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Yang JR, Li YY, Ran TJ, Lin XY, Xu JY, Zhou SL, Huang PJ. Esketamine Combined with Dexmedetomidine to reduce Visceral Pain During elective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study. Drug Des Devel Ther 2024; 18:2381-2392. [PMID: 38911034 PMCID: PMC11193401 DOI: 10.2147/dddt.s460924] [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: 01/23/2024] [Accepted: 06/09/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose We aimed to evaluate the effect of intravenous esketamine combined with dexmedetomidine as supplemental analgesia in reducing intraoperative visceral pain during elective cesarean section under combined spinal-epidural anesthesia (CSEA). Patients and Methods A total of 269 parturients scheduled for elective cesarean section under CSEA between May 2023 and August 2023 were assessed. The parturients were randomly allocated to receiving either intravenous infusion of 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine (group ED, n=76), 0.5-μg/kg dexmedetomidine (group D, n=76), or normal saline (group C, n=76) after umbilical cord clamping. The primary outcome was intraoperative visceral pain. Secondary outcomes included the visual analog scale (VAS) score for pain evaluation and other intraoperative complications. Results The incidence of visceral pain was lower in group ED [9 (12.7%)] than in group D [32 (43.8%)] and group C [36 (48.6%), P <0.0001]. The VAS score was also lower in group ED when exploring abdominal cavity [0 (0), P <0.0001] and suturing the muscle layer [0 (0), P =0.036]. The mean arterial pressure was higher in group D [83 (9) mmHg] and group ED [81 (11) mmHg] than in group C [75 (10) mmHg, P <0.0001] after solution infusion. The heart rate after infusion of the solution was lower in group D [80 (12) bpm] than in group C [86 (14) bpm] and group ED [85 (12) bpm, P = 0.016]. The incidence of transient neurologic or mental symptoms was higher in group ED compared to group C and group D (76.1% vs 18.9% vs 23.3%, P<0.0001). Conclusion During cesarean section, 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine can alleviate visceral traction pain and provide stable hemodynamics. Parturients receiving this regimen may experience transient neurologic or mental symptoms that can spontaneously resolve at the end of the surgery.
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Affiliation(s)
- Ji-Rong Yang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Ying-Yuan Li
- Department of Anesthesiology, Huadu District People’s Hospital, Guangzhou, Guangdong Province, People’s Republic of China
| | - Tao-Jia Ran
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xiao-Yu Lin
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jin-Yan Xu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Shao-Li Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Pin-Jie Huang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
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Yang L, Cai Y, Dan L, Huang H, Chen B. Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial. Korean J Anesthesiol 2023; 76:586-596. [PMID: 36924790 PMCID: PMC10718632 DOI: 10.4097/kja.22787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the pulmonary function of patients receiving OLV. METHODS The Embase, PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, and Chinese Clinical Trial Registry databases were systematically searched. The primary outcome was oxygenation index (OI). Other outcomes including the incidence of postoperative complications were assessed. RESULTS Fourteen randomized controlled trials involving 845 patients were included in this meta-analysis. Dexmedetomidine improved the OI at 30 (mean difference [MD]: 40.49, 95% CI [10.21, 70.78]), 60 (MD: 60.86, 95% CI [35.81, 85.92]), and 90 min (MD: 55, 95% CI [34.89, 75.11]) after OLV and after surgery (MD: 28.98, 95% CI [17.94, 40.0]) and improved lung compliance 90 min after OLV (MD: 3.62, 95% CI [1.7, 5.53]). Additionally, dexmedetomidine reduced the incidence of postoperative pulmonary complications (odds ratio: 0.44, 95% CI [0.24, 0.82]) and length of hospital stay (MD: -0.99, 95% CI [-1.25, -0.73]); decreased tumor necrosis factor-α, interleukin (IL)-6, IL-8, and malondialdehyde levels; and increased superoxide dismutase levels. However, only the results for the OI and IL-6 levels were confirmed by the sensitivity and trial sequential analyses. CONCLUSIONS Dexmedetomidine improves oxygenation in patients receiving OLV and may additionally decrease the incidence of postoperative pulmonary complications and shorten the length of hospital stay, which may be related to associated improvements in lung compliance, anti-inflammatory effects, and regulation of oxidative stress reactions. However, robust evidence is required to confirm these conclusions.
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Affiliation(s)
- Lin Yang
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongheng Cai
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Dan
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Chen
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Mo X, Huang F, Wu X, Feng J, Zeng J, Chen J. Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: a prospective, double-blinded, randomized trial for ED 50 determination using an up-down sequential allocation method. BMC Anesthesiol 2023; 23:325. [PMID: 37749533 PMCID: PMC10519004 DOI: 10.1186/s12871-023-02275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Intrathecal dexmedetomidine, as an adjuvant to local anesthetics, has been reported to improve the quality of spinal anesthesia and reduce the required local anesthetic dose. However, the optimal dosage regimen for intrathecal dexmedetomidine combined with plain ropivacaine for cesarean section (CS) remains undetermined. The present study aimed to determine the median effective dose (ED50) of intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during CS. METHODS Sixty parturients undergoing CS were randomly assigned to either group: plain ropivacaine 8 mg (Group Rop8) or plain ropivacaine 10 mg (Group Rop10). The initial dosage of intrathecal dexmedetomidine in each group was 5 µg. The effective dose was defined as a bilateral sensory block at the level of T6 or above to pinprick attained within 10 min after intrathecal injection, without the need for supplementary intraoperative epidural anesthesia. Effective or ineffective responses were determined, followed by a 1 µg increment or decrement in the dose of intrathecal dexmedetomidine for the next parturient using up-down sequential allocation. ED50 were calculated using probit regression. RESULTS The ED50 of intrathecal dexmedetomidine with plain ropivacaine was 5.9 µg (95% confidence interval [CI], 4.9-7.4 µg) in Group Rop8 and 3.1 µg (95% CI, 0.1-4.8 µg) in Group Rop10 (P < 0.05). Hemodynamic stability, side effects, patient satisfaction and neonatal outcomes were comparable between the two groups. CONCLUSIONS The present data suggested that the ED50 of intrathecal dexmedetomidine as an adjuvant to 8 mg and 10 mg plain ropivacaine in spinal anesthesia during cesarean section was approximately 6 µg and 3 µg, respectively. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier: ChiCTR2200055928.
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Affiliation(s)
- Xiaofei Mo
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fa Huang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Wu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jumian Feng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiequn Zeng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinghui Chen
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Yang Y, Feng L, Ji C, Lu K, Chen Y, Chen B. Inhalational Versus Propofol-based Intravenous Maintenance of Anesthesia for Emergence Delirium in Adults: A Meta-analysis and Trial Sequential Analysis. J Neurosurg Anesthesiol 2023; 35:177-186. [PMID: 35026799 DOI: 10.1097/ana.0000000000000830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Emergence delirium (ED) is a severe postoperative complication that increases the risk for injury, self-extubation, and hemorrhage. Inhalational maintenance of anesthesia is a risk factor for ED in pediatric patients, but its impact in adults is undefined. This meta-analysis compares the incidence of ED between inhalational and propofol-based intravenous maintenance of anesthesia. Following a search of the PubMed, Medline, Embase, and Cochrane Library databases, 12 high-quality randomized controlled trials including 1440 patients, were identified for inclusion in the meta-analysis. Compared with propofol-based intravenous maintenance of anesthesia, inhalational maintenance increased the incidence of ED in adults (risk ratio [RR], 2.02; 95% confidence interval [CI]: 1.30-3.14; P =0.002). This was confirmed by sensitivity analysis, trial sequential analysis, and subgroup analyses of studies that assessed ED via Aono's four-point scale (RR, 3.72; 95% CI: 1.48-9.31; P =0.005) and the Ricker Sedation Agitation Scale (RR, 3.48; 95% CI: 1.66-7.32; P =0.001), studies that included sevoflurane for maintenance of anesthesia (RR, 1.87; 95% CI: 1.13-3.09; P =0.02), studies that reported ED as the primary outcome (RR, 2.73; 95% CI: 1.53-4.86; P =0.0007), and studies that investigated ocular (RR, 2.98; 95% CI: 1.10-8.10; P =0.03), nasal (RR; 95% CI: 1.27-6.50; P =0.01), and abdominal (RR, 3.25; 95% CI: 1.12-9.40; P =0.03) surgeries, but not intracranial surgery (RR, 0.72; 95% CI: 0.34-1.54; P =0.40). In summary, inhalational maintenance of sevoflurane was a risk factor for ED compared with propofol-based intravenous maintenance in adults who underwent ocular, nasal, and abdominal surgeries but not intracranial surgery.
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Affiliation(s)
- Yong Yang
- Department of Anesthesia, Southwest Hospital, Army Medical University (The Third Military Medical University)
| | - Lin Feng
- Department of Anesthesia, Chongqing Jiangbei Hospital of Traditional Chinese Medicine
| | - Chengcheng Ji
- Department of Anesthesia, Chongqing Jiangbei Hospital of Traditional Chinese Medicine
| | - Kaizhi Lu
- Department of Anesthesia, Southwest Hospital, Army Medical University (The Third Military Medical University)
| | - Yang Chen
- Department of Anesthesia, Southwest Hospital, Army Medical University (The Third Military Medical University)
| | - Bing Chen
- Department of Anesthesia, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4886970. [PMID: 34745286 PMCID: PMC8568549 DOI: 10.1155/2021/4886970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min (P=0.002), 30 min (P=0.01), and 120 min (P=0.02) after block and at the moment of fetal disengagement (P=0.0002), decreased mean arterial pressure of 120 min (P=0.01), heart rate of 30 min (P=0.003), 60 min (P < 0.00001), and 120 min (P < 0.00001) after block, blood loss (P=0.02), and the incidence of nausea/vomiting (P=0.006), and increased the incidence of maternal bradycardia (P=0.04). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block (P < 0.00001) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting (P=0.002), increased the incidence of maternal bradycardia (P=0.04), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.
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Mohammadzadeh Jouryabi A, Sharami SH, Mansour Ghanaie M, Sedighinejad A, Imantalab V, Rafiee Sorouri Z, Biazar G, Zohari Nobijari T. Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section. Anesth Pain Med 2021; 11:e116429. [PMID: 34692439 PMCID: PMC8520676 DOI: 10.5812/aapm.116429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/26/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. Methods This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients' complications were recorded and compared among the groups. Results The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). Conclusions Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.
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Affiliation(s)
- Ali Mohammadzadeh Jouryabi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedeh Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mandana Mansour Ghanaie
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Sedighinejad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Vali Imantalab
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Rafiee Sorouri
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, 4144654839, Rasht, Iran. Tel: +98-9111350987,
| | - Tahereh Zohari Nobijari
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Li G, Wang H, Qi X, Huang X, Li Y. Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial. J Int Med Res 2021; 49:300060521999534. [PMID: 33827306 PMCID: PMC8040578 DOI: 10.1177/0300060521999534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. METHODS A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. RESULTS The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. CONCLUSION Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects.This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/).
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Affiliation(s)
- Gehui Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Hao Wang
- Department of Food Safety, Market Supervision Administration of Shenzhen Municipality, Shenzhen, Guangdong, P.R. China
| | - Xiaofei Qi
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Xiaolei Huang
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Yuantao Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
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Dehghanpisheh L, Azemati S, Hamedi M, Fattahisaravi Z. The effect of 1-mg versus 3-mg granisetron on shivering and nausea in cesarean section: a randomized, controlled, triple-blind, clinical trial. Braz J Anesthesiol 2021; 72:457-465. [PMID: 33819495 PMCID: PMC9373642 DOI: 10.1016/j.bjane.2021.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/14/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Intra- and postoperative nausea, vomiting and shivering are mentioned as the most common problem following spinal anesthesia. The aim of this study is to compare two different doses of granisetron to control the shivering, nausea, and vomiting caused by spinal anesthesia in women undergoing cesarean section (C/S). Method This study is a randomized, triple-blind clinical trial. The participants received 1-mg or 3-mg granisetron. Women who underwent elective C/S were enrolled. Inclusion criteria were ASA (American Society of Anesthesiologists) physical status grade I or II and age range of 18–40 years. Primary outcome was changes in the score of shivering, and nausea and vomiting. Secondary outcomes were Apgar score, mean arterial pressure, systolic blood pressure, diastolic blood pressure, temperature and heart rate. Results According to binary logistic regression, the incidence of shivering (6.9% vs. 1.5%; p-value = 0.049), and nausea and vomiting (19.2% vs. 9.2%; p-value = 0.024) was significantly higher in patients received 1-mg granisetron in comparison with 3-mg granisetron. Multinomial logistic regression showed that the occurrence of shivering, and nausea and vomiting were not associated with the dose of granisetron. There was no significant difference between the age and Apgar score of 1 (p = 0.908) and 5 (p = 0.843) minute(s) between the two groups. Conclusion This study showed that although 3-mg of granisetron reduces the incidence of intra- and postoperative shivering, nausea and vomiting after spinal anesthesia in comparison with 1-mg of granisetron, the difference was not statistically significant.
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Affiliation(s)
- Laleh Dehghanpisheh
- Shiraz University of Medical Sciences, Shiraz Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Simin Azemati
- Shiraz University of Medical Sciences, Shiraz Anesthesiology and Critical Care Research Center, Shiraz, Iran.
| | - Mahdi Hamedi
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinabsadat Fattahisaravi
- Shiraz University of Medical Sciences, Shiraz Anesthesiology and Critical Care Research Center, Shiraz, Iran
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Yuan X, Shen J, Chen L, Wang L, Yan Q, Zhang J. Onion extract gel is not better than other topical treatments in scar management: A meta-analysis from randomised controlled trails. Int Wound J 2020; 18:396-409. [PMID: 33372412 PMCID: PMC8244018 DOI: 10.1111/iwj.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022] Open
Abstract
To evaluate the efficacy and safety of onion extract (OE) gel on scar management, a systematic review was performed by searching Embase, PubMed, Medline, and the Cochrane Library databases, and a meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Finally, 13 randomised controlled trails were enrolled for meta-analysis. OE gel increased the total improvement scores assessed by investigators (P < .00001) and patients (P < .00001) than no treatment, but no differences were detected between OE gel and other commonly used topical treatments assessed by investigators (P = .56) and patients (P = .39). Moreover, OE in silicone gel increased the total improvement scores assessed by investigators (P < .00001) and patients (P = .0007) than other treatments. OE gel increased the incidence of total adverse effects compared with no treatment (P < .0001) and other treatments (P = .008) by a fixed-effects model, and increased the incidence of dropping out caused by intolerance of treatments (P = .0002). OE gel not only has no superiority to commonly used topical treatments, but also has the potential to increase the incidence of adverse effects on scar management; OE in silicone gel might be the optimal topical choice for scar treatment; however, more evidences are needed to strength these conclusions.
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Affiliation(s)
- Xi Yuan
- Department of Plastic Surgery, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Shen
- Department of Plastic Surgery, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Chen
- Department of Plastic Surgery, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Liang Wang
- Department of Plastic Surgery, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Qing Yan
- Department of Plastic Surgery, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Jiaping Zhang
- Department of Plastic Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
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Li XX, Li YM, Lv XL, Wang XH, Liu S. The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial. BMC Anesthesiol 2020; 20:190. [PMID: 32746864 PMCID: PMC7397624 DOI: 10.1186/s12871-020-01109-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and safety of spinal anesthesia by intrathecal dexmedetomidine (DEX) for parturients undergoing cesarean section are still lack of evidence. This aim of our study was to evaluate the efficacy and safety of intrathecal DEX for parturients undergoing cesarean section to provide more data evidence for intrathecal applications. METHODS Three hundred parturients undergoing cesarean section under spinal anesthesia were randomly assigned into three groups: group B: 9.0 mg (1.2 ml) of 0.75% bupivacaine with saline (1 ml); group FB: 9.0 mg (1.2 ml) of 0.75% bupivacaine with 20 μg of fentanyl (1 ml); group DB: 9.0 mg (1.2 ml) of 0.75% bupivacaine with 5 μg of DEX (1 ml). Intraoperative block characteristics, parturients' postoperative quality of recovery, maternal and neonatal outcomes and the plasma concentration of DEX were measured. All parturients were followed up for 30 days to determine whether nerve injury occurred. RESULTS Compared with group B, the duration of sensory block in group FB and group DB were significantly prolonged (108.4 min [95% Confidence Interval (CI) = 104.6-112.3] in group B, and 122.0 min [95% CI = 116.8-127.3] in group FB, 148.2 min [95% CI = 145.3-151.1] in group DB). The overall score of quality recovery in group DB (71.6 [95% CI = 71.0-72.2]) was significantly higher than that in group FB (61.5 [95% CI = 60.8-62.2]) and group B (61.7 [95% CI = 61.0-62.4]). There was no statistically significant difference among the three groups for PH, PaO2, and PaCO2 of newborn. The plasma concentration of DEX in umbilical artery and umbilical vein was low and cannot be detected. The 30-days follow-up of parturients did not show any new onset of back, buttock or leg pain or paresthesia. CONCLUSIONS DEX is a potential local anesthetic adjuvant that the intrathecal combination of 5 μg DEX can safely exhibit a facilitatory block effect and improve parturients' recovery quality. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration number # ChiCTR1900022019 ; Date of Registration on March 20th, 2019).
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Affiliation(s)
- Xiao-Xiao Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu-Mei Li
- Feng Xian People's Hospital of Jiangsu Province, Xuzhou, Jiangsu, China
| | - Xue-Li Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xing-He Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221000, Jiangsu, China.
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Liu L, Yang Z, Lu K, Yi B, Yang Y. Liposomal Bupivacaine Single‐Injection Compared With Continuous Local Anesthetic Nerve Blocks for Painful Surgeries: A Meta‐Analysis of Randomized Controlled Trials and Trial Sequential Analysis. Pain Pract 2020; 21:88-99. [DOI: 10.1111/papr.12927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/24/2020] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lue Liu
- Department of Anesthesia Southwest HospitalArmy Military Medical University Chongqing China
| | - Zhiyong Yang
- Department of Anesthesia Southwest HospitalArmy Military Medical University Chongqing China
| | - Kaizhi Lu
- Department of Anesthesia Southwest HospitalArmy Military Medical University Chongqing China
| | - Bin Yi
- Department of Anesthesia Southwest HospitalArmy Military Medical University Chongqing China
| | - Yong Yang
- Department of Anesthesia Southwest HospitalArmy Military Medical University Chongqing China
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12
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Liu S, Zhao P, Cui Y, Lu C, Ji M, Liu W, Jiang W, Zhu Z, Sun Q. Effect of 5-μg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis. Clin Ther 2020; 42:676-690.e5. [PMID: 32222361 DOI: 10.1016/j.clinthera.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Intrathecal dexmedetomidine (DEX) has been used to improve the quality and duration of spinal anesthesia. The aim of this meta-analysis is to evaluate whether intrathecal DEX could prolong the duration of sensory and motor block during spinal anesthesia. METHODS We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials that investigated the facilitatory effects of intrathecal administration of DEX compared with those of a placebo on spinal anesthesia from inception to April 2019. Sensory and motor block durations, sensory and motor block onset times, time to first analgesic request, and DEX-related adverse effects were evaluated. Results were combined using fixed-effects or random effects modeling when appropriate. FINDINGS A total of 1478 patients from 25 clinical studies were included in the analysis. Compared with placebo, intrathecal DEX significantly prolonged the durations of both sensory block (weighted mean difference [WMD] = 134.42 min; 95% CI, 109.71-159.13 min; P < 0.001) and motor block (WMD = 114.27 min; 95% CI, 93.18-135.35 min; P < 0.001). It also hastened the onset of sensory block (WMD = -0.80 min; 95% CI, -1.21 to -0.40; P < 0.001) and motor block (WMD = -1.03 min; 95% CI, -1.51 to -0.56 min; P < 0.001). Furthermore, it delayed the time to first analgesic request (WMD = 216.90 min; 95% CI, 178.90-254.90 min; P < 0.001) and reduced the incidence of shivering (risk ratio [RR] = 0.39; 95% CI, 0.27-0.55; P < 0.001). DEX was associated with increased risk of transient bradycardia (RR = 1.59; 95% CI, 1.07-2.37; P = 0.022) and hypotension (RR = 1.40; 95% CI, 1.04-1.89; P = 0.026) but did not increase the incidence of postoperative nausea and vomiting (RR = 0.87; 95% CI, 0.62-1.24; P = 0.45). IMPLICATIONS Intrathecal DEX can prolong the duration of sensory block, the duration of motor block, and the time to first analgesic request associated with spinal anesthesia.
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Affiliation(s)
- Shuyan Liu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Peng Zhao
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Yunfeng Cui
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Chang Lu
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Mingxin Ji
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Wenhua Liu
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Wei Jiang
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Zhuo Zhu
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Qianchuang Sun
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China.
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Bi YH, Wu JM, Zhang YZ, Zhang RQ. Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section. Front Pharmacol 2020; 11:342. [PMID: 32265713 PMCID: PMC7098998 DOI: 10.3389/fphar.2020.00342] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/09/2020] [Indexed: 01/08/2023] Open
Abstract
Objective In this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section. Methods Seventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 μg (RD3 group) and 5 μg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored. Results The onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05). Conclusion 3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia, alleviated shivering in parturients, and did not prolong the time of motor block or produce any side effects, which makes this dose appropriate for cesarean delivery. Cinical Trial Registration ChiCTR, identifier ChiCTR1800014454. Registered 15 January 2018, http://www.chictr.org.cn/edit.aspx?pid=24613&htm=4
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Affiliation(s)
- Yong-Hong Bi
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Min Wu
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan-Zhuo Zhang
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rui-Qin Zhang
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Bautista L, George RB. Dexmedetomidine for every Cesarean delivery…maybe not? Can J Anaesth 2019; 66:751-754. [PMID: 30919235 DOI: 10.1007/s12630-019-01355-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lesley Bautista
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, Canada.
| | - Ronald B George
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, Canada
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