General Anesthesia With Dexmedetomidine and Remifentanil in a Neonate During Oracotomy and Resection of a Congenital Cystic Adenomatoid Malformation

Dexmedetomidine attenuates haemorrhage-induced thalamic pain by inhibiting the TLR4/NF-κB/ERK1/2 pathway in mice

BACKGROUND

Thalamic pain, a neuropathic pain syndrome, frequently occurs after stroke. This research aimed to investigate the effect of dexmedetomidine (DEX) on thalamic pain.

METHODS

The cellular localization of the TLR4 protein was determined by immunostaining. The expression of Iba1, GFAP and protein associated with the TLR4/NF-κB/ERK1/2 pathway was measured by Western blotting. Continuous pain hypersensitivity was evaluated by behavioural tests. The results were analysed by one-way ANOVA, two-way ANOVA and Tukey's post hoc test.

RESULTS

The results demonstrated that DEX obviously alleviated thalamic pain induced by haemorrhage on the ipsilateral side and delayed the development of pain hypersensitivity. Furthermore, the expression levels of Iba1, GFAP and proteins associated with the TLR4/NF-κB/ERK1/2 signalling pathway were greatly increased in mice with thalamic pain, but these effects were reversed by DEX.

CONCLUSION

Our findings suggest that DEX alleviates the inflammatory response during thalamic pain through the TLR4/NF-κB/ERK1/2 signalling pathway and might be a potential therapeutic agent for thalamic pain.

Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study

BACKGROUND

Anesthetic regimens using dexmedetomidine and short-acting opioids have been suggested as potential alternatives to sevoflurane-based anesthesia in children. The primary aim of this study is to compare demographics, intraoperative characteristics, and complications of general anesthetics in which dexmedetomidine and opioids were used without sevoflurane, or in combination with a low sevoflurane concentration, in children 36 months old and younger. The secondary aim is to evaluate intraoperative bispectral index (BIS) values when available in these patients.

METHODS

General anesthetics performed between January 1, 2017, and May 1, 2018, in children 2 years and younger who received dexmedetomidine and remifentanil, with or without sevoflurane, were identified. Additional anesthetics performed during this time in children 36 months and younger who received dexmedetomidine and opioids and had BIS monitoring were also identified. Charts were reviewed for demographic and intraoperative variables, including drug administration and hemodynamic data.

RESULTS

A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety-two patients received sevoflurane with a mean end-tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1-0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4-0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1-14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%-79.8%).

CONCLUSION

Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.