The clinical effect of dexmedetomidine combined with parecoxib sodium on sedation, antianxiety and prevention of intubation stress in patients undergoing functional endoscopic sinus surgery: a randomised controlled trial

Opioid requirement and pain intensity after mandibular surgeries with dexmedetomidine administration in two ways: intraoperative infusion versus bolus injection

PURPOSE

The purpose of this study is to compare the opioid requirement and pain intensity after surgeries of mandibular fractures with administration of dexmedetomidine by two approaches of infusion and single bolus.

METHODS

In this double-blind clinical trial, the participants were randomized and matched in terms of age and gender in two groups (infusion and bolus). In both groups, the amount of narcotic used, hemodynamic indices, oxygen saturation, and pain intensity were collected based on the ten-point Visual Analogue Scale (VAS) at 7 time points for 24 h. SPSS version 24 software was used for data analysis. A significance level of less than 5% was considered.

RESULTS

A total of 40 patients were included in the study. There was no significant difference between the two groups in terms of gender, age, ASA class, and duration of surgery (P>0.05). There was no significant difference between the two groups in terms of nausea and vomiting and subsequently receiving anti-nausea medication (P>0.05). The need for opioid consumption after surgery was not different in two groups (P>0.05). Infusion of dexmedetomidine reduced postoperative pain more rapidly than its single bolus dose (P<0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation variables (P>0.05). Homodynamic indices including heart rate, systolic blood pressure, and diastolic blood pressure in the bolus group were significantly lower than the infusion group (P<0.05).

CONCLUSION

Administration of dexmedetomidine in the form of infusion can reduce postoperative pain better than bolus injection, with less probability of hypotension and bradycardia.

Music combined with dexmedetomidine relieves preoperative anxiety and promotes postoperative recovery in patients undergoing gynecologic laparoscopic surgery: a randomized clinical trial

OBJECTIVES

To investigate the effects of music combined with dexmedetomidine on perioperative anxiety and postoperative recovery in gynecologic laparoscopic patients.

METHODS

A total of 82 female patients were enrolled in this study. Patients were randomized to the patient-preferred Music+Dexmedetomidine group (M+DEX group, n=41) and the Dexmedetomidine group (DEX group, n=41). Prior to the induction of anesthesia, dexmedetomidine was pumped intravenously at 0.5 µg/kg for 10 minutes in both groups and then maintained at 0.2 µg/kg/hour until 30 minutes before the end of surgery. In contrast to the patients in the DEX group, the patients in the M+DEX group listened to 5 minutes of their favorite music during dexmedetomidine infusion. The primary outcome was the patient's preoperative State Anxiety Inventory (SAI) score. The secondary outcomes included visual analog scale (VAS) pain scores and QoR-15 scores at 24 hours postoperatively.

RESULTS

The clinical data of a total of 82 patients were analyzed. After the music intervention, we found that the preoperative SAI scores were lower in the M+DEX group than in the DEX group (37.9±5.6 vs. 41.5±6.9; P=0.01). The M+DEX group had lower VAS scores at 24 hours postoperatively than the DEX group (1 (1.0, 2.0) vs. 2 (2.0, 3.0), P < 0.01), and the M+DEX group had higher QoR-15 scores at 24 hours after the surgery than the DEX group (127.7±10.0 vs. 122.3±11.2; P=0.03).

CONCLUSION

Patients undergoing gynecologic laparoscopic surgery who listened to their favorite music before the induction of anesthesia had less preoperative anxiety and recovered better 24 hours postoperatively than those who only received dexmedetomidine.

Clinical Application of Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block in Patients with Severe COPD Undergoing Awake Fibreoptic Nasotracheal Intubation: A Randomized Controlled Clinical Trial

Purpose

The aim was to investigate the time for intubation, adverse events and the comfort score of ultrasound-guided internal branch of superior laryngeal nerve block in patients with severe chronic obstructive pulmonary disorder (COPD) undergoing awake fibreoptic nasotracheal intubation.

Methods

Sixty patients with COPD who needed awake fibreoptic nasotracheal intubation were randomly and evenly divided into the ultrasound-guided internal branch of the superior laryngeal nerve block group (group S) and the control group (group C). All patients received procedural sedation with dexmedetomidine and adequate topical anaesthesia of the upper respiratory tract. Then, bilateral block was performed (with 2 mL of 2% lidocaine or the same volume of saline) followed by fibreoptic nasotracheal intubation. The primary outcomes were time for intubation, adverse reactions and comfort score. The secondary outcomes were haemodynamic changes and serum norepinephrine (NE) and adrenaline (AD) concentrations immediately before intubation (T0); immediately after intubation to the laryngopharynx (T1); and immediately (T2), 5 min (T3) and 10 min (T4) after intubation between the groups.

Results

Compared with group C, the time for intubation, the incidence of adverse reactions and the comfort score in group S were significantly lower (P<0.01). Compared with T0, the mean arterial pressure (MAP), heart rate (HR), NE and AD were significantly higher at T1 - T4 in group C (P<0.05), but were not obviously higher at T1 - T4 in group S (P>0.05). MAP, HR, NE and AD at T1-T4 were significantly lower in group S than in group C (P<0.05).

Conclusion

Ultrasound-guided internal branch of the superior laryngeal nerve block can effectively shorten the time for intubation, reduce the incidence of adverse reactions, improve comfort score, maintain considerable haemodynamic stability and inhibit stress response in patients with severe COPD undergoing awake fibreoptic nasotracheal intubation.

Dexmedetomidine premedication increases preoperative sedation and inhibits stress induced by tracheal intubation in adult: a prospective randomized double-blind clinical study

OBJECTIVE

The aim of this prospective randomized double-blind study is to evaluate whether oral dexmedetomidine (DEX) premedication could increase sedation in order to reduce preoperative anxiety and inhibit stress response during general anesthesia tracheal intubation.

MATERIALS

A total of 100 ASA I and II adult patients undergoing elective neurosurgery were randomly divided into the control group (C group, n = 50) and the oral DEX premedication (DEX group, n = 50). Patients were administrated 4 μg/kg dexmedetomidine orally pre-anesthesia 120 min. Hemodynamic variables were monitored and recorded from premedication to 10 min after tracheal intubation. The primary outcome, the sedation level of all participants, was evaluated by Richmond Agitation Sedation Scale (RASS), and Numerical Rating Scale was to measure their intensity of thirst and satisfaction of patients' family members. During general anesthesia induction, the total dosage of induction anesthetics and complications relative to anesthesia induction were recorded. After tracheal intubation, blood sample was drain from radial atrial line to measure levels of adrenocorticotropic hormone (ACTH) and cortisol.

RESULTS

RASS scores at 60 min after premedication and on arrival in the operating room were significantly reduced in the DEX group (P < 0.001). Oral DEX premedication not only increased the intensity of thirst but also the satisfaction of their family members (P < 0.001). The cortisol level after tracheal intubation was deduced by oral DEX premedication (P < 0.05). Oral DEX premedication reduced heart rate (HR) and mean arterial pressure (MAP) on arrival in the operating room, and HR when tracheal intubation (P < 0.05). During the whole process of anesthesia induction, although the lowest MAP in two groups were not significantly different, the lowest HR was significantly lower in the DEX group (P < 0.05). Oral DEX premedication might reduce HR from premedication to 10 min after tracheal intubation. However MAP was reduced just from premedication to on arrival in the operating room. Total induction dosages of propofol, midazolam, sulfentanil and rocuronium were similar in two groups (P > 0.05), as well as the complications relative to anesthesia induction and cases of rescue dopamine therapy were similar (P > 0.05).

CONCLUSION

Oral DEX 4 μg/kg premedication was an efficient intervention to increase preoperative sedation and reduce stress reaction induced by general anesthesia tracheal intubation, but also it was with the stable hemodynamic during the process of general anesthesia tracheal intubation, and improved the satisfaction of patients' family members. In this study, the sparing-anesthetic effect of 4 μg/kg DEX oral premedication was not significant, and this would be needed to study in future.

TRIAL REGISTRATION

This trail was registered at Chinese Clinical Trial Registry ( https://www.chictr.org.cn , Jie Gao) on 15/04/2021, registration number was ChiCTR2100045458.

Effect of Parecoxib Sodium Preemptive Analgesia on the Recovery Period of General Anesthesia in Patients Undergoing Glioma Resection

Objective

To investigate the effect of parecoxib sodium preemptive analgesia on postoperative complications and postoperative recovery of patients undergoing glioma resection.

Methods

A total of 200 eligible patients with low-grade gliomas in the functional brain area scheduled for an awake craniotomy between January 2017 and December 2020 were reviewed. The subjects were divided into two groups: the study group (n = 100) given dexmedetomidine plus parecoxib sodium for pre-emptive analgesia 30 minutes preoperatively, and the control group (n = 100) receiving dexmedetomidine alone. Venous blood was collected before surgery, at the time of postoperative recovery, and 24 hours after operation, mean artery pressure (MAP) and heart rate (HR) were recorded during surgery. Sedation satisfaction, agitation rate, numerical pain score (NRS), postoperative complications, minimental state examination (MMSE) scores, quality of life (QoL) scores, and incidence of adverse events were also investigated after the surgery.

Results

There were no significant differences in operation time, awakening time, intraoperative awakening time, and extubation time between the two groups (P > 0.05). Compared with the control group, the ΔMAP (7.26 ± 2.21 versus 5.78 ± 2.36 mmHg) and the ΔHR (11.35 ± 3.66 versus 8.84 ± 2.47 beats/min) were significantly lower in the study group (P < 0.05). Compared with the control group, the satisfaction was higher and agitation rate was lower in the study group (P < 0.05). The incidence of intracranial infection and pulmonary infection decreased after operation (P < 0.05). The NRS of the study group was remarkably lower than the control group at 12 hours postoperatively Preoperative MMSE score and QoL score showed no statistical difference (P > 0.05), while postoperative MMSE and QoL scores showed statistical difference (P < 0.05).

Conclusion

This study suggests that parecoxib sodium can significantly improve the level of sedation and analgesia in patients undergoing glioma resection, reduce the incidence of intracranial infection and pulmonary infection.

Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy

Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management.

Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded.

Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation.

Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.

The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial

Background

Functional endoscopic sinus surgery (FESS) is required to minimize bleeding to maintain a clear operative field during surgery, so it is important to preoperative anti-anxiety and stable hemodynamics. Initial evidence suggests cognitive behavioral therapy (CBT) is effective to minimize surgery-related stress and to speed up recovery. The study aimed to evaluate the efficacy of a newly developed computer-assisted CBT (cCBT) program on surgery-related psychobiological responses in patients undergoing FESS.

Methods

Participants were allocated to a CCBT group (cCBT; n = 50) or a UC group (usual care; n = 50) by random number table. The State Anxiety Inventory (SAI), Patients Health Questionnaire-9 (PHQ-9), Athens Insomnia Scale (AIS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were assessed before intervention (T1), at 1 h before operation (T2), at postoperative 48 h (T3), and 96 h (T4: after intervention completed) respectively. The stress hormone was assayed at T1 and T2. The duration of surgery, anesthesia, and post-anesthesia care unit (PACU) were recorded. A satisfaction survey about nursing services was completed by participants before discharge.

Results

Compared to the UC group, the SAI scores at T2 and the AIS scores at T3 were lower in the CCBT group (p < 0.01 and p = 0.002). The positive rate of participants who were moderate and severe anxiety (SAI score > 37) at T2 were lower (72% vs. 88%, p = 0.04); the cortisol levels, SBP, DBP, and HR at T2 in the CCBT group were lower (p = 0.019 and all p < 0.01); the duration of anesthesia and PACU was shorter (p = 0.001 and p < 0.01); the CCBT group showed higher satisfaction scores.

Conclusion

The newly developed cCBT program was an effective non-pharmacological adjunctive treatment for improving the surgery-related psychosomatic responses and perioperative outcomes.

Trial registration

The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025994) on 17 September 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13741-021-00195-3.

Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial

Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg - 70 mmHg, provides a bloodless and visible surgical field during rhinoplasty. It has been shown that dexmedetomidine, an α2-adrenoreceptor agonist, is a suitable choice in this regard. One of the disadvantages of this drug is the possibility of severe bradycardia during infusion. Therefore, we compared lower intravenous (IV) loading doses to determine whether the hypotensive effect of the drug was preserved and the bradycardia incidence decreased. In this randomized, double-blinded clinical trial, 81 patients aged 18 to 50 years with the American Society of Anesthesiologists physical status (ASA-PS) class I and II, scheduled for rhinoplasty randomly received 1.0, 0.9, and 0.8 µg/kg (named as groups 1.0, 0.9, and 0.8, respectively) of IV dexmedetomidine before the induction of anesthesia followed by infusion (0.3 - 0.7 µg/kg/h) during operation. The patients' heart rate (HR), MAP, the requirements for nitroglycerin (NTG) and extra fentanyl, as well as the incidence of bradycardia, were recorded. Bleeding and visibility of the surgical field were scored by the surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG and extra fentanyl were similar in the studied groups. The surgical field was more visible and bloodless in group 1.0 compared to group 0.8 (P < 0.001); the differences were not significant between groups 1.0 and 0.9 (P = 0.605). The incidence (P = 0.027) and the severity of bradycardia (P = 0.017) were higher in the groups with higher loading doses. We concluded that dexmedetomidine is an acceptable agent to provide controlled hypotension. A loading dose of 0.9 µg/kg, but not 0.8 µg/kg, provides similar surgical field conditions as the dose of 1 µg/kg. Furthermore, despite the decrease in the incidence of bradycardia, the hypotensive effect of the drug is preserved.

Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized Control Trial for Postoperative Pain Evaluation

Objectives

Administration of medications such as dexmedetomidine as a topical anesthetic has been suggested in the pain control in dentistry. This double-blind randomized control trial study evaluated postoperative pain and associated factors following impacted third molar extraction surgery. Lidocaine alone was taken as the control and lidocaine plus dexmedetomidine as the intervention.

Materials and Methods

Forty patients undergoing mandibular third molar extraction entered the study and were randomly allocated to the control and interventional groups. 0.15 ml of dexmedetomidine was added to each lidocaine cartridge and the drug concentration was adjusted to 15 μg for the intervention group while only lidocaine was used in the control group. A visual analog scale was used to measure and record pain levels at the end of the surgery and 6, 12, and 24 hours after the surgery and number of painkillers taken by the patients after the surgery was also recorded.

Results

Pain scores of the intervention group decreased significantly during the surgery and also 6, 12, and 24 hours after the surgery compared to the control group. The pain score was correlated significantly with our intervention during the surgery and also 6 and 12 hours after that (all P value < 0.05). There was a nonsignificant reduction in the number of painkillers taken by the patients at 6, 12, and 24 hours after surgery (all P value > 0.05).

Conclusion

In patients undergoing molar surgery, administration of a combination of dexmedetomidine and lidocaine is beneficial for the pain control. Clinical Relevance. Compared to the injection of lidocaine alone, combination of dexmedetomidine and lidocaine can be used for a better pain control in molar surgeries.