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BioMed Research International 2022To evaluate the anesthetic effect and safety of dexmedetomidine in cesarean section. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the anesthetic effect and safety of dexmedetomidine in cesarean section.
METHODS
The Cochrane Library, EMBASE, and PubMed databases (established until September 2020) were searched by computer. Two authors independently screened and extracted literature related to the application of dexmedetomidine in the cesarean section according to inclusion and exclusion criteria. The control group received either subarachnoid block (lumbar anesthesia) or combined lumbar anesthesia and epidural anesthesia (combined lumbar epidural anesthesia) with bupivacaine or combined bupivacaine and fentanyl. The observation group was additionally given dexmedetomidine based on the control group, to analyze the anesthetic effect and safety of dexmedetomidine in cesarean section.
RESULTS
A total of 580 cesarean delivery women were included in 8 studies, and the results showed that the peak time of sensory block in the observation group was shorter than that in the control group (standard mean difference = -0.28; 95% confidence interval: -0.48, -0.08; = 0.006), sensory block lasted longer than that in the control group (standard mean difference = 1.49; 95% confidence interval: 1.21, 1.78; < 0.00001), the sedation rate was higher than that in the control group, the onset of the first postoperative pain was significantly delayed compared with that in the control group, and the incidence of postoperative pain, nausea and vomiting, postoperative chills, and fever was lower than that in the control group ( < 0.05).
CONCLUSION
Dexmedetomidine combined with lumbar anesthesia or combined lumbar epidural anesthesia for women in cesarean section has more clinical benefits and better safety.
Topics: Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Cesarean Section; Dexmedetomidine; Female; Humans; Pain, Postoperative; Pregnancy
PubMed: 35607304
DOI: 10.1155/2022/1681803 -
Acta Cirurgica Brasileira 2020To evaluate protective effects of dexmedetomidine, calcitriol and their combination.
PURPOSE
To evaluate protective effects of dexmedetomidine, calcitriol and their combination.
METHODS
Forty Wistar-albino rats were divided into 4 groups; group of Sham (Group Sham); group of dexmedetomidine (Group DEX); group of calcitriol (Group CAL) and group of dexmedetomidineandcalcitriol (Group DEX-CAL). Photographic analysis was used for macroscopic analysis and perfusion analyses were evaluated by scintigraphy. Additionally, tissue malondialdehyde (MDA) and total oxidant status (TOS) and total antioxidant activity (TAS) were recorded and oxidative stress index (OSI) was calculated. Each flap was assessed by histopathology.
RESULTS
Compared to Group Sham, the viable flap areas were higher in all treatment groups both by photographic image analyses and perfusion analyses (p<0.05). Group DEX-CAL had the highest viable flap percentage both in scintigraphic and photographic analyses; whereas Group Sham had the lowest viable flap percentage. Similarly, TAS and MDA levels were elevated and TOS levels were declined in all treatment groups compared to Group Sham (p<0.005). Histopathological analysis at flap demarcation zone confirmed neovascularization was significantly higher and edema, necrosis and inflammation were significantly lower in all treatment groups compared to Group Sham.
CONCLUSION
The outcomes show that additional premedication with either dexmedetomidine or calcitriol or their combination reduces ischemia-reperfusion injury of flap area and show significant increase in the percentage of viable flap tissue.
Topics: Animals; Calcitriol; Dexmedetomidine; Rats; Rats, Wistar; Reperfusion Injury; Surgical Flaps
PubMed: 33027360
DOI: 10.1590/s0102-865020200090000003 -
American Journal of Veterinary Research Jan 2021To determine the effects of dexmedetomidine, doxapram, and dexmedetomidine plus doxapram on ventilation ([Formula: see text]e), breath frequency, and tidal volume (Vt)...
OBJECTIVE
To determine the effects of dexmedetomidine, doxapram, and dexmedetomidine plus doxapram on ventilation ([Formula: see text]e), breath frequency, and tidal volume (Vt) in ball pythons () and of doxapram on the thermal antinociceptive efficacy of dexmedetomidine.
ANIMALS
14 ball pythons.
PROCEDURES
Respiratory effects of dexmedetomidine and doxapram were assessed with whole-body, closed-chamber plethysmography, which allowed for estimates of [Formula: see text]e and Vt. In the first experiment of this study with a complete crossover design, snakes were injected, SC, with saline (0.9% NaCl) solution, dexmedetomidine (0.1 mg/kg), doxapram (10 mg/kg), or dexmedetomidine and doxapram, and breath frequency, [Formula: see text]e, and Vt were measured before and every 30 minutes thereafter, through 240 minutes. In the second experiment, antinociceptive efficacy of saline solution, dexmedetomidine, and dexmedetomidine plus doxapram was assessed by measuring thermal withdrawal latencies before and 60 minutes after SC injection.
RESULTS
Dexmedetomidine significantly decreased breath frequency and increased Vt but did not affect [Formula: see text]e at all time points, compared with baseline. Doxapram significantly increased [Formula: see text]e, breath frequency, and Vt at 60 minutes after injection, compared with saline solution. The combination of dexmedetomidine and doxapram, compared with dexmedetomidine alone, significantly increased [Formula: see text]e at 30 and 60 minutes after injection and did not affect breath frequency and Vt at all time points. Thermal withdrawal latencies significantly increased when snakes received dexmedetomidine or dexmedetomidine plus doxapram, versus saline solution.
CONCLUSIONS AND CLINICAL RELEVANCE
Concurrent administration of doxapram may mitigate the dexmedetomidine-induced reduction of breathing frequency without disrupting thermal antinociceptive efficacy in ball pythons.
Topics: Analgesics; Animals; Boidae; Dexmedetomidine; Doxapram; Respiration
PubMed: 33369496
DOI: 10.2460/ajvr.82.1.11 -
Biomaterials Oct 2018Eye drops producing long-acting ocular anesthesia would be desirable for corneal pain management. Here we present liposome-based formulations to achieve very long ocular...
Eye drops producing long-acting ocular anesthesia would be desirable for corneal pain management. Here we present liposome-based formulations to achieve very long ocular anesthetic effect after a single eye drop instillation. The liposomes were functionalized with succinyl-Concanavalin A (sConA-Lip), which can bind corneal glycan moieties, to significantly prolong the dwell time of liposomes on the cornea. sConA-Lip were loaded with tetrodotoxin and dexmedetomidine (sConA-Lip/TD), and provided sustained release for both. A single topical instillation of sConA-Lip/TD on the cornea could achieve 105 min of complete analgesia and 608 min of partial analgesia, which was significantly longer than analgesia with proparacaine, tetrodotoxin/dexmedetomidine solution or unmodified liposomes containing tetrodotoxin and dexmedetomidine. sConA-Lip/TD were not cytotoxic in vitro to human corneal limbal epithelial cells or corneal keratocytes. Topical administration of sConA-Lip/TD provided prolonged corneal anesthesia without delaying corneal wound healing. Such a formulation may be useful for the management of acute surgical and nonsurgical corneal pain, or for treatment of other ocular surface diseases.
Topics: Administration, Topical; Anesthetics, Local; Animals; Concanavalin A; Cornea; Corneal Keratocytes; Dexmedetomidine; Liposomes; Male; Rats; Rats, Sprague-Dawley; Tetrodotoxin; Wound Healing
PubMed: 30099260
DOI: 10.1016/j.biomaterials.2018.07.054 -
Clinical Interventions in Aging 2023We investigated the effects of intraoperative intravenous lidocaine or dexmedetomidine infusion on inflammatory factors and cognitive function in patients undergoing... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial.
PURPOSE
We investigated the effects of intraoperative intravenous lidocaine or dexmedetomidine infusion on inflammatory factors and cognitive function in patients undergoing thoracoscopic surgery.
PATIENTS AND METHODS
Patients aged >65 years undergoing elective thoracoscopic lobectomy or segmentectomy were randomly grouped as dexmedetomidine group (group D), lidocaine group (group L), and control group (group C). The plasma cortisol, interleukin-6, and tumor necrosis factor-α concentrations were measured before anesthesia (T0) and immediately (T1), 24 h (T2), and 48 h postoperatively (T3). Postoperative delirium (POD) was assessed by 3D-CAM on days 2 and 7.
RESULTS
The cortisol concentrations decreased for all groups at T1 from T0 although they were significantly higher at T2. Group L had significantly lower interleukin-6 concentrations at T1 and T2 than the other groups (<0.05). The interleukin-6 concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups, significantly lower for groups D and L than for group C at T1 and T2 (<0.05), and significantly lower for group L than for group D at T2 (<0.05). The tumor necrosis factor-α concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups and significantly lower for groups D and L than for group C at T1 and T2 (<0.05), although they were not statistically significantly different for groups D and L. There were no statistically significant differences in the postoperative incidence of POD between the three groups on days 2 and day 7.
CONCLUSION
Intraoperative continuous intravenous lidocaine or dexmedetomidine infusion reduced surgical stress and inflammatory responses. The inhibitory effect of lidocaine on surgical stress remained significant for up to 24 h postoperatively without affecting patient awakening. However, the administration of either drug failed to prevent postoperative POD.
Topics: Humans; Dexmedetomidine; Emergence Delirium; Hydrocortisone; Interleukin-6; Lidocaine; Tumor Necrosis Factor-alpha; Thoracic Surgery
PubMed: 37554513
DOI: 10.2147/CIA.S419835 -
Veterinary Medicine and Science May 2022Many α -agonists are commonly used for sedation and analgesia in ruminants.
BACKGROUND
Many α -agonists are commonly used for sedation and analgesia in ruminants.
INTRODUCTION
The present study aims to compare the sedative and physiological effects of intravenous (IV) administration of xylazine, detomidine, medetomidine and dexmedetomidine in goats.
METHODS
Ten healthy goats aged 6 ± 1 months and weighing 15 ± 2 kg were used in experimental, crossover Latin square, randomised and blinded study. Animals were assigned to five IV treatments: control (normal saline); xylazine (100 μg kg ); detomidine (50 μg kg ); medetomidine (20 μg kg ) and dexmedetomidine (5 μg kg ). The degree of sedation was investigated using a numerical ranking scale of 0-10. Sedation scores were compared at each time using nonparametric (Kruskal-Wallis and Mann-Whitney U) tests.
RESULTS
Heart rate (HR), respiratory rate (RR), rectal temperature (RT), ruminal motility and capillary refill time (CRT) were performed before (baseline) and after drug administration. Animals in α -adrenergic agonist treatments were sedated at 5-60 min. There were no significant differences among α -adrenergic agonist treatments at 5-60 min in sedation scores. HR significantly decreased from baseline 5-90 min after α -adrenergic agonists' administration. Ruminal motility was decreased in α -adrenergic agonist treatments at 5, 90 and 120 min and absent at 10-60 min. A significant decrease from baseline in RR was detected between 30 and 90 min after α -adrenergic agonists' administration. RT was unchanged in any treatment for 120 min. CRT was less than 2 s at all time points following each treatment.
CONCLUSIONS
The duration of sedation was up to 60 min after IV administration of xylazine (100 μg kg ), detomidine (50 μg kg ), medetomidine (20 μg kg ) and dexmedetomidine (5 μg kg ) in goats in this study. No significant differences were detected between xylazine, detomidine, medetomidine and dexmedetomidine in goats.
Topics: Adrenergic Agonists; Animals; Dexmedetomidine; Goats; Hypnotics and Sedatives; Imidazoles; Medetomidine; Xylazine
PubMed: 35014205
DOI: 10.1002/vms3.732 -
Pharmacology Research & Perspectives Dec 2020At present, the efficacy and safety of dexmedetomidine in patients receiving mechanical ventilation (MV) is still controversial. Therefore, the purpose of this research... (Meta-Analysis)
Meta-Analysis Review
At present, the efficacy and safety of dexmedetomidine in patients receiving mechanical ventilation (MV) is still controversial. Therefore, the purpose of this research was to assess the efficacy and safety of dexmedetomidine in MV patients by reviewing the results of randomized controlled trials (RCT). RCTs evaluating the efficacy of dexmedetomidine in the treatment of MV patients were obtained by searching relevant online databases, including PubMed, EMbase, Web of Science, the Cochrane Library, Medline, OVID, and ClinicalTrials.gov. Literature meeting the inclusion criteria were selected and evaluated by two researchers independently. Risk ratio (RR)/standardized mean difference (SMD) and 95% confidence interval (CI) were used to express the differences between groups. Seven RCTs were included in our study, with 986 participants in the dexmedetomidine group and 862 participants in the control group. Summary analysis results displayed no reduction in 30-day mortality (RR = 0.77, 95% CI: 0.59 to 1.02), delirium (RR = 0.77, 95% CI: 0.57 to 1.03), and adverse events (RR = 1.06, 95% CI: 0.22 to 5.08) in the dexmedetomidine group compared with the control group. As the length of stay in the intensive care unit (ICU) were presented as median and interquartile range (IQR)/standard deviation (SD), descriptive analysis of the results were performed. Generally, for 99.65% (953/986) of patients, dexmedetomidine was not better than the control group in reducing ICU length of stay. Our results demonstrate that for patients requiring MV, dexmedetomidine was not superior to the control group. However, analysis of more RCTs is required to confirm this conclusion.
Topics: Analgesics, Non-Narcotic; Dexmedetomidine; Humans; Mortality; Randomized Controlled Trials as Topic; Respiration, Artificial
PubMed: 33179456
DOI: 10.1002/prp2.658 -
Drug Design, Development and Therapy 2017To compare the effects of dexmedetomidine (Dex) and fentanyl as adjuvants to local anesthetics in spinal anesthesia. (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To compare the effects of dexmedetomidine (Dex) and fentanyl as adjuvants to local anesthetics in spinal anesthesia.
METHODS
Two researchers independently searched the PUBMED, EMBASE, Cochrane library, and CBM for randomized controlled trials comparing the effects of Dex and fentanyl as adjuvants to local anesthetics for intrathecal injection.
RESULTS
A total of 639 patients from nine studies were included in this meta-analysis. The results showed that Dex resulted in statistically significant longer duration of stable sensory block (mean difference [MD] =27.12; 95% confidence interval [CI] [9.89, 44.34], <0.01, =97%), sensory block (standardized mean difference [SMD] =3.81; 95% CI [2.35, 5.27], <0.01, =97%), motor block (SMD =3.64; 95% CI [2.19, 5.08], <0.01, =97%), and pain free period (SMD =2.98; 95% CI [1.69, 4.27], <0.01, =96%); reducing the incidence of pruritus (relative risk [RR] =0.15; 95% CI [0.06, 0.39], <0.01, =0%) compared with fentanyl. However, the onset of sensory and motor block, the time to peak sensory level, and the incidence of hypotension and bradycardia, and the side effects (nausea, vomiting, shivering and respiratory depression) were not significantly different between Dex and fentanyl.
CONCLUSION
Compared to fentanyl, Dex as local anesthetics adjuvant in spinal anesthesia prolonged the duration of spinal anesthesia, improved postoperative analgesia, reduced the incidence of pruritus, and did not increase the incidence of hypotension and bradycardia.
Topics: Adjuvants, Anesthesia; Adolescent; Adult; Anesthesia, Spinal; Anesthetics, Local; Dexmedetomidine; Fentanyl; Humans; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Young Adult
PubMed: 29238167
DOI: 10.2147/DDDT.S146092 -
Journal of the American Association For... Sep 2020Due to their unpredictability and variable effects, injectable anesthetic regimens in laboratory rodent species warrant refinement. In our study we sought to evaluate...
Due to their unpredictability and variable effects, injectable anesthetic regimens in laboratory rodent species warrant refinement. In our study we sought to evaluate alfaxalone, which has gained recent popularity in veterinary medicine, alone and in combination with dexmedetomidine to evaluate their anesthetic ability in Sprague-Dawley rats when administered intraperitoneally. Three doses of alfaxalone only and 4 dose combinations of alfaxalone-dexmedetomidine were tested in males and female rats. The time to induction, anesthetic duration, pulse rate, respiratory rate, temperature, and time to recovery were recorded by a blind observer. The level of anesthesia induced by the various anesthetic protocols was assessed by using pedal withdrawal reflex to a noxious stimulus and scored according to the response. Dependent on the treatment group, atipamezole or saline was administered intraperitoneally once animals reached 60 min of anesthesia. Regardless of the dose, alfaxalone alone achieved only a sedative level of anesthesia, whereas all alfaxalone-dexmedetomidine combinations led to a surgical level of anesthesia in all animals. Anesthesia regimens using alfaxalone alone and in combination with dexmedetomidine demonstrated sex-associated differences, with female rats maintaining longer durations of sedation or anesthesia than their male counterparts. Both male and female rats displayed decreases in physiologic parameters consistent with the effects of dexmedetomidine. Given the results described herein, we recommend 20 mg/kg alfaxalone for sedation and 30 mg/kg alfaxalone combined with 0.05 mg/kg dexmedetomidine for surgical anesthesia in female rats. Appropriate doses of alfaxalone only and alfaxalone-dexmedetomidine for male rats were not determined in this study and need further evaluation.
Topics: Anesthesia; Anesthetics; Animals; Dexmedetomidine; Female; Heart Rate; Hypnotics and Sedatives; Laboratory Animal Science; Male; Pregnanediones; Rats; Rats, Sprague-Dawley; Respiratory Rate
PubMed: 32758333
DOI: 10.30802/AALAS-JAALAS-19-000161 -
Journal of the American Veterinary... Feb 2022To investigate the effects of dexmedetomidine (DXM) and its subsequent reversal with atipamezole (APM) on the echocardiogram and circulating concentrations of cardiac...
OBJECTIVE
To investigate the effects of dexmedetomidine (DXM) and its subsequent reversal with atipamezole (APM) on the echocardiogram and circulating concentrations of cardiac biomarkers in cats.
ANIMALS
14 healthy cats.
PROCEDURES
Cats underwent echocardiography and measurements of circulating cTn-I and NT-proBNP concentrations before (PRE) and during (INTRA) DXM sedation (40 µg/kg IM) and 2 to 4 (2H POST) and 24 (24H POST) hours after reversal with APM.
RESULTS
Administering DXM significantly decreased heart rate, right ventricular and left ventricular (LV) outflow tract velocities, and M-mode-derived LV free-wall thickness; increased LV end systolic diameter and volume; and caused valvar regurgitation. While sedative effects resolved within 25 minutes of APM reversal, the evolution of echocardiographic changes was mixed: LV ejection fraction and mitral valvar regurgitation score were different at 2H POST than at both INTRA and PRE (partial return toward baseline), LV end-diastolic volume was different PRE to INTRA and INTRA to 2H POST but not different PRE to 2H POST (full return toward baseline), and M-mode-derived LV free-wall thickness was significantly different from PRE to INTRA and PRE to 2H POST (no return toward baseline). Serum cTn-I and plasma NT-proBNP concentrations increased significantly with DXM, which remained significant 2H POST.
CLINICAL RELEVANCE
Administration of DXM and APM reversal produced changes in echocardiographic results and in circulating cTn-I and NT-proBNP concentrations. Understanding these changes could help veterinarians differentiate drug effects from cardiac disease.
Topics: Animals; Biomarkers; Cats; Dexmedetomidine; Echocardiography; Imidazoles; Natriuretic Peptide, Brain; Peptide Fragments; Stroke Volume
PubMed: 35175929
DOI: 10.2460/javma.21.06.0299