reflexively at levels other than the true vocal folds; 2. The widely held belief that positive-pressure ventilation by mask can “break” laryngospasm is not supported by the otorhinolaryngology literature. We review the differential diagnosis of acute airway obstruction after extubation, discuss techniques for achieving smooth extubation with avoidance of coughing and expectoration of secretions, and recommend, on the basis of this review, a clinical pathway for optimal management of upper airway obstruction including laryngospasm to avoid adverse outcomes.
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Affiliation(s)
- Karen S Sibert
- Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA) Health, Los Angeles, USA
| | - Jennifer L Long
- Head and Neck Surgery, University of California, Los Angeles (UCLA) Health, Los Angeles, USA.,Surgery and Perioperative Medicine, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA
| | - Steven M Haddy
- Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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