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Jason AS, Sundaram GA, J P, Kumar SP, Krishnan M. Comparison of the Efficacy of Midazolam and Dexmedetomidine As Sedative Agents in Third Molar Surgery. Cureus 2023; 15:e49477. [PMID: 38156170 PMCID: PMC10753092 DOI: 10.7759/cureus.49477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Minor dental and oral surgical procedures have been made comfortable with the rise in the use of daycare sedatives. Of these sedatives, midazolam is deemed a common sedative used for minor oral surgical procedures. Newer and safer sedatives such as dexmedetomidine have certain properties that may prove more efficient in oral surgical procedures. Third molar surgery is one of the most common minor oral surgical procedures performed in dentistry. Thus, this study aims to compare the efficacy of midazolam and dexmedetomidine as sedative agents in third molar surgery. Materials and methods Sixty young adult patients free from other comorbidities were included in the study with ages ranging between 18 and 50 years. The samples were matched for the difficulty of impacted teeth and randomly distributed among the groups. Groups were administered the respective sedative drugs midazolam and dexmedetomidine and their effects were observed through the Observer's Assessment of Alertness/Sedation scale. The intraoperative vitals and sedation effects were checked every 15 minutes. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Independent samples t-test and analysis of variance were the statistical tests employed to analyze the obtained data with p<0.05 considered as statistically significant. Results The depth of sedation has been both subjectively and objectively assessed and had no significant difference among the groups. The intra-operative heart rate assessment proved a more efficient reduction of pulse rate in the dexmedetomidine group as compared with the midazolam group. However, it was not statistically significant (p=0.121). The mean diastolic blood pressure showed a statistically significant difference between the groups with dexmedetomidine having lower blood diastolic pressure compared to midazolam (p=0.004). Quick arousal was witnessed in the dexmedetomidine group. Conclusion It can be concluded from the study that both dexmedetomidine and midazolam were equally effective as sedative agents for third molar surgery. However, the nature of cardio-protection, anti-sialagogue, and analgesic properties of dexmedetomidine can prove helpful, especially in minor oral surgical procedures like third molar surgery and it is recommended.
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Affiliation(s)
- Alden S Jason
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Gidean A Sundaram
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Preethi J
- Anesthesiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Wang Q, Chen C, Wang L. Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis. J Pediatr (Rio J) 2022; 98:15-25. [PMID: 34252370 PMCID: PMC9432289 DOI: 10.1016/j.jped.2021.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist, which is the main sedative in the intensive care unit. This study aims to investigate the effectiveness and adverse events of DEX in maintaining hemodynamic stability in pediatric cardiac surgery. SOURCES Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA and China National Knowledge Infrastructure were searched for articles about the application of DEX in maintaining hemodynamic stability during and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized controlled trials were included and random-effects model meta-analysis was applied to calculate the standardized mean deviation (SMD), odds ratio (OR) and 95% confidence interval (CI). SUMMARY OF THE FINDINGS Fifteen articles were included for this meta-analysis, and 9 articles for qualitative analysis. The results showed that preoperative prophylaxis and postoperative recovery of DEX in pediatric patients undergoing cardiac surgery were effective in maintaining systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI: -1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI: -2.29, -1.13). In addition, the frequency of Junctional Ectopic Tachycardia in the DEX treatment group was lower than that in the placebo group. CONCLUSIONS The application of DEX for preoperative prophylaxis and postoperative recovery in pediatric cardiac surgery patients are effective in maintaining hemodynamic stability, and the clinical dose of DEX is not significantly related to the occurrence of pediatric adverse events which may be related to individual differences.
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Affiliation(s)
- Qing Wang
- Hainan Women and Children's Medical Center, Department of Anesthesiology, Haikou, China
| | - Chuikai Chen
- Hainan Women and Children's Medical Center, Department of Anesthesiology, Haikou, China
| | - Li Wang
- The First Hospital of Hebei Medical University, Department of Anesthesiology, Shijiazhuang, China.
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Jiang H, Kang Y, Ge C, Zhang Z, Xie Y. ONE-LUNG VENTILATION PATIENTS: CLINICAL CONTEXT OF ADMINISTRATION OF DIFFERENT DOSES OF DEXMEDETOMIDINE. J Med Biochem 2021; 41:230-237. [PMID: 35510198 PMCID: PMC9010045 DOI: 10.5937/jomb0-33870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/11/2021] [Indexed: 12/05/2022] Open
Abstract
Background Open and endoscopic thoracic surgeries improve surgical exposure by One-lung ventilation (OLV). The aim of this study was to investigate the effects of different doses of dexmedetomidine on inflammatory response, oxidative stress, cerebral tissue oxygen saturation (SctO2) and intrapulmonary shunt in patients undergoing one-lung ventilation (OLV). Methods Seventy-five patients undergoing open pulmonary lobectomy in our hospital from January 2016 to December 2017 were enrolled and randomly divided into high-dose dexmedetomidine group (group D1, 1 mg/kg, n=25), low-dose dexmedetomidine group (group D2, 0.5 mg/kg, n=25) and control group (group C, n=25). Then, arterial blood and internal jugular venous blood were taken before anesthesia induction (T0) and at 15 min after twolung ventilation (T1) and 5 min (T2) and 30 min (T3) after OLV for later use. Next, the changes in hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2)] of patients were observed in each group. Enzyme-linked immunosorbent assay (ELISA) was carried out to detect serum inflammatory factors such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and oxidative stress indicators [superoxide dismutase (SOD) and malondialdehyde (MDA)]. The changes in SctO2, arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt Qs/Qt (a measurement of pulmonary shunt: right-to-left shunt fraction) were observed. Additionally, the changes in lung function indicators like lung dynamic compliance (Cdyn) and airway peak pressure (Ppeak) were determined. Results There were no statistically significant differences in the MAP, HR and SpO2 among three groups at each observation time point (P>0.05). At T2 and T3, the levels of serum IL-6, TNF-α and IL-8 were obviously decreased in group D1 and D2 compared with those in group C (P<0.05), and the decreases in group D1 were overtly larger than those in group D2, and the decreases at T3 were markedly greater than those at T2 (P<0.05). In comparison with group C, group D1 and D2 had notably reduced levels of serum reactive oxygen species (ROS) and MDA (P<0.05) and remarkably increased SOD content (P<0.05) at T2 and T3, and the effects were markedly better in group D1 than those in group D2. Besides, they were significantly superior at T3 to those at T2 (P<0.05). The SctO2 in group D1 and D2 was evidently lowered at T2 and T3 compared with that at T0, and the decrease in group D1 was distinctly smaller than that in group D2 (P<0.05). The Qs/Qt was significantly lower in group D1 and D2 than that in group C at T2 and T3 (P<0.05), while the PaO2 content was notably raised (P<0.05), and the decrease and increase were significantly larger in group D1 than those in group D2, and they were obviously greater at T3 to those at T2 (P<0.05). At T0 and T1, no significant differences were detected in the Cdyn, Pplat and Ppeak among three groups. At T2 and T3, the Cdyn was significantly elevated, while the Pplat and Ppeak overtly declined (P<0.05), and group D1 had greater changes in comparison with group D2, and the changes were obviously more evident at T3 to those at T2 (P<0.05). Conclusions Dexmedetomidine effectively ameliorates inflammatory response and oxidative stress, lowers oxygenation, Qs/Qt and the decrease in SctO2 and improves lung function during OLV, with good efficacy.
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Affiliation(s)
- Hui Jiang
- Xuhui District Central Hospital, Department of Anesthesiology, Shanghai, China
| | - Yu Kang
- Shanghai Jiao Tong University School of Medicine, Tongren Hospital, Department of Anesthesiology, Shanghai, China
| | - Chunlin Ge
- Xuhui District Central Hospital, Department of Anesthesiology, Shanghai, China
| | - Zhenying Zhang
- Xuhui District Central Hospital, Department of Anesthesiology, Shanghai, China
| | - Yan Xie
- Xuhui District Central Hospital, Department of Anesthesiology, Shanghai, China
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Effectiveness of Chloral Hydrate on Brain MRI in Children with Developmental Delay/Intellectual Disability Comparing with Normal Intelligence: Single Tertiary Center Experience. CHILDREN 2021; 8:children8121097. [PMID: 34943293 PMCID: PMC8700059 DOI: 10.3390/children8121097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
Neurodiagnostic investigation requirements are expanding for diagnostic and therapeutic purposes in children, especially in those with developmental delay/intellectual disability (DD/ID). Thus, determination of optimal sedatives to achieve successful sedation and immobility without further neurological compromise is important in children with DD/ID. The purpose of this study is to assess the effectiveness and adverse reactions of chloral hydrate (CH) for brain magnetic resonance imaging (B-MRI) in children with DD/ID compared to those with normal intelligence (NI). We performed a retrospective chart review of children aged from 1 day to 12 years who required elective sedation using CH for B-MRI. About 730 cases (415 with DD/ID and 315 with NI) of CH sedation were conducted for B-MRI. Children with DD/ID showed a higher failure rate (22%) than did those with NI (6%); additional CH and prolonged sedation time were required. There was no difference in incidence of adverse reactions between DD/ID and NI groups (p = 0.338). Older or heavier children with DD/ID (p = 0.036 and p = 0.013, respectively), as well as those diagnosed with epilepsy or neuropsychiatric disorders showed higher risk of sedation failure (p < 0.001 for each). In conclusion, CH was a suboptimal sedative drug for children with DD/ID compared with those with NI. Other alternative or supplementary sedatives should be taken into consideration especially for those vulnerable groups.
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Dexmedetomidine vs Midazolam for Sedation in Mechanically Ventilated Children: Few Concerns. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim JY, Kim KN, Kim DW, Lim HJ, Lee BS. Effects of dexmedetomidine sedation for magnetic resonance imaging in children: a systematic review and meta-analysis. J Anesth 2021; 35:525-535. [PMID: 34002258 DOI: 10.1007/s00540-021-02946-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/07/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Pediatric sedation is commonly required to obtain high-quality images in magnetic resonance imaging (MRI). We performed a systematic review and meta-analysis to assess the effects of dexmedetomidine sedation for MRI in children. METHODS A systematic review was conducted to find all randomized controlled trials concerning dexmedetomidine sedation for MRI in children. We searched databases using the Ovid platform in the Cochrane Controlled Trials Register, MEDLINE, and EMBASE. This study was registered in the PROSPERO database: CRD42020198368. RESULTS Seven studies and 753 participants were included. Dexmedetomidine sedation showed a significantly delayed onset time [weighted mean differences (WMD) = 8.13 min, 95% confidence interval (CI) 4.64 to 11.63, I2 = 98%] and recovery time (WMD = 5.22 min, 95% CI 0.35 to 10.09, I2 = 92%) compared to propofol, ketamine, and midazolam sedation. There was no difference in quality of sedation [risk ratio (RR) = 1.25, 95% CI 0.92 to 1.69, I2 = 89%], or incidence of sedation failure (RR = 1.39, 95% CI 0.53 to 3.66, I2 = 83%) between groups. Although a significantly decreased heart rate (WMD = - 17.34 beats/minute, 95% CI - 22.42 to - 12.26, I2 = 96%) was observed, bradycardia that required treatment was not increased (RR = 8.00, 95% CI 1.02 to 62.64, I2 = 0%). Dexmedetomidine sedation had a lower incidence of desaturation events (RR = 0.42, 95% CI 0.20 to 0.86, I2 = 4%). However, there was no difference in incidence of postoperative vomiting (RR = 0.42, 95% CI 0.15 to 1.17, I2 = 17%) between groups. CONCLUSIONS Dexmedetomidine sedation provided a similar sedation quality with a reduced incidence of desaturation events. However, the delayed onset and recovery times were drawbacks. The clinical significance of bradycardia is considered to be low. GRADE assessment revealed the quality of the evidence in this meta-analysis ranged from very low to moderate.
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Affiliation(s)
- Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 04763, Republic of Korea
| | - Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 04763, Republic of Korea.
| | - Dong Won Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 04763, Republic of Korea
| | - Hyun Jin Lim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 04763, Republic of Korea
| | - Bong Soo Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 04763, Republic of Korea
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Wu B, Shan J, Zhou Q, Wang L. Determination of the ED 95 of a single bolus dose of dexmedetomidine for adequate sedation in obese or nonobese children and adolescents. Br J Anaesth 2021; 126:684-691. [PMID: 33495020 DOI: 10.1016/j.bja.2020.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND With the increasing prevalence of children who are overweight and with obesity, anaesthesiologists must determine the optimal dosing of medications given the altered pharmacokinetics and pharmacodynamics in this population. We therefore determined the single dose of dexmedetomidine that provided sufficient sedation in 95% (ED95) of children with and without obesity as measured by a minimum Ramsay sedation score (RSS) of 4. METHODS Forty children with obesity (BMI >95th percentile for age and gender) and 40 children with normal weight (BMI 25th-84th percentile), aged 3-17 yr, ASA physical status 1-2, undergoing elective surgery, were recruited. The biased coin design was used to determine the target dose. Positive responses were defined as achievement of adequate sedation (RSS ≥4). The initial dose for both groups was dexmedetomidine 0.3 μg kg-1 i.v. infusion for 10 min. An increment or decrement of 0.1 μg kg-1 was used depending on the responses. Isotonic regression and bootstrapping methods were used to determine the ED95 and 95% confidence intervals (CIs), respectively. RESULTS The ED95 of dexmedetomidine for adequate sedation in children with obesity was 0.75 μg kg-1 with 95% CI of 0.638-0.780 μg kg-1, overlapping the CI of the ED95 estimate of 0.74 μg kg-1 (95% CI: 0.598-0.779 μg kg-1) for their normal-weight peers. CONCLUSIONS The ED95 values of dexmedetomidine administered over 10 min were 0.75 and 0.74 μg kg-1 in paediatric subjects with and without obesity, respectively, based on total body weight. CLINICAL TRIAL REGISTRATION ChiCTR1800014266.
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Affiliation(s)
- Bin Wu
- Department of Anaesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Jiaqi Shan
- Department of Anaesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Quanhong Zhou
- Department of Anaesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Wang
- Department of Anaesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Chauhan R, Luthra A, Sethi S, Panda N, Meena SC, Bhatia V, Bloria SD. A Prospective Randomized Controlled Trial Using Propofol or Dexmedetomidine for Conscious Sedation in Pediatric Patients Undergoing Sclerotherapy. J Pediatr Neurosci 2021; 15:379-385. [PMID: 33936302 PMCID: PMC8078632 DOI: 10.4103/jpn.jpn_167_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022] Open
Abstract
Aim: Sodium tetradecyl sulfate (STS) sclerotherapy in pediatric patients is usually undertaken under sedation inside digital subtraction angiography (DSA) suite. These patients are day-care patients and need adequate sedation for small duration. We performed this study to compare propofol and dexmedetomidine as sedative agents in these patients. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) physical status I patients scheduled to undergo sclerotherapy for low-flow venous malformations under sedation were randomized to be administered either dexmedetomidine (Group D) or propofol (Group P). In Group D, initially 2 µg/kg of dexmedetomidine was administered over 10min (or till attainment of a Ramsay sedation score [RSS] of 5), followed by an infusion at the rate of 0.3 µg/kg/h. In Group P, propofol 1mg/kg bolus followed by an infusion at 100 µg/kg/min was administered, titrated to an RSS of 5. We measured intraoperative heart rate, blood pressure, respiratory rate, duration of procedure, and incidence of arterial desaturation, bradycardia, and respiratory depression in the two groups. Results: All the patients in both groups completed the procedure. The mean anesthesia time was significantly longer in Group D. Intraoperative heart rates remained comparable in the two groups, whereas systolic and diastolic BP were significantly higher in Group D throughout the procedure. No patient in Group D experienced arterial desaturation, whereas five patients in Group P reported a SpO2 of <90%. Conclusion: Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
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Affiliation(s)
- Rajeev Chauhan
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ankur Luthra
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Nidhi Panda
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shyam Charan Meena
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Summit D Bloria
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Kumar S, Hussain M, Arun N, Kumar A, Kumar M. The Effect of Midazolam and Dexmedetomidine Sedation on Block Characteristic Following Spinal Bupivacaine: A Randomized Comparative Study. Anesth Essays Res 2020; 14:497-503. [PMID: 34092865 PMCID: PMC8159054 DOI: 10.4103/aer.aer_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Dexmedetomidine is widely used as an adjunct to general as well as regional anesthesia. Aims: This study was conducted to compare and evaluate the synergistic effect of single intravenous (i.v.) bolus dose of dexmedetomidine with midazolam on spinal block duration, analgesia, and sedation in patients undergoing infra-umbilical surgeries. Settings and Design: Prospective, randomized, comparative, and double-blinded study. Materials and Methods: One hundred patients between 18 and 60 years of age of American Society of Anesthesiologists physical status I and II posted for elective infra-umbilical surgery under subarachnoid block were randomly divided into two groups (Group D and Group M). Patients of Group D received i.v. dexmedetomidine 0.5 μg.kg−1 and of Group M received i.v. midazolam 0.05 mg.kg−1 as premedication 5 min before spinal anesthesia over 10 min. Vital parameters, Ramsay sedation score, level of sensory and motor block, recovery time for sensory blockade, postoperative numerical rating scale, time of requirement of the first dose of postoperative rescue analgesic, and duration of analgesia were recorded and analyzed. Statistical Analysis: Chi-square test, t-test, and analysis of variance test were applied to analyze data using SPSS package for Windows. Results and Conclusion: Premedication with single i.v. dexmedetomidine prolonged the duration and increased the maximum upper level of only sensory component of spinal anesthesia (6.42 ± 3.21 vs. 4.8 ± 1.21 thoracic segments higher than with midazolam sedation). This property can be beneficial in preventing undesirable prolongation of motor block and facilitating early ambulation in shorter duration of infra-umbilical surgeries. In addition, dexmedetomidine slowed the regression of sensory block and increased the time of the first request of analgesic.
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Affiliation(s)
- Sanjay Kumar
- Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mumtaz Hussain
- Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nidhi Arun
- Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Arvind Kumar
- Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mukesh Kumar
- Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2020; 62:109736. [DOI: 10.1016/j.jclinane.2020.109736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/20/2019] [Accepted: 01/25/2020] [Indexed: 01/04/2023]
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Lang B, Zhang L, Zhang W, Lin Y, Fu Y, Chen S. A comparative evaluation of dexmedetomidine and midazolam in pediatric sedation: A meta-analysis of randomized controlled trials with trial sequential analysis. CNS Neurosci Ther 2020; 26:862-875. [PMID: 32347647 PMCID: PMC7366749 DOI: 10.1111/cns.13377] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
Background The present study with trial sequential analysis (TSA) was conducted to evaluate comprehensively the efficacy and safety of dexmedetomidine and midazolam in pediatric sedation, and to investigate whether the outcomes achieved the required information size to draw the conclusions. Methods PubMed, Embase, and Cochrane Library were searched from inception to October 2019. All randomized controlled trials used dexmedetomidine and midazolam in pediatric sedation were enrolled. Sedative efficacy, postoperative analgesic effect, and incidence of emergence agitation were considered as the co‐primary outcomes. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to rate the quality of evidences. Results We acquired data from 34 studies involving 2281 pediatric patients. The results indicated that administration of dexmedetomidine was associated with less incidence of emergence agitation (RR = 0.78, with 95% CI [0.65, 0.92]) and more satisfactory sedation at parental separation (RR = 0.31, with 95% CI [0.24, 0.41]) compared to midazolam, and the current sample sizes were sufficient with unnecessary further trials. Two groups did not differ significantly in sedation level at mask induction (RR = 0.86, with 95% CI [0.74, 1.00]). And using of dexmedetomidine was associated with less incidence of postoperative analgesic rescue (RR = 0.57, with 95% CI [0.35, 0.93]), but the number of patients was too few to achieve the required information size and to draw reliable conclusions. Premedication of dexmedetomidine was associated with significant less value of SBP, heart rate, increased incidence of bradycardia, and a lower rate of shivering. And there were no differences about onset of sedation and recovery time between two groups. Conclusions Given that more satisfactory sedation at separation from parents and less incidence of emergence agitation, dexmedetomidine is preferred for pediatric sedation. However, compared with midazolam, the superiority of dexmedetomidine in providing adequate sedation at mask induction and postoperative analgesic effects has not yet been defined.
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Affiliation(s)
- Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wensheng Zhang
- Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunzhu Lin
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuzhi Fu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shouming Chen
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China
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Smith DF, He S, Peddireddy NS, Vairavan Manickam P, Heubi CH, Shott SR, Cohen AP, Ishman SL. Effectiveness of pediatric drug-induced sleep endoscopy for REM-predominant obstructive sleep apnea. Sleep Breath 2020; 24:1705-1713. [PMID: 32277395 DOI: 10.1007/s11325-020-02056-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVES Because dexmedetomidine (DEX)-induced sedation mimics non-rapid eye movement (NREM) sleep, its utility in sedating children with REM-predominant disease is unclear. We sought to determine the effectiveness of pediatric drug-induced sleep endoscopy (DISE) using DEX and ketamine for children with REM-predominant OSA, specifically whether or not at least one site of obstruction could be identified. METHODS A retrospective case series of children without tonsillar hypertrophy undergoing DISE at a tertiary pediatric hospital from 10/2013 through 9/2015 who underwent subsequent surgery to address OSA with polysomnography (PSG) before and after. RESULTS We included 56 children, mean age 5.6±5.4 years, age range 0.1-17.4 years, mean BMI 20.3±7.4 kg/m2 (76±29 percentile). At least one site of obstruction was identified in all patients, regardless of REM- or NREM-predominance. The mean obstructive apnea-hypopnea index (oAHI) improved (12.6 ± 10.7 to 9.0 ± 14.0 events/h) in children with REM-predominant (P = 0.013) and NREM-predominant disease (21.3 ± 18.9 to 10.3 ± 16.2 events/h) (P = 0.008). The proportion of children with a postoperative oAHI < 5 was 53% and 55% for REM- and NREMpredominant OSA, respectively. Unlike children with NREM-predominant disease, children with REM-predominant disease had significant improvement in the mean saturation nadir (P < 0.001), total sleep time (P = 0.006), and sleep efficiency (P = 0.015). CONCLUSIONS For children with OSA without tonsillar hypertrophy, DISE using DEX/ketamine was useful to predict at least one site of obstruction, even for those with REM-predominant OSA. DISE-directed outcomes resulted in significant improvements in mean oAHI, total sleep time, sleep efficiency, saturation nadir, and the proportion with oAHI < 5, after surgery for some children with REM-predominant disease.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shan He
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Department of Otolaryngology, Shanghai Children's Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nithin S Peddireddy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
| | - P Vairavan Manickam
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Christine H Heubi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sally R Shott
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA.
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA.
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Lei H, Chao L, Miao T, Ya Jun L, Shen Ling L, Yan Ying P, Xiao Han P, Yun Bo X, Xin T. Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation. Acta Anaesthesiol Scand 2020; 64:464-471. [PMID: 31736052 DOI: 10.1111/aas.13509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/16/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dexmedetomidine is widely used for non-invasive pediatric procedural sedation. However, the hemodynamic effects of intravenous dexmedetomidine are a concern. There has been a growing interest in the application of intranasal dexmedetomidine as a sedative in children. OBJECTIVE To investigate the incidence of bradycardia in children undergoing intranasal dexmedetomidine sedation and to identify the associated risk factors. METHODS Data pertaining to pediatric patients who underwent intranasal dexmedetomidine sedation for non-invasive investigations at the Kunming Children's Hospital between October 2017 and August 2018 were retrospectively analyzed. RESULTS Out of 9984 children who qualified for inclusion, 228 children (2.3%) developed bradycardia. The incidence of bradycardia in the group that received additional dose of dexmedetomidine was higher than that in the group that did not receive additional dose (9.2% vs 16.7%; P = .003). The incidence of bradycardia in males was higher than that in females (2.6% vs 1.8%; P = .007). On multivariate logistic regression, only male gender showed an independent association with the occurrence of bradycardia (odds ratio 1.48; 95% confidence interval 1.11-1.97; P = .008). CONCLUSIONS The overall incidence of bradycardia in children after sole use of intranasal dexmedetomidine sedation was 2.3%. Male children showed a 1.48-fold higher risk of bradycardia. However, the blood pressure of the children who developed bradycardia was within the normal range. Simple wake-up can effectively manage bradycardia induced by intranasal dexmedetomidine sedation.
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Affiliation(s)
- Huang Lei
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Li Chao
- Department of Anesthesiology Kunming Children's Hospital Kunming China
| | - Tan Miao
- Department of Anesthesiology Second Affiliated Hospital of Kunming Medical University Kunming China
| | - Li Ya Jun
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Liu Shen Ling
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Pu Yan Ying
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Peng Xiao Han
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Xu Yun Bo
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
| | - Tan Xin
- Sedation and Analgesia Center Kunming Children's Hospital Kunming China
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A Comparative Evaluation of Intranasal Dexmedetomidine & Intranasal Midazolam for Pre-Operative Sedation in Children. ACTA ACUST UNITED AC 2020. [DOI: 10.14260/jemds/2020/159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30:209-220. [PMID: 31886922 DOI: 10.1111/pan.13809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022]
Abstract
Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short-acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile-based anesthesia versus TIVA. This pro-con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.
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Affiliation(s)
- Gillian R Lauder
- Department of Anesthesia, BC Children's Hospital, Vancouver, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Mark Thomas
- Department of Anaesthesia, Great Ormond St Hospital, London, UK
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Thomas Engelhardt
- Department of Anesthesia, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
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16
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Bi Y, Ma Y, Ni J, Wu L. Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial. BMC Anesthesiol 2019; 19:219. [PMID: 31791239 PMCID: PMC6886218 DOI: 10.1186/s12871-019-0892-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background Tracheobronchial foreign body aspiration in children is a life-threatening, emergent situation. Currently, the use of fiberoptic bronchoscopy for removing foreign bodies is attracting increasing attention. Oxygen desaturation, body movement, laryngospasm, bronchospasm, and breath-holding are common adverse events during foreign body removal. Dexmedetomidine, as a highly selective α2-adrenergic agonist, produces sedative and analgesic effects, and does not induce respiratory depression. We hypothesized that intranasal dexmedetomidine at 1 μg kg − 1 administered 25 min before anesthesia induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under inhalation general anesthesia with sevoflurane. Methods In all, 40 preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 μg·kg − 1 or normal saline at 0.01 ml kg− 1 25 min before anesthesia induction. The primary outcome was the incidence of perioperative adverse events. Heart rate, respiratory rate, parent-child separation score, tolerance of the anesthetic mask, agitation score, consumption of sevoflurane, and recovery time were also recorded. Results Following pre-anesthesia treatment with either intranasal dexmedetomidine or saline, the incidences of laryngospasm (15% vs. 50%), breath-holding (10% vs. 40%), and coughing (5% vs. 30%) were significantly lower in patients given dexmedetomidine than those given saline. Patients who received intranasal dexmedetomidine had a lower parent–child separation score (P = 0.017), more satisfactory tolerance of the anesthetic mask (P = 0.027), and less consumption of sevoflurane (38.18 ± 14.95 vs. 48.03 ± 14.45 ml, P = 0.041). The frequency of postoperative agitation was significantly lower in patients given intranasal dexmedetomidine (P = 0.004), and the recovery time was similar in the two groups. Conclusions Intranasal dexmedetomidine 1 μg·kg− 1, with its sedative and analgesic effects, reduced the incidences of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for FB removal. Moreover, it reduced postoperative agitation without a prolonged recovery time. Trail registration The study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017273) on July 20, 2018.
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Affiliation(s)
- Yanmei Bi
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Yushan Ma
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Juan Ni
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Lan Wu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China.
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17
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Tang Y, Meng J, Zhang X, Li J, Zhou Q. Comparison of dexmedetomidine with propofol as sedatives for pediatric patients undergoing magnetic resonance imaging: A meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med 2019; 18:1775-1785. [PMID: 31410137 PMCID: PMC6676186 DOI: 10.3892/etm.2019.7751] [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] [Received: 09/14/2018] [Accepted: 03/23/2019] [Indexed: 11/10/2022] Open
Abstract
Dexmedetomidine and propofol are commonly used sedative agents in pediatric patients undergoing magnetic resonance imaging (MRI). The present meta-analysis aimed to compare dexmedetomidine with propofol in pediatric patients undergoing MRI using trial sequential analysis (TSA). The PubMed, Cochrane Library and Web of Knowledge databases were systematically searched for entries up to August 2018 for potential randomized controlled trials comparing dexmedetomidine with propofol in pediatric patients undergoing MRI. Data were extracted by two independent authors and analyzed using Revman version 5.2 software. Six trials involving 415 pediatric patients were included in the final analysis. A shorter recovery time (P<0.01) and onset time of sedation were identified for propofol compared with dexmedetomidine (P<0.01); however, there were no significant differences in the duration of sedation (P=0.37). Furthermore, pediatric patients receiving propofol were discharged sooner than those receiving dexmedetomidine (P=0.02). The incidence of failed sedation did not significantly differ between the two groups (P=0.81). Propofol induced a lower incidence of 5-min (P=0.03) and 10-min Pediatric Anesthesia Emergence Delirium (P<0.01), but a higher incidence of desaturation (P<0.01). The duration of MRI was similar between the two groups (P=0.15). TSA indicated that the monitoring boundary was crossed by the cumulative z curve, providing supportive evidence for the shorter recovery time in the propofol group. Propofol is recommended for pediatric sedation during MRI, owing to shorter recovery time and onset of sedation time, as well as a faster discharge from hospital, and a lower incidence of PAED score >10, compared with dexmedetomidine. However, considering the possibility of desaturation, propofol should be used with caution.
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Affiliation(s)
- Yong Tang
- Department of Radiology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Juan Meng
- Operating Room, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Xinxian Zhang
- Department of Radiology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Jiong Li
- Department of Radiology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Qiang Zhou
- Department of Radiology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
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18
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Pérez-Guillé MG, Toledo-López A, Rivera-Espinosa L, Alemon-Medina R, Murata C, Lares-Asseff I, Chávez-Pacheco JL, Gómez-Garduño J, Zamora Gutiérrez AL, Orozco-Galicia C, Ramírez-Morales K, Lugo-Goytia G. Population Pharmacokinetics and Pharmacodynamics of Dexmedetomidine in Children Undergoing Ambulatory Surgery. Anesth Analg 2019; 127:716-723. [PMID: 29782406 PMCID: PMC6110617 DOI: 10.1213/ane.0000000000003413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dexmedetomidine (DEX) is an α-2 adrenergic agonist with sedative and analgesic properties. Although not approved for pediatric use by the Food and Drug Administration, DEX is increasingly used in pediatric anesthesia and critical care. However, very limited information is available regarding the pharmacokinetics of DEX in children. The aim of this study was to investigate DEX pharmacokinetics and pharmacodynamics (PK-PD) in Mexican children 2-18 years of age who were undergoing outpatient surgical procedures. METHODS Thirty children 2-18 years of age with American Society of Anesthesiologists physical status score of I/II were enrolled in this study. DEX (0.7 μg/kg) was administered as a single-dose intravenous infusion. Venous blood samples were collected, and plasma DEX concentrations were analyzed with a combination of high-performance liquid chromatography and electrospray ionization-tandem mass spectrometry. Population PK-PD models were constructed using the Monolix program. RESULTS A 2-compartment model adequately described the concentration-time relationship. The parameters were standardized for a body weight of 70 kg by using an allometric model. Population parameters estimates were as follows: mean (between-subject variability): clearance (Cl) (L/h × 70 kg) = 20.8 (27%); central volume of distribution (V1) (L × 70 kg) = 21.9 (20%); peripheral volume of distribution (V2) (L × 70 kg) = 81.2 (21%); and intercompartmental clearance (Q) (L/h × 70 kg) = 75.8 (25%). The PK-PD model predicted a maximum mean arterial blood pressure reduction of 45% with an IC50 of 0.501 ng/ml, and a maximum heart rate reduction of 28.9% with an IC50 of 0.552 ng/ml. CONCLUSIONS Our results suggest that in Mexican children 2-18 years of age with American Society of Anesthesiologists score of I/II, the DEX dose should be adjusted in accordance with lower DEX clearance.
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Affiliation(s)
| | | | | | | | - Chiharu Murata
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, México
| | | | | | | | | | | | | | - Gustavo Lugo-Goytia
- Departamento de Anestesiología y Medicina Crítica, Instituto Nacional de Ciencias Médicas y Nutrición, México
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19
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Abulebda K, Louer R, Lutfi R, Ahmed SS. A Comparison of Safety and Efficacy of Dexmedetomidine and Propofol in Children with Autism and Autism Spectrum Disorders Undergoing Magnetic Resonance Imaging. J Autism Dev Disord 2019; 48:3127-3132. [PMID: 29680960 DOI: 10.1007/s10803-018-3582-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Children with autism and autism spectrum disorders have a high incidence of neurologic comorbidities. Consequently, evaluation with magnetic resonance imaging (MRI) is deemed necessary. Sedating these patients poses several challenges. This retrospective study compared the efficacy and safety of dexmedetomidine to propofol in sedating autistic patients undergoing MRI. There were 56 patients in the dexmedetomidine group and 49 in the propofol group. All of the patients successfully completed the procedure. Recovery and discharge times were significantly lower in the propofol group, while the dexmedetomidine group maintained more stable hemodynamics. Both propofol and dexmedetomidine proved to be adequate and safe medications in the sedation of autistic children undergoing MRI.
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Affiliation(s)
- Kamal Abulebda
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA.
| | - Ryan Louer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Riad Lutfi
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA
| | - Sheikh Sohail Ahmed
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202, USA
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20
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Syed S, Hakim T, Riyaz MR, Bedi RS. To Evaluate the Efficiency of Dexmedetomidine in Atomized Intranasal form for Sedation in Minor Oral Surgical Procedures. Ann Maxillofac Surg 2019; 9:89-95. [PMID: 31293934 PMCID: PMC6585198 DOI: 10.4103/ams.ams_273_18] [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
Aim This study aims to evaluate the efficiency of dexmedetomidine in atomized intranasal form for sedation in minor oral surgical procedures. Materials and Methods A total 25 patients fitting the inclusion and exclusion criteria were selected from the outpatient Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow. The drug was administered intranasally half an hour before the surgical procedure. The volume of drug used was recorded. The readings of all the parameters of sedation began 30 min after the drug had been administered. Intranasal sedation status was assessed by Ramsay sedation score and observer's assessment of alertness/sedation scales, every 15 min throughout the procedure. Results The primary outcome variable in this study is depth of sedation produced by intranasally administered dexmedetomidine. Secondary variables included respiratory rate, blood pressure (BP), heart rate (HR), and oxygen saturation (SpO2). The statistical software used was SPSS 20.0 for Windows (SPSS, Chicago, IL, USA). Data were expressed as mean and standard deviation or number (percentages). Sedation and behavior scores were analyzed by proportions. Hemodynamic variables including HR, SpO2, and BP and respiratory rate were analyzed by repeated measures ANOVA. When a significant result was obtained, the Tukey test was applied for post hoc pairwise comparisons. P < 0.05 was considered as statistically significant. All the parameters were recorded at a set interval of time. Conclusion In conclusion, intranasal administration of 1.5 mg/kg atomized dexmedetomidine was clinically effective, convenient, and safe for the sedation of patients undergoing minor oral surgical procedures.
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Affiliation(s)
- Sadaf Syed
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Tajamul Hakim
- Department of Oral and Maxillofacial Surgery, Govt. Dental College and Hospital, Srinagar, India
| | - Mohd Rameez Riyaz
- Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ravinder Singh Bedi
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
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21
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Balasubramanian B, Malde AD, Kulkarni SB. A non-randomized controlled study of total intravenous anesthesia regimens for magnetic resonance imaging studies in children. J Anaesthesiol Clin Pharmacol 2019; 35:379-385. [PMID: 31543589 PMCID: PMC6747997 DOI: 10.4103/joacp.joacp_289_17] [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: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS We studied the efficacy and safety of different total intravenous anesthesia used for pediatric magnetic resonance imaging (MRI). MATERIAL AND METHODS Children of 1-7 years age (n = 88), undergoing MRI received a loading dose of dexmedetomidine 1 μg/kg over 10 min, ketamine 1 mg/kg, and propofol 1 mg/kg in sequence. University of Michigan Sedation Scale (UMSS) of 3 was considered an acceptable level for starting the scan. Rescue ketamine 0.25-0.5 mg/kg was given if UMSS remained <3. After the loading dose of drugs, some children attained UMSS = 4 or progressive decline in heart rate, therefore, did not receive any infusion. The rest received either dexmedetomidine (0.7 μg/kg/h) (n = 35) or propofol (3 mg/kg/h) (n = 38) infusion for maintenance. Ketamine 0.25 mg/kg was used as rescue. Sedation failure was considered if either there was inability to complete the scan at the pre-set infusion rate, or there was need for >3 ketamine boluses or serious adverse events occurred. Statistical Package for Social Sciences 20 was used for analysis. RESULTS Initiation of scan was 100% successful with median induction time of 10 min. Maintenance of sedation was successful in 100% with dexmedetomidine and 97.4% with propofol infusion. Recovery time (25 min v/s 30 min), discharge time (35 min v/s 60 min), and total care duration (80 min v/s 105 min) were significantly less with propofol as compared to dexmedetomidine (P = 0.002, 0.000, and 0.000, respectively). There were no significant adverse events observed. CONCLUSION Dexmedetomidine 1μg/kg, ketamine 1 mg/kg, and propofol 1 mg/kg provide good conditions for initiation of MRI. Although dexmedetomidine at 0.7μg/kg/h and propofol at 3 mg/kg/h are safe and effective for maintenance, propofol provides faster recovery.
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Affiliation(s)
- Bhuvaneswari Balasubramanian
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Anila D. Malde
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Shantanu B. Kulkarni
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
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22
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Lee S. Dexmedetomidine: present and future directions. Korean J Anesthesiol 2019; 72:323-330. [PMID: 31220910 PMCID: PMC6676029 DOI: 10.4097/kja.19259] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022] Open
Abstract
Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response, which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium than other sedatives or even prevent delirium. The analgesic effect of dexmedetomidine is not strong; however, it can be administered as a useful analgesic adjuvant. As an anesthetic adjuvant, dexmedetomidine decreases the need for opioids, inhalational anesthetics, and intravenous anesthetics. The sympatholytic effect of dexmedetomidine may provide stable hemodynamics during the perioperative period. Dexmedetomidine-induced cooperative sedation with minimal respiratory depression provides safe and acceptable conditions during neurosurgical procedures in awake patients and awake fiberoptic intubation. Despite the lack of pediatric labelling, dexmedetomidine has been widely studied for pediatric use in various applications. Most adverse events associated with dexmedetomidine occur during or shortly after a loading infusion. There are some case reports of dexmedetomidine-related cardiac arrest following severe bradycardia. Some extended applications of dexmedetomidine discussed in this review are promising, but still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use. Moreover, it is necessary to select patients carefully and to determine the appropriate dosage of dexmedetomidine to ensure patient safety.
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Affiliation(s)
- Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
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Prevention of sevoflurane agitation in children undergoing congenital hernia repair, impact of adding dexmedetomidine to caudal analgesia. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Comparative study between novel sedative drug (dexmedetomidine) versus midazolam–propofol for conscious sedation in pediatric patients undergoing oro-dental procedures. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2010.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Effect of oral dextromethorphan versus oral ketamine on sevoflurane related emergence agitation in children undergoing adenotonsillectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hasanin AS, Sira AM. Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in pediatric patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ashraf S. Hasanin
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Ahmad M. Sira
- Department of Pediatric Hepatology, National Liver Institute, Menoufia University, Egypt
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Dexmedetomidine versus fentanyl in anesthesia of cochlear implantation in pediatric patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Park JH, Kim SY, Kwon MA. Fatal pulmonary aspiration during balanced sedation with dexmedetomidine and midazolam - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jeong Heon Park
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Sang Yun Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
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Tarıkçı Kılıç E, Aydın G. Effects of dexmedetomidine infusion during spinal anesthesia on hemodynamics and sedation. Libyan J Med 2018; 13:1436845. [PMID: 29457538 PMCID: PMC5827766 DOI: 10.1080/19932820.2018.1436845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: We evaluated the effects of intravenous dexmedetomidine during spinal anesthesia on hemodynamics, respiratory rate, oxygen saturation, sedpain, and compared them with those of saline infusion. Sixty American Society of Anesthesiologists physical status I and II cases were randomly divided into two groups. Patients were connected to the monitor after premedication, and spinal anesthesia was administered. Sensory and motor blockades were assessed using pinprick test and Bromage scale, respectively. Group I received dexmedetomidine infusion and Group II received saline infusion. Throughout the infusion process, hemodynamic data, respiratory rate, oxygen saturation, sedation, pain, Bromage score, amnesia, bispectral index, and side effects were recorded. Postoperative hemodynamic measurements, oxygen saturation, sedation, pain scores were obtained. Sedation and pain were evaluated using the Ramsay and visual analog scales, respectively. Analgesics were administered in cases with high scores on the visual analog scale. Postoperative analgesic consumption, side effects, treatments were recorded. No significant differences were found between the groups with respect to oxygen saturation, respiratory rate, pain, and side effects in the intraoperative period. Time to onset of sensorial block, maximum sensorial block, onset of motor block, and maximum motor block; bispectral index values; and apex heartbeat until 80 min of infusion, systolic arterial blood pressure until 90 min, and diastolic arterial blood pressure until 50 min were lower, whereas amnesia and sedation levels were higher in dexmedetomidine group. Postoperative pain and analgesic requirement were not different. Apex heartbeat at 15 min and systolic arterial blood pressure at 30 min were lower and sedation scores were higher in the dexmedetomidine infusion group. We demonstrated dexmedetomidine infusion had a hemodynamic depressant effect intraoperatively whereas it had no significant effect on peripheral oxygen saturation, respiratory rate, visual analog scale scores, and side effects. Dexmedetomidine infusion enhanced motor and sensory blockade quality and induced amnesia and sedation.
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Affiliation(s)
- Ebru Tarıkçı Kılıç
- a Anesthesiology Department , Ümraniye Training and Research Hospital , İstanbul , Turkey
| | - Gaye Aydın
- b Anesthesiology Department , Tepecik Training and Research Hospital , İzmir , Turkey
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Le Chevallier D, Slingsby L, Murrell JC. Randomised clinical trial comparing clinically relevant sedation outcome measures in dogs after intramuscular administration of medetomidine in combination with midazolam or butorphanol for routine diagnostic imaging procedures. Vet J 2018; 239:30-34. [PMID: 30197106 DOI: 10.1016/j.tvjl.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/11/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to investigate the sedative effects of medetomidine in combination with midazolam or butorphanol for routine imaging procedures in dogs. Eighty client owned dogs were recruited in a prospective, randomised, blinded clinical study and randomly assigned to receive one of four treatments intramuscularly (IM): (1) 30μg/kg medetomidine (Med30); (2) 20μg/kg medetomidine combined with 0.3mg/kg butorphanol (Med20But0.3); (3) 20μg/kg medetomidine combined with 0.3mg/kg midazolam (Med20Mid0.3); and (4) 10μg/kg medetomidine combined with 0.3mg/kg midazolam (Med10Mid0.3). The level of sedation was evaluated using a composite sedation scale assessed by one investigator (0=no sedation, 15=profound sedation). The number of dogs deemed to be adequately clinically sedated and the dose of propofol administered as rescue sedation were recorded. Mean±standard deviation sedation scores at 30min after the commencement of treatment in the groups that received Med20But0.3 (9.8±4) and Med20Mid0.3 (8.9±4.4) were not statistically significantly different from each other, but were significantly different from the group receiving Med10Mid0.3 (5.6±3.6). Only Med20But0.3 was significantly associated with adequate clinical sedation, while Med10Mid0.3 was associated with 85% sedation failure. The rescue sedation dose of propofol (1.5±1mg/kg) for the Med10Mid0.3 group was significantly higher than for other treatments. A sedation score≥10 out of 15 was a satisfactory cut-off to predict adequate clinical sedation. In healthy dogs, the combination of medetomidine with midazolam did not provide comparable sedation to the same dose of medetomidine in combination with butorphanol in a clinical setting.
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Affiliation(s)
- D Le Chevallier
- Bristol Veterinary School, University of Bristol, Langford, Bristol BS40 5DU, UK.
| | - L Slingsby
- Bristol Veterinary School, University of Bristol, Langford, Bristol BS40 5DU, UK
| | - J C Murrell
- Bristol Veterinary School, University of Bristol, Langford, Bristol BS40 5DU, UK
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Hassan PF, Saleh AH. Dexmedetomidine versus Magnesium Sulfate in Anesthesia for Cochlear Implantation Surgery in Pediatric Patients. Anesth Essays Res 2017; 11:1064-1069. [PMID: 29284876 PMCID: PMC5735451 DOI: 10.4103/aer.aer_72_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Cochlear implantation surgery represents a great advance in ENT surgeries. Special anesthetic managements were required to provide bloodless surgical field and monitoring of the facial nerve. Aims: We aimed to compare both dexmedetomidine and magnesium sulfate as regards their efficacy in inducing deliberate hypotension and providing better quality of the surgical field during cochlear implantation in pediatrics. Settings and Design: Prospective, randomized double-blinded study. Subjects and Methods: Forty-six pediatric patients aging 1.5–2.5 years of either sex with American Society of Anesthesiologists physical status classes I and II were randomized into dexmedetomidine (D) group (n = 23) and magnesium sulfate (M) group (n = 23). In the D group, after induction of anesthesia but before the surgery, a bolus dose of 0.4 μg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.4 μg/kg/h until the end of surgery. In M group, after induction of anesthesia but before the surgery, magnesium sulfate 10% (50 mg/kg) was given slowly, then continuous infusion by a rate of 10 mg/kg/h during the whole surgery. Intraoperative hemodynamics, quality of surgical field, fentanyl consumption, blood loss, operative time, FLACC pain scores, and adverse effects were compared in both groups. Statistical Analysis Used: Data were presented as mean ± standard deviation, ranges, numbers, and percentages as appropriate. Comparison of demographic data and time of surgery was done by Student's t-test. Two-way analysis of variance with correction for repeated measurements was used for heart rate and blood pressure comparison. Mann–Whitney U-test was used for nonparametric measurements. Results: Surgical field score and blood loss were better in D group than M group. Fentanyl consumption was less in D group than M group. Heart rate and mean atrial blood pressure were lower in D group except in the initial times than M group. Conclusions: In our study, both drugs were effective in achieving hypotensive anesthesia in pediatrics; however, dexmedetomidine proved to have superior effect on the surgical field and blood loss compared to magnesium sulfate with no intra- and post-operative complications for cochlear implantation surgery.
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Affiliation(s)
| | - Amany Hassan Saleh
- Department of Anesthesia and Intensive Care Unit, Cairo University, Giza, Egypt
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Zhou Q, Shen L, Zhang X, Li J, Tang Y. Dexmedetomidine versus propofol on the sedation of pediatric patients during magnetic resonance imaging (MRI) scanning: a meta-analysis of current studies. Oncotarget 2017; 8:102468-102473. [PMID: 29254262 PMCID: PMC5731972 DOI: 10.18632/oncotarget.22271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a widely applied diagnostic approach for detection of pediatric diseases. Sedatives are commonly used to acquire the accurate MRI images. Dexmedetomidine and propofol serve as sole or combined sedatives in pediatric MRI scanning. This meta-analysis aimed to compare the efficacy of dexmedetomidine and propofol in children ubdergoing MRI. Pubmed, Cochrane Library and Web of Science were searched up to June, 2017. Onset of sedation time, recovery time, sedation time, MRI time, MRI quality and emergence delirium were analyzed. 6 studies with 368 subjects were enrolled in this meta-analysis. The pooling data showed that propofol had a shorter onset of sedation time (WMD: 6.05, 95% CI: 3.12 – 8.98, P < 0.0001) and recovery time (WMD: 1.01, 95% CI: 0.36–1.67, P < 0.001) than dexmedetomidine. But for sedation time and MRI scanning time, there were no differences between the two groups (sedation time: P = 0.29; MRI scanning time: P = 0.50). There were no significance between dexmedetomidine and propofol on MRI quality (MRI quality 1: P = 1.00; MRI quality 2: P = 0.68; MRI quality 3: P = 0.45). Two studies using Pediatric Anesthesia Emergence Delirium (PAED) to assess emergence delirium 10 minutes after awakening showed that propofol had a lower PAED than dexmedetomidine (WMD: 2.57, 95% CI: 0.15–5.00, P = 0.04). Thus, propofol should be encouraged in pediatric patients undergoing MRI for its better sedative effects and a low incidence of emergence delirium.
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Affiliation(s)
- Qiang Zhou
- Department of Radiology, XuZhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Lingli Shen
- Department of Neurology, The Tenth Ward, XuZhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Xinxian Zhang
- Department of Radiology, XuZhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Jiong Li
- Department of Radiology, XuZhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Yong Tang
- Department of Radiology, XuZhou Children's Hospital, Xuzhou, Jiangsu 221006, China
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Sannakki D, Dalvi NP, Sannakki S, Parikh DP, Garg SK, Tendolkar B. Effectiveness of dexmedetomidine as premedication prior to electroconvulsive therapy, a Randomized controlled cross over study. Indian J Psychiatry 2017; 59:370-374. [PMID: 29085099 PMCID: PMC5659090 DOI: 10.4103/psychiatry.indianjpsychiatry_33_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study evaluated the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity, and recovery profile in patients undergoing electroconvulsive therapy (ECT). AIMS To study the effectiveness of dexmedetomidine 1 μg/kg intravenous in ECT in terms of attenuation of the hyperdynamic response, seizures duration, and sedation. DESIGN This was a prospective, randomized, double-blinded, crossover study. MATERIALS AND METHODS Thirty patients were included in the study and were treated as both cases and controls. The study drug was given 10 min before induction of anesthesia. Vital parameters and recovery scores were recorded. RESULTS In Group D, heart rates at 3rd and 5th min after electric stimulus (T6 and T7, respectively) were 94.5 ± 20.1 and 90.4 ± 12.8/min as compared to 111.9 ± 15.5 and 109.0 ± 13.7 in Group N, respectively (P < 0.0001). The systolic blood pressure in Group D and Group N were 116.53 ± 26.09 and 138.03 ± 19.32 at T6, respectively (P < 0.001). Diastolic blood pressure and mean arterial pressure were significantly reduced after induction and electric stimulus in Group D. The seizures duration was similar in both groups. Modified Aldrete's Score and Richmond Agitation-Sedation Score were prolonged in Group D. CONCLUSION Dexmedetomidine, before the induction of anesthesia, prevents the acute hyperdynamic responses to ECT without altering the seizures duration. However, patients may have delayed recovery and delayed discharge.
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Affiliation(s)
- Deepa Sannakki
- Department of Anaesthesia, Yatharth hospital, Noida, Uttar Pradesh, India
| | - Naina Parag Dalvi
- Department of Anaesthesiology, R.N. Cooper Hospital and H.B.T. Medical College Mumbai, Mumbai, Maharashtra, India
| | | | - Devangi P Parikh
- Department of Anaesthesiology, Lokamanya Tilak Municipal Medical College and Lokamanya Tilak Municipal Government Hospital, Mumbai, Maharashtra, India
| | - Sanchita K Garg
- Department of Anaesthesiology, Fortis Hospital, Chandigarh, India
| | - Bharati Tendolkar
- Department of Anaesthesiology, Lokamanya Tilak Municipal Medical College and Lokamanya Tilak Municipal Government Hospital, Mumbai, Maharashtra, India
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Küçükebe ÖB, Özzeybek D, Abdullayev R, Ustaoğlu A, Tekmen I, Küme T. Efeito de dexmedetomidina sobre lesão pulmonar aguda em modelo experimental de isquemia‐reperfusão. Braz J Anesthesiol 2017; 67:139-146. [DOI: 10.1016/j.bjan.2016.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/20/2015] [Accepted: 08/17/2015] [Indexed: 01/24/2023] Open
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Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon. Neurotoxicol Teratol 2017; 60:102-116. [PMID: 28065636 DOI: 10.1016/j.ntt.2017.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Growing and consistent preclinical evidence, combined with early clinical epidemiological observations, suggest potentially neurotoxic effects of commonly used anesthetic agents in the developing brain. This has prompted the FDA to issue a safety warning for all sedatives and anesthetics approved for use in children under three years of age. Recent studies have identified dexmedetomidine, the potent α2-adrenoceptor agonist, and xenon, the noble gas, as effective anesthetic adjuvants that are both less neurotoxic to the developing brain, and also possess neuroprotective properties in neonatal and other settings of acute ongoing neurologic injury. Dexmedetomidine and xenon are effective anesthetic adjuvants that appear to be less neurotoxic than other existing agents and have the potential to be neuroprotective in the neonatal and pediatric settings. Although results from recent clinical trials and case reports have indicated the neuroprotective potential of xenon and dexmedetomidine, additional randomized clinical trials corroborating these studies are necessary. By reviewing both the existing preclinical and clinical evidence on the neuroprotective effects of dexmedetomidine and xenon, we hope to provide insight into the potential clinical efficacy of these agents in the management of pediatric surgical patients.
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Kamal K, Asthana U, Bansal T, Dureja J, Ahlawat G, Kapoor S. Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging. Saudi J Anaesth 2017; 11:163-168. [PMID: 28442954 PMCID: PMC5389234 DOI: 10.4103/1658-354x.203014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: A deep level of sedation is required for magnetic resonance imaging (MRI) in children to ensure optimum image quality. The present study was conducted to evaluate the efficacy and safety of dexmedetomidine versus propofol for sedation in children undergoing MRI. Materials and Methods: A total of sixty children aged 2–10 years, having physical status 1 or 2 according to the American Society of Anesthesiologists, undergoing MRI were included in the study. Group D: (n = 30) received injection dexmedetomidine 2 μg/kg for 10 min followed by continuous infusion of 1.0 μg/kg/h. Group P (n = 30) received injection propofol 1 mg/kg bolus followed by continuous infusion of 100 μg/kg/min. Results: The mean time for onset of sedation in Group D was much longer than in Group P (P = 0.000). Mean duration of sedation was comparable in the two groups. The number of patients requiring increased infusion of study drug was significantly higher in Group D (30%) as compared to Group P (16.7%) (P < 0.05). The average recovery time in Group D was much longer than in Group P (P < 0.001). Conclusion: Propofol had an advantage of providing rapid onset of sedation and quicker recovery time. Dexmedetomidine resulted in a better preservation of respiratory rate and oxygen saturation, so it may be more suitable in children who are prone to respiratory depression. Hence, both the drugs could achieve required sedation in children posted for MRI.
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Affiliation(s)
- Kirti Kamal
- Department of Anaesthesiology and Critical Care, University of Health Sciences, Rohtak, Haryana, India
| | - Unnati Asthana
- Department of Anaesthesiology and Critical Care, University of Health Sciences, Rohtak, Haryana, India
| | - Teena Bansal
- Department of Anaesthesiology and Critical Care, University of Health Sciences, Rohtak, Haryana, India
| | - Jagdish Dureja
- Department of Anaesthesiology and Critical Care, BPS Medical College, Sonepat, Haryana, India
| | - Geeta Ahlawat
- Department of Anaesthesiology and Critical Care, University of Health Sciences, Rohtak, Haryana, India
| | - Saloni Kapoor
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Gong M, Man Y, Fu Q. Incidence of bradycardia in pediatric patients receiving dexmedetomidine anesthesia: a meta-analysis. Int J Clin Pharm 2016; 39:139-147. [DOI: 10.1007/s11096-016-0411-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
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Ter Bruggen FFJA, Eralp I, Jansen CK, Stronks DL, Huygen FJPM. Efficacy of Dexmedetomidine as a Sole Sedative Agent in Small Diagnostic and Therapeutic Procedures: A Systematic Review. Pain Pract 2016; 17:829-840. [PMID: 27862903 DOI: 10.1111/papr.12519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/07/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
Dexmedetomidine is an upcoming agent with sedative, anxiolytic, and analgesic properties. This review summarizes empirical evidence for the efficacy of dexmedetomidine as a sole sedative agent, and its effectiveness for small diagnostic and therapeutic procedure, in comparison with other frequently used sedatives. All randomized controlled trials on the effect of dexmedetomidine were reviewed. Pain level, patient satisfaction, operator satisfaction, procedure duration, recovery time, and hemodynamic and respiratory characteristics were examined. A total of 1993 patients (1,621 adults; 372 children) from 35 studies were included. In the adult studies, dexmedetomidine yielded significantly lower pain levels compared to the other sedatives (in 31.25% of the included studies) and significantly more patient satisfaction (68.2%). In studies on children, more favorable results concerning respiratory safety and the level of adequate sedation were found compared to the control sedatives. Implications for future studies are discussed.
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Affiliation(s)
| | - Ismail Eralp
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Chris K Jansen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk L Stronks
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
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Li A, Yuen VMY, Goulay-Dufay S, Kwok PCL. Pharmacokinetics and pharmacodynamics of dexmedetomidine. Drug Dev Ind Pharm 2016; 42:1917-1927. [PMID: 27595299 DOI: 10.1080/03639045.2016.1232727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dexmedetomidine is an alpha-2 adrenoceptor agonist and has been used as a general anesthetic, sedative and analgesic for about 30 years. The aim of this paper is to review the pharmacokinetics and pharmacodynamics of dexmedetomidine, evaluate physiological factors that may affect the pharmacokinetics of dexmedetomidine, and summarize the pharmacodynamics of dexmedetomidine at different plasma levels. The pharmacokinetic parameters reported in previous studies according to noncompartmental analyses or population modeling results are compared. We concluded that the pharmacokinetic profile can be adequately described by a two-compartment model in population pharmacokinetic modeling. Body weight, height, albumin level, cardiac output, disease condition and other factors were considered to have significant influence on the clearance and/or distribution volume in different population pharmacokinetic models. The pharmacological effects of dexmedetomidine, such as sedation, heart rate reduction and biphasic change of blood pressure, vary at different plasma levels. These findings provide a reference for individualizing the dose of dexmedetomidine and achieving the desired pharmacological effects in clinical applications.
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Affiliation(s)
- Aiwei Li
- a Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam , Hong Kong SAR , China
| | - Vivian Man Ying Yuen
- b Department of Anesthesiology , University of Hong Kong Shenzhen Hospital , Futian , Guangdong , Shenzhen , China
| | - Sophie Goulay-Dufay
- c Département Laboratoires, AGEPS , Assistance Publique des Hôpitaux de Paris , Paris , France
| | - Philip Chi Lip Kwok
- a Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam , Hong Kong SAR , China
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Najafi N, Veyckemans F, Van de Velde A, Poelaert J. Usability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities. Acta Anaesthesiol Scand 2016; 60:865-73. [PMID: 26940080 DOI: 10.1111/aas.12715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with respiratory morbidities are at increased risk of developing adverse respiratory events while undergoing deep sedation. Dexmedetomidine possesses sedative properties with minimal respiratory depression. This report aimed to determine the usability of dexmedetomidine in children with significant respiratory morbidities who require deep sedation. METHODS Medical records of children with ASA classification III who had at least three characteristics of respiratory morbidities and who received dexmedetomidine sedation for magnetic resonance imaging (MRI) between January 2014 and May 2015 were retrospectively reviewed. Dexmedetomidine was administered as a bolus of 1 μg/kg over 10 min followed by 1 μg/kg/h infusion. If necessary, an additional bolus dose was given and the infusion rate was increased to 2 μg/kg/h. Respiratory morbidities, haemodynamic parameters, total dexmedetomidine dose, adverse cardiorespiratory events and sedation characteristics were analysed. RESULTS Nineteen out of 642 children who underwent MRI were eligible for evaluation. Seventeen children (89%) had at least four characteristics of respiratory morbidities. The median [IQR] age was 9 months [3.5-14]. All patients completed MRI scans while breathing spontaneously via the native airway. No episodes of adverse respiratory events or haemodynamic instability were observed. Children who were administered a lower dexmedetomidine dose and had a shorter sedation time were more likely to be younger than 1 year of age. CONCLUSION These data demonstrate that dexmedetomidine deep sedation was well-tolerated in children with significant respiratory morbidities. Moreover, children younger than 1 year of age were administered lower dexmedetomidine dose than children older than 1 year of age for the same sedation level. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02555605.
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Affiliation(s)
- N. Najafi
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - F. Veyckemans
- Department of Anaesthesiology; Cliniques universitaires Saint Luc (UCL); Brussels Belgium
| | - A. Van de Velde
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - J. Poelaert
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
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Jarineshin H, Fekrat F, Kargar Kermanshah A. Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block. Anesth Pain Med 2016; 6:e39495. [PMID: 27847704 PMCID: PMC5101645 DOI: 10.5812/aapm.39495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Caudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block. OBJECTIVES The aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair. METHODS This randomized, double-blind clinical trial included children aged 1 - 5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement. RESULTS A total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups. CONCLUSIONS The results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.
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Affiliation(s)
- Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fereydoon Fekrat
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Aida Kargar Kermanshah
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Corresponding author: Aida Kargar Kermanshah, Anesthesiology, Critical Care and Pain Management Research Center, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tel/Fax: +98-7633345009, E-mail:
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Ahmed SS, Unland TL, Slaven JE, Nitu ME. Dexmedetomidine versus Propofol: Is One Better Than the Other for MRI Sedation in Children? J Pediatr Intensive Care 2016; 6:117-122. [PMID: 31073434 DOI: 10.1055/s-0036-1584683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objective The aim of this article is to determine whether dexmedetomidine or propofol is better for MRI sedation in children. Design This study is a retrospective review of patients sedated with dexmedetomidine or propofol for MRI between July 2007 and July 2015. Dexmedetomidine group (group D) was administered a bolus of 2 µg/kg over 10 minutes followed by a 1 ug/kg/hour infusion. Propofol group (group P) received a bolus of 2 mg/kg over 2 minutes followed by 83 µg/kg/minute infusion. Results Of the 996 cases completed, 452 were in group P and 544 were in group D. Patients in group P were heavier and older than those in group D. All the patients except one in group D completed the procedures. Hypotension occurred in 59% in group P versus 4% in group D (89 ± 11.4 SBP vs. 103.80 ± 19.4; p < 0.05). Bradycardia was observed in 2.9% in group P versus 0.6% in group D. Apnea occurred in two patients in group D. Although procedure time was longer in patients receiving propofol versus dexmedetomidine (58.87 ± 28.17 vs. 45 ± 23.6; p < .05), the discharge time was significantly shorter (37. ± 12.30 vs. 92.61 ± 28.19; p < 0.05). Conclusion Dexmedetomidine appears to provide a useful alternative to propofol for MRI sedation with a longer recovery time, stable hemodynamics, and less reliable respiratory profile, while the propofol had the advantage of quicker onset and rapid recovery.
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Affiliation(s)
- Sheikh S Ahmed
- Section of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
| | - Tamara L Unland
- Pediatric Procedural Sedation, IU Health North Hospital, Carmel, Indiana, United States
| | - James E Slaven
- Department of Biostatistics Indiana University, School of Medicine Indiana University, Indianapolis, Indiana, United States
| | - Mara E Nitu
- Section of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
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Mudakangoudar MS, Hegde HV, Koppad BA. Sedation for magnetic resonance imaging in a child with lingual venolymphatic malformation. Indian J Anaesth 2016; 60:289-90. [PMID: 27141116 PMCID: PMC4840813 DOI: 10.4103/0019-5049.179470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Harihar Vishwanath Hegde
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Bhavana A Koppad
- Department of Paediatrics, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Lu X, Li J, Li T, Zhang J, Li ZB, Gao XJ, Xu L. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit. Chin J Traumatol 2016; 19:94-6. [PMID: 27140216 PMCID: PMC4897849 DOI: 10.1016/j.cjtee.2015.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU. METHODS This randomized, prospective study was conducted in Tianjin Third Central Hospital, China. Using a sealed-envelope method, the patients were randomly divided into 2 groups (40 patients per group). Each patient of group A received an initial loading dose of midazolam at 0.3-3mg/kg·h 24 h before extubation, followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation. Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation. The dose of sedation was regulated according to RASS sedative scores maintaining in the range of -2-1. All patients were continuously monitored for 60 min after extubation. During the course, heart rate (HR), mean artery pressure (MAP), extubation time, adverse reactions, ICU stay, and hospital stay were observed and recorded continuously at the following time points: 24 h before extubation (T1), 12 h before extubation (T2), extubation (T3), 30 min after extubation (T4), 60 min after extubation (T5). RESULTS Both groups reached the goal of sedation needed for ICU patients. Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam, reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)), respectively (p= 0.017). There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam. In the group A, HR was not significantly increased after extubation; however, in the group B, HR was significantly increased compared with the preextubation values (p < 0.05). HR was significantly higher in the group B compared with the group A at 30 and 60 min after extubation (both, p <0.05). Compared with preextubation values, MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3, T4, T5 in the group B than group A (p < 0.05). There was a significant difference in extubation time ((3.0 ± 1.5) d vs (4.3 ± 2.2) d, p < 0.05), ICU stay ((5.4 ± 2.1) d vs (8.0 ± 1.4) d, p < 0.05), hospital stay ((10.1 ± 3.0) d vs (15.3 ± 2.6) d, p <0.05) between group A and B. CONCLUSION Midazolam sequential with dexmedetomidine can reach the goal of sedation for ICU agitated patients, meanwhile it can maintain the respiratory and circulation parameters and reduce adverse reactions.
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Effect of dexmedetomidine on acute lung injury in experimental ischemia-reperfusion model. Braz J Anesthesiol 2016; 67:139-146. [PMID: 28236861 DOI: 10.1016/j.bjane.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/20/2015] [Accepted: 08/17/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Ischemia-reperfusion injury is one of the consequences of tourniquet application for extremity surgery. The aim of the study was to establish the effect of dexmedetomidine on the acute lung injury following lower extremity experimental ischemia-reperfusion model in rats. METHODS Twenty-eight Wistar-Albino breed Rats were recruited after Ethics Committee approval and allocated into 4 groups, each with 7 subjects. Group 1 (SHAM) received only anesthesia. Group 2 (IR) had experienced 3h of ischemia and 3h of reperfusion using left lower extremity tourniquet after anesthesia application. Groups 3 (D-50) and 4 (D-100) had undergone the same procedures as in the Group 2, except for receiving 50 and 100mg·kg-1, respectively, dexmedetomidine intraperitoneally 1h before the tourniquet release. Blood samples were obtained for the analysis of tumor necrosing factor-α and interleukin-6. Pulmonary tissue samples were obtained for histological analysis. RESULTS No significant difference regarding blood tumor necrosing factor-α and interleukin-6 values was found among the groups, whereas pulmonary tissue injury scores revealed significant difference. Histological scores obtained from the Group 2 were significantly higher from those in the Groups 1, 3 and 4 with p-values 0.001 for each comparison. Moreover, Group 1 scores were found to be significantly lower than those in the Groups 3 and 4 with p-values 0.001 and 0.011, respectively. No significant difference was observed between the Groups 3 and 4. CONCLUSION Dexmedetomidine is effective in reduction of the experimental ischemia-reperfusion induced pulmonary tissue injury in rats, formed by extremity tourniquet application.
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Eficácia de dexmedetomidina para o surgimento de agitação em lactentes submetidos à palatoplastia: estudo clínico randomizado. Braz J Anesthesiol 2016; 66:37-43. [DOI: 10.1016/j.bjan.2015.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/07/2015] [Indexed: 11/23/2022] Open
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Richa F, Chalhoub V, Dagher C, Yazbeck PH. Dexmedetomidine sedation for a claustrophobic patient with obstructive sleep apnea undergoing magnetic resonance imaging. J Clin Anesth 2015; 27:698-9. [PMID: 26138628 DOI: 10.1016/j.jclinane.2015.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Freda Richa
- Saint-Joseph University, Hotel-Dieu de France Hospital, Anesthesia and Intensive Care Department, Beirut, Lebanon.
| | - Viviane Chalhoub
- Saint-Joseph University, Hotel-Dieu de France Hospital, Anesthesia and Intensive Care Department, Beirut, Lebanon
| | - Christine Dagher
- Saint-Joseph University, Hotel-Dieu de France Hospital, Anesthesia and Intensive Care Department, Beirut, Lebanon
| | - Patricia H Yazbeck
- Saint-Joseph University, Hotel-Dieu de France Hospital, Anesthesia and Intensive Care Department, Beirut, Lebanon
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Ghodki PS, Sardesai SP, Halikar SS. Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1028225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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