Dexmedetomidine Improved Sleep Quality in the Intensive Care Unit After Laryngectomy

Purpose

To examine whether nighttime dexmedetomidine infusion improved sleep quality in patients after laryngectomy.

Patients and Methods

Thirty-five post-laryngectomy patients admitted to the intensive care unit (ICU) were randomly assigned to a 9-h (from 2100 h on surgery day to 0600 h the morning after laryngectomy) dexmedetomidine (0.3 μg/kg/h continuous infusion) or placebo group. Polysomnography results were monitored during the dexmedetomidine infusion period. The percentage of stage 2 non-rapid eye movement (stage N2) sleep was the primary outcome measure.

Results

Thirty-five patients (18 placebo group; 17 dexmedetomidine group) had complete polysomnogram recordings. The percentage of stage N3 sleep was significantly increased in the dexmedetomidine infusion group (from median 0% (0 to 0) in placebo group to 0% (interquartile range, 0 to 4) in dexmedetomidine group (difference, -2.32%; 95% CI, -4.19 to -0.443; P = 0.0167)). Infusion had no effect on total sleep time, stage N1 or N2 sleep percentages, or sleep efficiency. It decreased muscle tensity and snore non-rapid eye movement. Subjective sleep quality improved. Hypotension incidence increased in the dexmedetomidine group, but significant intervention was not required.

Conclusion

Dexmedetomidine infusion improved overall patient sleep quality in the ICU after laryngectomy.

Case report: Low dose dexmedetomidine infusion for the management of hypoglycemia in a dog with an insulinoma

Objective

To describe the use of a low dose dexmedetomidine infusion as preoperative treatment for hypoglycemia secondary to a functional pancreatic tumor in a dog.

Case summary

An 8.7-year-old castrated male Hungarian Vizsla presented for further evaluation of persistent hypoglycemia after the referring veterinarian established a tentative diagnosis of insulinoma based on paired insulin and glucose measurements. Abdominal ultrasound and computed tomography demonstrated evidence of a pancreatic mass with possible hepatic metastases. Attempts to aspirate the lesions under ultrasound guidance were unsuccessful, and the dog was hospitalized overnight for planned surgical resection of the presumed pancreatic tumor and biopsy of the hepatic lesions the following day. In response to a progressive increase in patient anxiety and agitation trazodone was prescribed ~5 mg/kg orally every 8 h and gabapentin at ~7 mg/kg every 8 h. As the dog continued to remain anxious dexmedetomidine at a dose of 1 mcg/kg was administered intravenously immediately followed with an infusion of dexmedetomidine at 1 mcg/kg/h. The anxious behaviors were successfully controlled with minimal cardiovascular side effects. Serial blood glucose measurements obtained during this time demonstrated euglycemia. The dog remained euglycemic while receiving dexmedetomidine for the remainder of the pre-operative period and for duration of hospitalization following surgical resection and biopsy.

New or unique information provided

This case report demonstrates a possible role for dexmedetomidine to counteract hypoglycemia in dogs with insulinomas.

Dexmedetomidine Compared to Remifentanil Infusion as Adjuvant to Sevoflurane Anesthesia during Laparoscopic Sleeve Gastrectomy

Objectives

Evaluation of postoperative (PO) analgesic effects of intraoperative (IO) Dexmedetomidine (DEX) compared to remifentanil (REMI) infusions during sevoflurane anesthesia for laparoscopic gastric sleeve surgery.

Patients and Methods

One hundred and thirty-two patients with body mass index >35 kg.m^-2 and ASA Grades II or III were randomly divided into group R received REMI infusion (6-18 μg.kg^-1.h^-1) and Group D received DEX infusion (0.2-0.5 μg.kg^-1.h^-1) after tracheal intubation till before stoppage of inhalational anesthetic. Heart rate and mean arterial pressure were noninvasively monitored during and after surgery. Emergence time, time until postanesthetic care unit transfer, and total operating room (OR) time was recorded. PO shoulder-tip pain and wound pain scores were recorded and rescue analgesia was provided as 50 mg pethidine intramuscular injection. Occurrence of PO nausea and vomiting (PONV) and frequency of the need for antiemetic therapy were recorded. Primary study outcome was the ability of the study infusions to reduce consumption of PO pethidine down to one dose during 24-hr PO.

Results

IO use of REMI or DEX infusion allowed hemodynamic control to surgical stresses with nonsignificant difference between both infusions. REMI infusion insured significantly rapid recovery and short OR times but required larger volume of sevoflurane during surgery and proper PO follow-up for pain and PONV. DEX infusion significantly improved control of PO pain with a larger number of patient requested rescue analgesia only once, reduced the dose of PO analgesia, reduced the frequency of PONV, and the need for antiemetic therapy.

Conclusion

REMI or DEX infusion as IO adjuvant to general anesthesia is appropriate option to achieve hemodynamic control of surgical stresses and to improve perioperative outcomes. REMI infusion may be preferred for its induced rapid recovery and short OR time, whereas DEX infusion may be chosen for its improved control of PO pain and reduction of PO analgesia and frequency of PONV.