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Modir H, Mahmoodiyeh B, Shayganfard M, Abdus A, Almasi-Hashiani A. Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients: a double-blind randomized clinical trial. Med Gas Res 2022; 13:112-117. [PMID: 36571375 PMCID: PMC9979203 DOI: 10.4103/2045-9912.350860] [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] [Indexed: 12/27/2022] Open
Abstract
Electroconvulsive therapy (ECT) is one of the therapeutic opportunities for patients with psychological disorders when they may decline to take medication. We sought to systematically compare the anesthetic efficacy of ketamine, propofol, and dexmedetomidine for electroconvulsive therapy in treatment-resistant major depressive disorder patients. This double-blind trial enrolled treatment-resistant major depressive disorder patients (n = 85) who had been hospitalized for ECT in the Amir Kabir Hospital's psychiatric ward (Arak, Iran). The ketamine, propofol, and dexmedetomidine groups received a dose of 0.2 μg/kg ketamine, 1.5 mg/kg propofol, and 0.8 mg/kg dexmedetomidine, respectively. In all intervention groups, 10 mL of interventional drugs was injected intravenously for 10 minutes, and in the placebo group, 10 mL of normal saline was given over the same period. The dexmedetomidine group's blood pressure was revealed comparatively lower at all times. Dexmedetomidine-treated patients showed their marked satisfaction, while those treated with propofol had shorter recovery time, shorter seizure duration, and shorter time to achieve an Aldrete score of 9-10 and increased relaxation, and next dexmedetomidine produced deeper relaxation. Propofol could shorten recovery time and seizure duration, and enhance relaxation, while dexmedetomidine was associated with higher patient satisfaction. Considering that any anesthetic which does not shorten seizure duration may serve efficiently for ECT and that ketamine-treated patients had more prolonged seizure duration, the preferred drug can hence be considered from various angles, thereby offering anesthetic agents with highly favorable efficacy in treatment-resistant major depressive disorder patients needing ECT. The drug choice thus depends on physical conditions, underlying diseases, and psychiatrist consultation.
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Affiliation(s)
- Hesameddin Modir
- Anesthesiology Department Arak University of Medical Sciences, Arak, Iran
| | - Behnam Mahmoodiyeh
- Anesthesiology Department Arak University of Medical Sciences, Arak, Iran,Correspondence to: Behnam Mahmoodiyeh, E-mail:
| | - Mehran Shayganfard
- Departments of Psychiatry Arak University of Medical Sciences, Arak, Iran
| | - Ayda Abdus
- Student Research Committee Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
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Safavi SMR, Honarmand A, Nazemroaya B, Ataie AM, Kamran Z. The effect of intranasal dexmedetomidine on hemodynamic disturbances caused by laryngoscopy and endotracheal intubation. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2022; 14:225-232. [PMID: 36161264 PMCID: PMC9490210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Induced stimulation while endotracheal intubating affects hemodynamic status. The present study compares the hemodynamic changes caused by endotracheal intubating after administering two doses of intranasal Dexmedetomidine. METHODS In an experimental (before-after) trial, 88 patients undergoing general anesthesia enrolled in the study. The Iranian Register of Clinical Trial (IRCT) code of the study was IRCT20160307026950N15 (https://en.irct.ir/trial/39269). Patients were allocated to two intervention groups and one control group by random. Intranasal Dexmedetomidine and Normal saline 0.9% were administrated 30 minutes before induction of anesthesia. (1 μg/kg Dexmedetomidine in group 1, 2 μg/kg Dexmedetomidine in group 2 and 1 mg Normal saline 0.9% in group 3). Vital signs and hemodynamic parameters were measured and recorded in minutes 1, 3, 5, and 10th after induction. Data analysis was done by ANOVA and Chi-square tests. RESULTS Heart rate, systolic and diastolic blood pressure, and mean arterial pressure were reduced in patients receiving dexmedetomidine (P<0.05), but there were no significant changes in the control group. In arterial oxygenation (P>0.05), there was no significant difference between the three groups in the arterial blood oxygen amount. CONCLUSION Premedication of intranasal dexmedetomidine influences the hemodynamic changes due to anesthesia induction. The dose of 2 µg/kg is better than one µg/kg in improving the hemodynamic state following intubation.
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Affiliation(s)
- Seyed Mohammad Reza Safavi
- Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Behzad Nazemroaya
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Amir Mohammad Ataie
- Urology & Nephrology Research Center, Hamadan University of Medical SciencesHamadan, Iran
| | - Zahra Kamran
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Modir H, Moshiri E, Yazdi B, Kamalpour T, Goodarzi D, Mohammadbeigi A. Efficacy of dexmedetomidine-ketamine vs. fentanylketamine on saturated oxygen, hemodynamic responses and sedation in cystoscopy: a doubleblinded randomized controlled clinical trial. Med Gas Res 2021; 10:91-95. [PMID: 33004704 PMCID: PMC8086618 DOI: 10.4103/2045-9912.296037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cystoscopy is a diagnostic and invasive procedure for treatment and follow-up of genitourinary system patients and could be performed with a variety of anesthesia techniques. The study aimed to assess the efficacy of dexmedetomidine-ketamine vs. fentanyl-ketamine on sedation and analgesia for cystoscopy. This double-blind randomized controlled clinical trial enrolled 60 patients undergoing cystoscopy in two groups. Patients were assigned randomly by block random allocation method into dexmedetomidine-ketamine group (1 μg/kg dexmedetomidine) and fentanyl-ketamine group (2 μg/kg fentanyl) receiving ketamine (0.5 mg/kg). Subsequently, mean blood pressure, heart rate, saturated oxygen, respiratory rate, pain intensity, Ramsay score for sedation level, cystoscopy duration, and urologic satisfaction were measured and compared between two groups. Both the groups were similar regarding age, sex and baseline hemodynamic parameters (P > 0.05). Lower heart rate and pain score were revealed in the dexmedetomidine-ketamine group at 25–50 and 30–60 minutes, respectively, after cystoscopy (P < 0.05). Moreover, repeated measure test showed that there was significant difference in trend of respiratory rate and pain score between two groups (P = 0.017) and was lower in dexmedetomidine-ketamine group. The dexmedetomidine-ketamine group relieves pain 30 minutes after cystoscopy with stable hemodynamic parameters during operation. Therefore, dexmedetomidine-ketamine is recommended to be employed for pain relief in subjects undergoing cystoscopy. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1397.108 on July 2, 2018, and registered in Iranian Registry Clinical Trial center with code IRCT20141209020258N105 on April 21, 2019.
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Affiliation(s)
- Hesameddin Modir
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Departments of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Tannaz Kamalpour
- Students Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Davood Goodarzi
- Department of Urologic Surgery, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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Saidie S, Modir H, Yazdi B, Moshiri E, Noori G, Mohammadbeigi A. The effect of dexmedetomidine on decrease of cough, hemodynamic parameters and Ramsay score versus lidocaine during general anesthesia: a randomized clinical trial. Med Gas Res 2021; 11:1-5. [PMID: 33642330 PMCID: PMC8103969 DOI: 10.4103/2045-9912.310052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Physiological responses remain common during anesthesia emergence and endotracheal extubation, causing some complications. We aimed to address the effect of dexmedetomidine (DEX) on decrease of cough, hemodynamic parameters and Ramsay score in comparing to lidocaine (LID) during anesthesia. In this double-blinded randomized clinical trial 120 hospitalized patients undergoing general anesthesia were enrolled after obtaining written consent. Block random allocation was used to assign patients into three groups including DEX (intravenous injection; 0.5 μg/kg), LID (1.5 mg/kg), and PBO (10 mL normal saline) at 10 minutes before anesthesia. No statistical significance was uncovered among three groups in blood pressure, oxygen saturation, frequency of laryngospasm and duration of surgery amongst the groups (P > 0.05), but DEX having lower heart rate and cough frequency (P < 0.05). Moreover, the mean of Ramsay score was statistically higher in DEX and LID groups than PBO except at the 50th and 60th minutes after extubation (P < 0.05). Since the mean of Ramsay score was higher in DEX vs. LID groups and reduced heart rate and cough frequency demonstrates in DEX, it seems that DEX could be an appropriate drug on suppressing cough during anesthesia without side effects. The study protocol was approved by the Ethical Committee of Arak University of Medical Sciences by code IR.ARAKMU.REC.1397.140 on August 19, 2018, and the protocol was registered at Iranian Registry of Clinical Trials by code IRCT20141209020258N97 on February 22, 2019.
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Affiliation(s)
- Soheila Saidie
- Students Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Gholamreza Noori
- Department of Surgery, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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Bilgi M, Velioglu Y, Yoldas H, Cosgun M, Yuksel A, Karagoz I, Yildiz I, Es A, Caliskan D, Erdem K, Demirhan A. Effects of Lidocaine Oropharyngeal Spray Applied Before Endotracheal Intubation on QT Dispersion in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Controlled Study. Braz J Cardiovasc Surg 2020; 35:291-298. [PMID: 32549100 PMCID: PMC7299595 DOI: 10.21470/1678-9741-2019-0112] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. METHODS A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. RESULTS The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. CONCLUSION Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. TRIAL REGISTRATION NCT03304431.
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Affiliation(s)
- Murat Bilgi
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Yusuf Velioglu
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Hamit Yoldas
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Mehmet Cosgun
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Ahmet Yuksel
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Ibrahim Karagoz
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Isa Yildiz
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Abdulhamit Es
- Abant Izzet Baysal University Faculty of Economics and Administrative Sciences Bolu Turkey Abant Izzet Baysal University Faculty of Economics and Administrative Sciences, Bolu, Turkey
| | - Duygu Caliskan
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Kemalettin Erdem
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Abdullah Demirhan
- Abant Izzet Baysal University Medical School Bolu Turkey Abant Izzet Baysal University Medical School, Bolu, Turkey
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