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Brain Sciences Jul 2023Our anesthetic technique proposed for awake craniotomy is the monitored anesthesia care (MAC) technique, with the patient in sedation throughout the intervention. Our...
Our anesthetic technique proposed for awake craniotomy is the monitored anesthesia care (MAC) technique, with the patient in sedation throughout the intervention. Our protocol involves analgo-sedation through the administration of dexmedetomidine and remifentanil in a continuous intravenous infusion, allowing the patient to be sedated and in comfort, but contactable and spontaneously breathing. Pre-surgery, the patient is pre-medicated with intramuscular clonidine (2 µg/kg); it acts both as an anxiolytic and as an adjuvant in pain management and improves hemodynamic stability. In the operating setting, dexmedetomidine in infusion and remifentanil in target controlled infusion (TCI) for effect are started. The purpose of the association is to exploit the pharmacodynamics of dexmedetomidine which guarantees the control of respiratory drive, and the pharmacokinetics of remifentanil characterized by insensitivity to the drug. Post-operative management: at the end of the surgical procedure, the infusion of drugs was suspended. Wake-up craniotomy is associated with reduced hospital costs compared to craniotomy performed in general anesthesia, mainly due to reduced costs in the operating room and shorter hospital stays. Greater patient satisfaction and the benefits of avoiding hospital stay have led to the evolution of outpatient intracranial neurosurgery.
PubMed: 37508963
DOI: 10.3390/brainsci13071031 -
Scientific Reports Oct 2023Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic... (Comparative Study)
Comparative Study
Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic valve replacement (TAVR), as it allows rapid detection of neurologic deficits. The purpose of this study was to compare arousal time and outcomes between monitored anesthesia care (MAC) with remimazolam and remifentanil and conventional MAC with dexmedetomidine, propofol, and remifentanil. This study was a single center retrospective study. All TAVR cases performed under MAC (MAC-TAVR) at our institution between 2019 and 2021 were included. Patients were classified by anesthesia method into remimazolam and dexmedetomidine groups. Among 258 MAC-TAVR patients, 253 were enrolled. After propensity score matching, 76 patients were assigned to each group. The time from end of drug-administration to arousal [20.0 (16.0, 24.0) min vs. 38.5 (30.0, 56.3) min, p < 0.0001] and the time from attempted-arousal to arousal [1.0 (1.0, 1.0) min vs. 12.5 (3.0, 26.8) min, p < 0.0001] were significantly shorter in the remimazolam group. There was no significant difference in the length of ICU stay [2.0 (2.0, 2.0) days vs. 2.0 (2.0, 2.0) days, p = 0.157] and postoperative hospital stay [6.0 (4.0, 9.0) days vs. 5.0 (4.0, 8.0) days, p = 0.262].Trial registration: Clinical trial number: R03-123, Registry URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051635 Registration number: UMIN000045195, Principal investigator's name: Atsuhiro Kitaura, Date of registration: 20 August 2021.
Topics: Humans; Anesthesia, General; Aortic Valve Stenosis; Benzodiazepines; Dexmedetomidine; Remifentanil; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 37816802
DOI: 10.1038/s41598-023-43895-0 -
Medicine Sep 2023The efficacy of dexmedetomidine was elusive for septic shock. This meta-analysis aimed to explore the efficacy of dexmedetomidine for septic shock. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The efficacy of dexmedetomidine was elusive for septic shock. This meta-analysis aimed to explore the efficacy of dexmedetomidine for septic shock.
METHODS
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases have been searched through October 2022 and we included randomized controlled trials reporting the effect of dexmedetomidine in patients with septic shock.
RESULTS
Five randomized controlled trials were included in the meta-analysis. Compared with control group for septic shock, dexmedetomidine treatment was able to substantially decrease Sequential Organ Failure Assessment score (mean difference [MD] = -0.99; 95% confidence interval [CI] = -1.14 to -0.84; P < .00001) and duration of mechanical ventilation (MD = -0.90; 95% CI = -1.27 to -0.54; P < .00001), but showed no obvious influence on morality at 28 days (odds ratio = 0.79; 95% CI = 0.38 to 1.66; P = 054), hospital mortality (odds ratio = 0.66; 95% CI = 0.35 to 1.24; P = .20) or intensive care unit length of stay (MD = -1.47; 95% CI = -4.60 to 1.66; P = .36).
CONCLUSIONS
Dexmedetomidine administration may help treat patients with septic shock.
Topics: Humans; Dexmedetomidine; Shock, Septic; Randomized Controlled Trials as Topic; Control Groups; Databases, Factual
PubMed: 37657031
DOI: 10.1097/MD.0000000000034414 -
Journal of Pharmacy & Pharmaceutical... 2023Dexmedetomidine exerts a sedative effect by promoting the sleep pathway endogenously and producing a state similar to N2 sleep. This study aimed to study the efficacy... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical observation of dexmedetomidine nasal spray in the treatment of sleep disorders on the first night after undergoing maxillofacial surgery: a single-center double-blind randomized controlled study.
Dexmedetomidine exerts a sedative effect by promoting the sleep pathway endogenously and producing a state similar to N2 sleep. This study aimed to study the efficacy and safety of dexmedetomidine nasal spray in the treatment of postoperative sleep disturbance. This study enrolled 120 participants [men and women; age, 18-40 years; American Society of Anesthesiologists grade, I or II] who underwent maxillofacial surgery under general anesthesia through nasotracheal intubation. The participants were randomly divided into three groups: blank control group (BC group), 1.0 μg/kg dexmedetomidine group (1.0 Dex group), and 1.5 μg/kg dexmedetomidine group (1.5 Dex group), with 40 patients allocated to each group. At 21:30 on the night after the operation, the intervention groups were administered their corresponding doses of dexmedetomidine nasal spray. The Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate the baseline sleep status of participants 1 month preoperatively and on the night after the operation. Polysomnography (PSG) was used to record the sleep status on the night after the operation. We recorded the rescue times of sedative and analgesic drugs on the first night after surgery, adverse reactions, total hospital stay duration, and total costs. Compared with patients in the BC group, those in 1.0 Dex and 1.5 Dex groups had longer N2 sleep duration, were awake for a shorter time after dose administration, woke up less often, and had significantly improved sleep efficiency ( < 0.05). Compared with the BC group, the PSQI scores of 1.0 Dex and 1.5 Dex groups were significantly lower on the night after operation, and the proportion of PSQI > 5 was significantly lower ( < 0.05). Compared with patients in the BC group and the 1.0 Dex group, those in the 1.5 Dex group had significantly prolonged N3 sleep, reduced frequency of requiring sufentanil rescue, lower incidence of sore throat after surgery, and shorter average length of hospital stay (all, < 0.05). The sleep quality of participants on the night after having undergone maxillofacial surgery was safely and effectively improved by 1.0-1.5 μg/kg dexmedetomidine atomized nasal sprays. Notably, only the latter could prolong N3 sleep. : Evidence was obtained from at least one properly designed randomized controlled trial.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Dexmedetomidine; Nasal Sprays; Hypnotics and Sedatives; Analgesics; Sleep Wake Disorders; Double-Blind Method
PubMed: 37854323
DOI: 10.3389/jpps.2023.11699 -
Frontiers in Medicine 2024Postoperative acute kidney injury (AKI) is a serious and distressing complication connected to various adverse outcomes following the surgical operation. Controversy... (Review)
Review
BACKGROUND
Postoperative acute kidney injury (AKI) is a serious and distressing complication connected to various adverse outcomes following the surgical operation. Controversy remains regarding the dexmedetomidine's preventive impact on postoperative AKI. Therefore, this investigation aims to explore the efficiency and safety of dexmedetomidine in preventing AKI after surgical operation.
METHODS
We systematically searched electronic databases such as PubMed, Embase, Web of Science, and the Cochrane Library to detect eligible randomized controlled studies that used dexmedetomidine for the prevention of AKI following operation up to April 30, 2023. The main outcome evaluated was AKI incidence. The evidence quality was assessed employing the Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS
The meta-analysis included 25 trials, including 3,997 individuals. Of these, 2,028 were in the dexmedetomidine group, and 1,969 were in the control group. The result showed that patients administered dexmedetomidine significantly decreased the AKI incidence following surgical operation in contrast to the control group (risk ratio, 0.60; 95% confidence intervals, 0.45-0.78; < 0.05; = 46%). In addition, dexmedetomidine decreased the period of hospitalization in both the intensive care unit (ICU) and the hospital while also reducing postoperative delirium (POD) occurrence. However, dexmedetomidine elevated the incidence of bradycardia but did not have a significant impact on other indicators.
CONCLUSION
Our meta-analysis indicates that the dexmedetomidine treatment reduces the postoperative AKI and POD risk while also shortening the time of hospitalization in the ICU and hospital. However, it is connected to an increased bradycardia risk.
PubMed: 38854666
DOI: 10.3389/fmed.2024.1414794 -
Indian Journal of Anaesthesia Aug 2023Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised...
Nebulised fentanyl, dexmedetomidine and magnesium sulphate for attenuation of haemodynamic response to laryngoscopy and tracheal intubation: A double-blinded, randomised comparative study.
BACKGROUND AND AIMS
Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised forms of fentanyl, dexmedetomidine and magnesium sulphate to attenuate the haemodynamic response to laryngoscopy and tracheal intubation.
METHODS
This double-blinded, randomised study was conducted on 90 patients undergoing elective surgery requiring endotracheal intubation. Nebulisation was done with fentanyl 1 μg/kg (Group A), dexmedetomidine 1 μg/kg (Group B) and magnesium sulphate (MgSO) (40 mg/kg) (Group C). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR were recorded before nebulisation (T), post-nebulisation (T) and at 2, 5 and 10 min after intubation (T, T, T). The statistical analysis for comparing continuous variables between the groups was performed using analysis of variance (ANOVA), and a value <0.05 was considered statistically significant.
RESULTS
Compared to T, an increase in HR at T and T was seen in Group A only, which reached baseline values at T ( values <0.0001 and 0.037, respectively). No HR value was higher than the baseline readings in groups B and C. The decreasing trend of SBP, DBP and MAP was seen in all three groups. Groups B and C had a statistically significant decrease in all the values from baseline ( values <0.0001).
CONCLUSION
Nebulised form of dexmedetomidine (1 μg/kg) and magnesium (40 mg/kg) seems to be superior to fentanyl (1 μg/kg) in blunting the stress response to laryngoscopy and tracheal intubation.
PubMed: 37693019
DOI: 10.4103/ija.ija_397_22 -
European Journal of Histochemistry : EJH Jul 2023It has been shown that dexmedetomidine (Dex) could attenuate postoperative cognitive dysfunction (POCD) via targeting circular RNAs (circRNAs). Circ-Shank3 has been...
It has been shown that dexmedetomidine (Dex) could attenuate postoperative cognitive dysfunction (POCD) via targeting circular RNAs (circRNAs). Circ-Shank3 has been found to be involved in the neuroprotective effects of Dex against POCD. However, the role of circ-Shank3 in POCD remains largely unknown. Reverse transcription quantitative PCR (RT-qPCR) was performed to detect circ-Shank3 and miR-140-3p levels in lipopolysaccharide (LPS)-treated microglia BV-2 cells in the absence or presence of Dex. The relationship among circ-Shank3, miR-140-3p and TLR4 was confirmed by dual-luciferase reporter assay. Additionally, Western blot and immunofluorescence (IF) assays were conducted to evaluate TLR4, p65 and Iba-1 or CD11b levels in cells. In this study, we found that Dex notably decreased circ-Shank3 and TLR4 levels and elevated miR-140-3p level in LPS-treated BV2 cells. Mechanistically, circ-Shank3 harbor miR-140-3p, functioning as a miRNA sponge, and then miR-140-3p targeted the 3'-UTR of TLR4. Additionally, Dex treatment significantly reduced TLR4 level and phosphorylation of p65, and decreased the expressions of microglia markers Iba-1 and CD11b in LPS-treated BV2 cells. As expected, silenced circ-Shank3 further reduced TLR4, p65 and Iba-1 and CD11b levels in LPS-treated BV2 cells in the presence of Dex, whereas these phenomena were reversed by miR-140-3p inhibitor. Collectively, our results found that Dex could attenuate the neuroinflammation and microglia activation in BV2 cells exposed to LPS via targeting circ-Shank3/miR-140-3p/TLR4 axis. Our results might shed a new light on the mechanism of Dex for the treatment of POCD.
Topics: Humans; Neuroinflammatory Diseases; Dexmedetomidine; Lipopolysaccharides; Microglia; Toll-Like Receptor 4; MicroRNAs; Cell Proliferation; Apoptosis
PubMed: 37491974
DOI: 10.4081/ejh.2023.3766 -
Perioperative Medicine (London, England) Nov 2023Myocardial injury after noncardiac surgery (MINS) is common in elderly patients and considered as an independent predictor of 30-day mortality after noncardiac surgery....
AIMS
Myocardial injury after noncardiac surgery (MINS) is common in elderly patients and considered as an independent predictor of 30-day mortality after noncardiac surgery. Dexmedetomidine possesses cardiac-protective profile. Previous clinical studies have found that perioperative application of dexmedetomidine is associated with decreased 1-year mortality in patients undergoing cardiac surgery. The current study protocol aims to investigate the effects of dexmedetomidine on the incidence of MINS, complications, and 30-day mortality in elderly patients subjected to noncardiac surgery.
METHODS
A multicenter, randomized, controlled, double-blind, prospective trial is designed to explore cardiac protection of dexmedetomidine in the elderly patients undergoing noncardiac surgery. A total of 960 patients aged over 65 years will be recruited and randomly assigned to dexmedetomidine group (group Dex) and normal saline placebo group (group NS) in a ratio of 1:1. Patients in group Dex will receive a bolus dose of 0.5 μg/kg dexmedetomidine within 10 min before surgical incision, followed by a consistent infusion at the rate of 0.3-0.5 μg/kg/h throughout the operation. Group NS patients will receive the same volume of normal saline. The primary outcome is the incidence of MINS via detecting the hs-TnT level within 3 days after the operation. The secondary outcome includes myocardial ischemic symptoms, the incidence of major adverse cardiovascular events (MACE) in hospital, length of ICU and postoperative hospital stay, the incidence of inhospital complications, and 30-day all-cause mortality.
DISCUSSION
The results of the current study will illustrate the effect of dexmedetomidine on myocardial injury for elderly patients undergoing major noncardiac surgery.
TRIAL REGISTRATION
The trial was registered with Chinese Clinical Trial Registry (CHICTR) on Aug 24, 2021 (ChiCTR2100049946, http://www.chictr.org.cn/showproj.aspx?proj=131804 ).
PubMed: 37951962
DOI: 10.1186/s13741-023-00348-6 -
Indian Journal of Anaesthesia May 2024Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or...
BACKGROUND AND AIMS
Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients.
METHODS
A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias.
RESULTS
In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group.
CONCLUSION
This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.
PubMed: 38764958
DOI: 10.4103/ija.ija_790_23 -
Anesthesiology and Pain Medicine Aug 2023Postoperative pain management is vital to improve patient care. Successful postoperative pain relief is currently achieved only through NSAIDs and narcotics.
BACKGROUND
Postoperative pain management is vital to improve patient care. Successful postoperative pain relief is currently achieved only through NSAIDs and narcotics.
OBJECTIVES
We compared dexmedetomidine and clonidine as additives to hyperbaric levobupivicaine 0.5% for the sub-arachnoid block (spinal anesthesia) concerning the onset time, duration of the block, hemodynamic changes, level of sedation intraoperatively and postoperatively and time taken for the first postoperative analgesic request and frequency.
METHODS
This prospective, double-blind study enrolled 60 patients who underwent lower abdominal surgeries and were eligible for a sub-arachnoid block. They were allocated randomly to one of the two groups. Group D received intrathecal dexmedetomidine 5 µg and 0.5% hyperbaric levobupivicaine 15 mg. Group C received intrathecal clonidine 50 µg and 0.5% hyperbaric levobupivicaine 15 mg.
RESULTS
Patients who received dexmedetomidine had a longer duration of the block (2-segment regression: 135 ± 15 min vs. 130 ± 20 min, S1 segment regression: 305 ± 50.4 min vs. 290 ± 47.2 min, Bromage 0: 285 ± 60 min vs. 280 ± 45 min), delayed first rescue analgesia request (700 ± 160 min vs. 506 ± 112 min), reduced frequency of rescue analgesics (1 vs. 2), and desired level of sedation (1.3 ± 0.46 vs. 0.4 ± 0.01) when compared to those receiving clonidine. There were insignificant differences between the groups in intraoperative hemodynamic parameters, such as minimal bradycardia and minimal hypotension. Though dexmedetomidine had an early onset, there was no statistically significant difference compared to clonidine.
CONCLUSIONS
Comparing dexmedetomidine and clonidine as additives in the sub-arachnoid block, the group who received dexmedetomidine had similar onset, prolonged duration of blockade, delayed first rescue analgesia demand, reduced frequency of analgesics, and desired sedation with similar minimal hemodynamic changes such as bradycardia and hypotension.
PubMed: 38023998
DOI: 10.5812/aapm-138274