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Gaikawad J, Choudhary S, Sharma S, Meena K, Verma D, Bedi V. Comparative evaluation of lignocaine nebulization with and without dexmedetomidine for flexible videoendoscopic guided awake nasal intubation for general anaesthesia. J Anaesthesiol Clin Pharmacol 2023; 39:372-378. [PMID: 38025547 PMCID: PMC10661621 DOI: 10.4103/joacp.joacp_483_21] [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: 10/16/2021] [Revised: 11/21/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Awake fibreoptic intubation is considered a safe approach in airway management of a patient with difficult airway. Awake fibreoptic endoscopy needs appropriate anaesthesia of airway to suppress airway reflexes and prevent discomfort. We planned this study to evaluate effect of adding dexmedetomidine to lignocaine nebulization on conditions for awake videoendoscopic intubation. Material and Methods In this prospective randomized double blind controlled study, ninety six ASA grade I, II patients of either gender, aged 18-65 years, scheduled for elective surgeries under general anaesthesia, were randomly allocated into two groups, Group D and L to receive nebulization with 4% Lignocaine 5 ml + Dexmedetomidine 2 mcg/kg and 4% Lignocaine alone respectively, 20 min before procedure. Time taken to intubate the patient, ease of intubation assessed by cough severity score, patient comfort score, post-intubation patient satisfaction and hemodynamic changes were recorded and compared. Results Group D and L had comparable intubation time (196.8 ± 61.2 s) and (205.8 ± 52.2 s) (p = 0.437). Cough severity, patient comfort and quality of procedure with post intubation patient satisfaction score were significantly better in Group D. Haemodynamics parameters were better post nebulization in group D as compared to group L. Conclusion Addition of Dexmedetomidine 2 mcg/kg with 4% Lignocaine during nebulization improves intubating conditions during awake flexible videoendoscopy in terms of ease of intubation, cough severity, patients comfort and satisfaction along with providing stable Haemodynamics profile.
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Affiliation(s)
- Jyoti Gaikawad
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Santosh Choudhary
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Sandeep Sharma
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Khemraj Meena
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Devendra Verma
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Vikram Bedi
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
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Thakore S, Gupta N, Madan K, Bhatnagar S. Near ideal anesthetic technique for tracheal stenting in central airway obstruction with dexmedetomidine-ketamine infusion: a case report. Braz J Anesthesiol 2021; 71:447-450. [PMID: 33895217 PMCID: PMC9373335 DOI: 10.1016/j.bjane.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
Central airway obstruction presents as an emergency with dyspnea and stridor. Anesthetic management of rigid bronchoscopy-guided tracheal stenting is highly stimulating procedure requiring general anesthesia. But it may lead to life threatening airway obstruction and cardiovascular collapse after induction. Total intravenous anesthesia based on propofol-remifentanil is an optimal anesthetic technique, but remifentanil is not available in many countries. Although dexmedetomidine-ketamine has been used for procedural sedation, its use for rigid bronchoscopy in the setting of central airway obstruction has not been described in literature. We describe near ideal anesthetic technique for management of central airway obstruction using dexmedetomidine-ketamine combination.
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Affiliation(s)
- Sakshi Thakore
- Department of onco-Anesthesiology, DRBRAIRCH, AIIMS, New Delhi.
| | - Nishkarsh Gupta
- Department of onco-Anesthesiology, DRBRAIRCH, AIIMS, New Delhi.
| | - Karan Madan
- Department of Pulmonary and critical care medicine, AIIMS, New Delhi
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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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Gautam NK, Bober K, Pierre JA, Pawelek O, Griffin E. Deep Tracheal Extubation Using Dexmedetomidine in Children With Congenital Heart Disease Undergoing Cardiac Catheterization: Advantages and Complications. Semin Cardiothorac Vasc Anesth 2019; 23:387-392. [PMID: 31431142 DOI: 10.1177/1089253219870628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. Deep tracheal extubation using dexmedetomidine is safe and provides smooth recovery in children with congenital heart disease undergoing cardiac catheterization. Design. Single-institution, retrospective study of prospectively collected data. Participants. All patients aged between 1 month and 5 years who underwent general endotracheal anesthesia for diagnostic and interventional cardiac catheterizations in the cardiac catheterization suite from January 2015 (change in standard operating procedure) through October 2016 (approval of institutional review board for study). Measurement and Main Results. One hundred and eighty-nine patients (81%) of the 232 patients who underwent cardiac catheterization during the study period were noted to undergo deep tracheal extubation. Cyanotic heart disease was present in 87 patients (46%), history of prematurity in 51 (27%), and pulmonary hypertension in 26 (14%) patients. A documented smooth recovery in the postoperative care unit (PACU) requiring no additional analgesics or sedatives was observed in 91% of the patients. The majority of patients required no airway support after deep extubation (n = 140, 74%, P = .136). The presence of pulmonary hypertension (odds ratio = 4.45, P = .035) and presence of a cough on the day of the procedure (odds ratio = 7.10, P = .03) were significantly associated with the use of oxygen or use of oral airway for greater than 20 minutes in the PACU. After extubation, there were no reported events of aspiration, the use of noninvasive positive pressure ventilation, reintubation, heart block, or systemic hypotension requiring treatment or cardiac arrest. Conclusions. Deep extubation using dexmedetomidine in infants and toddlers after cardiac catheterization is feasible and enables smooth postoperative recovery with minimal adverse effects.
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Affiliation(s)
| | - Kayla Bober
- University of Texas Health, Houston, TX, USA
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Takahashi N, Ogawa T, Wajima Z, Omi A. Dexmedetomidine-based intravenous anesthesia of a pediatric patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency: A case report. Medicine (Baltimore) 2017; 96:e6986. [PMID: 28538406 PMCID: PMC5457886 DOI: 10.1097/md.0000000000006986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect, resulting in deficits in nicotinamide adenine dinucleotide phosphate production, an important intracellular antioxidant enzyme. G6PD-deficient subjects present with a susceptibility of erythrocytes to oxidative stress and hemolysis, and should avoid drugs or stressors that have oxidative actions. Dexmedetomidine is an anesthetic agent with antioxidant actions. PATIENT CONCERNS AND DIAGNOSES A 5-year-old boy with G6PD deficiency. The patient was diagnosed with G6PD deficiency at birth. His red blood cell levels were indicating Class II G6PD activity by the World Health Organization (WHO) classification, but had no history of hemolytic anemia. INTRAVENTIONS Because of the patient's anxiety and hyperactivity prior to an operation for upper labial frenum resection, we performed perioperative management using intravenous sedation with dexmedetomidine, which provides upper airway patency and has an antioxidant action. OUTCOMES There was no abnormal breathing observed during anesthesia, and arousal was smooth with stable hemodynamics. The patient had no symptoms of hemolytic anemia up to 1 week postsurgery. CONCLUSION Antioxidant sedatives such as dexmedetomidine may be useful for reducing the risk of hemolysis after surgery in infant G6PD deficiency cases.
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Affiliation(s)
| | - Takashi Ogawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Di M, Han Y, Yang Z, Liu H, Ye X, Lai H, Li J, ShangGuan W, Lian Q. Tracheal extubation in deeply anesthetized pediatric patients after tonsillectomy: a comparison of high-concentration sevoflurane alone and low-concentration sevoflurane in combination with dexmedetomidine pre-medication. BMC Anesthesiol 2017; 17:28. [PMID: 28222678 PMCID: PMC5320744 DOI: 10.1186/s12871-017-0317-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dexmedetomidine can facilitate a smooth extubation process and reduce the requirement of sevoflurane and emergence agitation when administrated perioperatively. We aimed to observe the extubation process and the recovery characteristics in pediatric patients undergoing tonsillectomy while anesthetized with either high-concentration sevoflurane alone or low-concentration sevoflurane combined with pre-medication of single dose of intravenous dexmedetomidine. METHODS Seventy-five patients (ASA I or II, aged 3-7 years) undergoing tonsillectomy were randomized into three equal groups: to receive intravenous saline (Group D0), dexmedetomidine 1 μg/kg (Group D1), or dexmedetomidine 2 μg/kg (Group D2) approximately 10 min before anesthesia. Before the end of surgery, sevoflurane were adjusted to 1.5 times, 1.0 time and 0.8 times the minimal effective concentration in groups D0, D1 and D2, respectively. The sevoflurane concentration for each group was maintained for at least 10 min before the tracheal deep-extubation was performed. The extubation event, recovery characteristics and post-op respiratory complications were recorded. RESULTS All tracheal tubes in three groups were removed successfully during deep anesthesia. Nine patients in Group D0, three patients in Group D1, and two patients in Group D2 required oral airway to maintain a patent airway after extubation. The frequency of oral airway usage in groups D1 and D2 were significantly lower than that in Group D0. The percentages of patients with ED and the requirements of fentanyl in groups D1 and D2 were also significantly lower than those in Group D0. The time from extubation to spontaneous eye opening in Group D2 was longer than that in groups D0 and D1. The times of post-anesthesia care unit discharge in groups D0 and D2 were longer than that in Group D1. No other respiratory complications and vomiting were observed. CONCLUSION A single dose of intravenous dexmedetomidine as pre-medication in combination with low-concentration sevoflurane at the end of surgery provided safe and smooth deep extubation condition and it also lowered the emergence agitation in sevoflurane-anaesthetized children undergoing tonsillectomy. Preoperative dexmedetomidine at 1 μg/kg did not prolong postoperative recovery time. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16008423 , date of registration: 06 may 2016.
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Affiliation(s)
- Meiqin Di
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Yuan Han
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Zhuqing Yang
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Huacheng Liu
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Xuefei Ye
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Hongyan Lai
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Jun Li
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Wangning ShangGuan
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China
| | - Qingquan Lian
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
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Mahmoud M, Mason K. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth 2015; 115:171-82. [DOI: 10.1093/bja/aev226] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Lauder GR. Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice. Paediatr Anaesth 2015; 25:52-64. [PMID: 25312700 DOI: 10.1111/pan.12553] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
Inhalational anesthesia has dominated the practice of pediatric anesthesia. However, as the introduction of agents such as propofol, short-acting opioids, midazolam, and dexmedetomidine a monumental change has occurred. With increasing use, the overwhelming advantages of total intravenous anesthesia (TIVA) have emerged and driven change in practice. These advantages, outlined in this review, will justify why TIVA will supercede inhalational anesthesia in future pediatric anesthetic practice.
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Affiliation(s)
- Gillian R Lauder
- Department of Pediatric Anesthesia, British Columbia's Children's Hospital, Vancouver, BC, Canada
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9
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Sun Y, Liu C, Zhang Y, Luo B, She S, Xu L, Ruan X. Low-dose intramuscular dexmedetomidine as premedication: a randomized controlled trial. Med Sci Monit 2014; 20:2714-9. [PMID: 25529851 PMCID: PMC4278696 DOI: 10.12659/msm.891051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/12/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dexmedetomidine-induced bradycardia or hypotension has recently attracted considerable attention because of potentially grave consequences, including sinus arrest and refractory cardiogenic shock. A route other than intravenous injection or a low dose may help minimize cardiovascular risks associated with dexmedetomidine. However, few studies have addressed the clinical effects of low-dose intramuscular dexmedetomidine as premedication. MATERIAL AND METHODS Forty American Society of Anesthesiologists physical status I adult patients undergoing suspension laryngoscopic surgery were randomized to receive intramuscular dexmedetomidine (1 µg·kg-1) or midazolam (0.02 mg·kg-1) 30 minutes prior to anaesthesia induction. The sedative, hemodynamic, and adjuvant anaesthetic effects of both premedications were assessed. RESULTS The levels of sedation (Observer's Assessment of Alertness/Sedation scales) and anxiety (visual analog score) at pre-induction, and the times to eye-opening and extubation, were not different between the groups. The heart rate response following tracheal intubation and extubation, and mean arterial pressure responses after extubation, were attenuated in the dexmedetomidine group compared to the midazolam group. No bradycardia or hypotension was noted in any patients. Propofol target concentrations at intubation and at start and completion of surgery were decreased in the dexmedetomidine group, whereas no difference in respective remifentanil levels was detected. CONCLUSIONS This study provides further evidence that dexmedetomidine premedication in low dose (1 μg·kg-1) by intramuscular route can induce preoperative sedation and adjuvant anaesthetic effects without clinically significant bradycardia or hypotension.
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Affiliation(s)
- Yang Sun
- Department of Anaesthesiology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chaolei Liu
- Department of Anaesthesiology, Second Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuehong Zhang
- Department of Ophthalmology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bin Luo
- Department of Anaesthesiology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shouzhang She
- Department of Anaesthesiology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lixin Xu
- Department of Anaesthesiology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiangcai Ruan
- Department of Anaesthesiology, Guangzhou First People’s Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Corresponding Author: Xiangcai Ruan, e-mail:
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Chen K, Shen X. Dexmedetomidine and propofol total intravenous anesthesia for airway foreign body removal. Ir J Med Sci 2014; 183:481-4. [PMID: 24619368 DOI: 10.1007/s11845-014-1105-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To detail our experience using dexmedetomidine in combination with propofol for airway foreign body removal in spontaneously breathing patients. CLINICAL FEATURES Dexmedetomidine and propofol intravenous anesthesia as a primary anesthetic was used for three pediatric patients with severe respiratory impairment due to foreign body aspiration and two elderly patients requiring airway foreign body removal by rigid bronchoscopy. All patients were spontaneously ventilating, and had successful airway foreign body removal without severe hypoxemia. The three pediatric patients maintained stable respiratory and hemodynamic profiles. However, dexmedetomidine caused a significant change in the hemodynamics of the elderly patients. CONCLUSION Dexmedetomidine and propofol intravenous anesthesia provided good anesthesia without causing respiratory depression. However, this technique related to more hemodynamic depression in elderly patients than in pediatrics.
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Affiliation(s)
- K Chen
- Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, 200031, China
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Chen KZ, Ye M, Hu CB, Shen X. Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children. Br J Anaesth 2014; 112:892-7. [PMID: 24554548 DOI: 10.1093/bja/aet490] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children. METHODS Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed. RESULTS The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001). CONCLUSIONS Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.
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Affiliation(s)
- K-Z Chen
- Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai 200031, China
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Cai Y, Li W, Chen K. Efficacy and safety of spontaneous ventilation technique using dexmedetomidine for rigid bronchoscopic airway foreign body removal in children. Paediatr Anaesth 2013; 23:1048-53. [PMID: 23701115 DOI: 10.1111/pan.12197] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND In children, removal of an airway foreign body is usually performed by rigid bronchoscopy under general anesthesia. Debate continues regarding the respiratory mode (spontaneous or controlled ventilation) and appropriate anesthetic drugs. Dexmedetomidine has several desirable pharmacologic properties and appears to be a useful agent for airway surgeries. OBJECTIVES This study evaluates the efficacy of spontaneous ventilation (SV) technique using dexmedetomidine for bronchoscopic removal of foreign bodies in children. METHODS Eighty pediatric patients undergoing rigid bronchoscopy for airway foreign body removal were randomly divided into two groups. In the SV group, dexmedetomidine (4 μg∙kg(-1)) and topical lidocaine (3-5 mg∙kg(-1)) were administered and the patients were breathing spontaneously throughout the procedure. In the manual jet ventilation (MJV) group, anesthesia was induced with fentanyl (2 μg∙kg(-1)), propofol (3-5 mg∙kg(-1)), and succinylcholine (1 mg∙kg(-1)), and MJV was performed. RESULTS The success rates of foreign body removal, the incidence of body movement and other perioperative adverse events, and hemodynamic changes were similar between the two groups. The SV patients required longer stays in the postanesthesia care unit (P < 0.01) but experienced less coughing (P = 0.029) in the recovery room. CONCLUSION Dexmedetomidine may provide appropriately deep anesthesia and ideal conditions for rigid bronchoscopic airway foreign body removal without respiratory depression or hemodynamic instability.
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Affiliation(s)
- Yirong Cai
- Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
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McCormick ME, Johnson YJ, Pena M, Wratney AT, Pestieau SR, Zalzal GH, Preciado DA. Dexmedetomidine as a Primary Sedative Agent after Single-Stage Airway Reconstruction. Otolaryngol Head Neck Surg 2013; 148:503-8. [DOI: 10.1177/0194599812471784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To examine the outcomes of children receiving dexmedetomidine after single-stage airway reconstruction. Study Design Historical cohort study. Setting Tertiary care children’s hospital. Subjects and Methods Of 61 eligible patients, 50 children undergoing single-stage airway reconstruction were included in the study. Thirty children received dexmedetomidine (Dex) as a primary sedative agent, and 20 received a more traditional sedation protocol (no Dex). Primary outcomes included complications, intubation lengths, and lengths of pediatric intensive care unit (PICU)/hospital admission. Secondary analysis incorporating polypharmacy and age was performed using multivariate linear regression models. Results Median age was 18.0 months. Age, sex, and weight were similar between the groups. Intubation length was equal in the 2 groups, and there were no statistical differences between lengths of PICU or hospital stay after extubation. Similarly, overall and individual complications were all similar, and there was no difference between the 2 groups in the amount of polypharmacy administered. On multivariate analysis, polypharmacy and younger age were independently correlated with an increase in overall complications, and polypharmacy alone was correlated with an increased length of stay after extubation. Conclusion The use of dexmedetomidine as a primary sedation agent after single-stage airway surgery does not appear to improve outcomes or decrease the need for additional pharmacologic agents. Polypharmacy was associated with an increase in overall complications and an increased length of stay after extubation. Although success can be expected in greater than 90% of these surgical patients, the optimal postoperative sedation management remains challenging.
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Affiliation(s)
- Michael E. McCormick
- Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
| | - Yewande J. Johnson
- Division of Anesthesiology and Pain Medicine, Children’s National Medical Center, Washington, DC
| | - Maria Pena
- Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
| | - Angela T. Wratney
- Critical Care Medicine Department, Children’s National Medical Center, Washington, DC
| | - Sophie R. Pestieau
- Division of Anesthesiology and Pain Medicine, Children’s National Medical Center, Washington, DC
| | - George H. Zalzal
- Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
| | - Diego A. Preciado
- Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
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Gupta P, Tobias JD, Goyal S, Miller MD, De Moor MM, Noviski N, Mehta V. Preliminary experience with a combination of dexmedetomidine and propofol infusions for diagnostic cardiac catheterization in children. J Pediatr Pharmacol Ther 2012; 14:106-12. [PMID: 23055898 DOI: 10.5863/1551-6776-14.2.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
No specific regimen has been universally accepted as ideal for procedural sedation during cardiac catheterization in infants and children. In this paper, we retrospectively describe our preliminary experience with a continuous infusion of dexmedetomidine and propofol for sedation during cardiac catheterization in children with congenital heart disease. The short-half life of these two drugs creates a potential for easier titration, quicker recovery and less prolonged sedation-related adverse effects. This combination was not only able to limit the dose of either drugs, but was also very stable from cardio-respiratory standpoint. There were no adverse effects noted in our two patients. This initial experience showed that the combination of propofol and dexmedetomidine as a continuous infusion may be a suitable alternative for sedation in spontaneously breathing children undergoing cardiac catheterization.
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Affiliation(s)
- Punkaj Gupta
- Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Liao W, Ma G, Su Q, Fang Y, Gu B, Zou X. Dexmedetomidine versus Midazolam for Conscious Sedation in Postoperative Patients Undergoing Flexible Bronchoscopy: A Randomized Study. J Int Med Res 2012; 40:1371-80. [DOI: 10.1177/147323001204000415] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: This prospective randomized study evaluated the efficacy and patient tolerance of dexmedetomidine compared with midazolam for sedation in postoperative patients undergoing flexible bronchoscopy. METHODS: A total of 198 postoperative patients were randomized to receive dexmedetomidine ( n = 99) or midazolam ( n = 99) to produce conscious sedation for bronchoscopy. Peripheral oxygen saturation, heart rate and systolic and diastolic arterial pressures were recorded before, during and after the procedure. Patient tolerance was recorded using various visual analogue scales. RESULTS: The mean lowest peripheral oxygen saturation was significantly lower in the midazolam group than in the dexmedetomidine group. Heart rate and systolic arterial pressure were both significantly higher during bronchoscopy in the midazolam group than in the dexmedetomidine group. Bronchoscopy was well tolerated in both groups; there was no between-group difference in patient discomfort scores or in the percentage of patients who would accept repeat bronchoscopy. CONCLUSIONS: Compared with midazolam, dexmedetomidine provided better oxygen saturation and was equally well tolerated for conscious sedation in postoperative patients undergoing bronchoscopy.
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Affiliation(s)
- W Liao
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - G Ma
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Qg Su
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Y Fang
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Bc Gu
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Xm Zou
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
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Silver AL, Yager P, Purohit P, Noviski N, Hartnick CJ. Dexmedetomidine use in pediatric airway reconstruction. Otolaryngol Head Neck Surg 2010; 144:262-7. [PMID: 21493428 DOI: 10.1177/0194599810391397] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assess the postoperative use of dexmedetomidine (Precedex) in pediatric patients following airway reconstruction. STUDY DESIGN Historical cohort study. SETTING Tertiary medical center. SUBJECTS AND METHODS A retrospective review of 24 children undergoing laryngotracheal reconstruction (LTR) or laryngeal cleft repair (LCR) was conducted. Twelve children were treated with standard sedation protocols where dexmedetomidine was administered in lieu of propofol (Diprivan); 12 age-, gender-, and procedure-matched controls were selected. Subjects were divided into groups based on duration of postoperative intubation for cross-comparison; group 1 was intubated <24 hours, group 2 was intubated 2 to 6 days, and group 3 was intubated 7 days or longer. Baseline heart rate and blood pressure measurements were compared to hourly measurements for the first 6 hours following initiation of dexmedetomidine or mechanical ventilation in the control group. Number of supportive respiratory interventions, adverse events, self-extubations, premature termination of dexmedetomidine, amount of muscle relaxants, agents to treat withdrawal, and length of stay were evaluated. RESULTS Ten patients undergoing LTR and 2 patients undergoing LCR receiving dexmedetomidine were compared to 10 LTR and 2 LCR control patients. Overall, dexmedetomidine was well tolerated and without significant adverse effects, particularly in cases of short-term intubation or as a bridge to extubation. CONCLUSION In cases requiring short-term intubation following airway reconstruction, dexmedetomidine may offer a safe alternative to propofol by providing readily reversible sedation during the periextubation period. Further studies are needed to determine the safety, efficacy, dosing, and potential complications of longer term dexmedetomidine administration in pediatric airway reconstruction.
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Affiliation(s)
- Amanda L Silver
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, and Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02114, USA
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A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol 2010; 27:648-52. [PMID: 20531094 DOI: 10.1097/eja.0b013e3283347bfe] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The intent of our study was to compare the effects of dexmedetomidine versus midazolam on perioperative hemodynamics, sedation, pain, satisfaction and recovery scores during colonoscopy. MATERIAL AND METHODS A total of 60 ASA I-II patients, between 20 and 80 years of age were included in the study. Patients were randomly assigned to two groups. Midazolam 0.05 mg kg(-1) and fentanyl citrate 1 microg kg(-1) were administered intravenously to cases in Group I (n = 30). An initial loading dose of 1 microg kg(-1) dexmedetomidine was administered intravenously in 10 min to cases in Group II (n = 30) before the procedure and as a continuous infusion dose of 0.5 microg kg(-1) h(-1) just before the procedure started. Also 1 microg kg(-1) fentanyl citrate was administered intravenously immediately before the procedure. Peripheral oxygen saturation (S(pO2)), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS), Numeric Rating Scale (NRS) scores and colonoscopist satisfaction scores of the cases were recorded. RESULTS Although statistically significant values were not detected between the two groups with regard to mean arterial pressure, in Group I heart rates were higher and S(pO2) scores were lower in a statistically significant manner. When the groups were compared with regard to RSS, the RSS scores of Group I at the 10th and 15th minutes were significantly lower than Group II. There was no statistically significant difference between the two groups when compared with regard to NRS scores. Satisfaction scores were significantly lower in Group II. CONCLUSION Dexmedetomidine provides more efficient hemodynamic stability, higher Ramsay sedation scale scores, higher satisfaction scores and lower NRS scores in colonoscopies. According to our results we believe that dexmedetomidine can be used safely as a sedoanalgesic agent in colonoscopies.
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Quezado ZMN, Groblewski JC, Gelfand HJ, Shah RK. Dexmedetomidine and proprofol in complex microlaryngeal surgery in infants. Int J Pediatr Otorhinolaryngol 2009; 73:1311-2. [PMID: 19556016 PMCID: PMC2742991 DOI: 10.1016/j.ijporl.2009.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 05/17/2009] [Indexed: 10/20/2022]
Abstract
We describe the case of an infant undergoing endoscopic repair of a laryngeal cleft where the combination of dexmedetomidine and propofol infusions was used as the anesthetic technique. With this regimen, endotracheal intubation was unnecessary during the perioperative period, the procedure lasted approximately 3h, and the child recovered uneventfully. Historically, the techniques used for microlaryngeal surgery involve the use of intermittent endotracheal intubation and insufflation of halogenated anesthetics to the oropharynx. Given the potential benefits of a technique that obviates the need for endotracheal intubation during microlaryngeal surgery and prevents insufflation of halogenated anesthetics in an open environment, the combination of propofol and dexmedetomidine should be considered as a viable and desirable anesthetic option for infants undergoing complex microlaryngeal surgery.
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Affiliation(s)
- Zenaide M. N. Quezado
- Department of Anesthesia and Surgical Services, NIH Clinical Center, National Institutes of Health, Bethesda, MD, Division of Anesthesiology and Pain Medicine, George Washington University Medical Center, Washington, DC
| | - Jan C. Groblewski
- Division of Otolaryngology, Children’s National Medical Center, George Washington University Medical Center, Washington, DC
| | - Harold J. Gelfand
- Division of Anesthesiology and Pain Medicine, George Washington University Medical Center, Washington, DC
| | - Rahul K. Shah
- Division of Otolaryngology, Children’s National Medical Center, George Washington University Medical Center, Washington, DC
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Abstract
OBJECTIVE To describe the use of dexmedetomidine for sedating intubated children in a general medical/surgical pediatric intensive care unit (PICU). DESIGN Retrospective, observational study. SETTING Multidisciplinary PICU of a tertiary, university-affiliated children's hospital. PATIENTS All children receiving dexmedetomidine within the PICU during the period of August 2003 to August 2005. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, 121 mechanically ventilated patients, median age 36 months (range 2 months to 21 years), who received dexmedetomidine infusions. The infusion was initiated and adjusted per our PICU protocol. The average dose was 0.55 microg/kg/hr (range 0.15-0.70 microg/kg/hr) and average length of use was 25.8 hours (range 20 minutes to 60 hours). During the dexmedetomidine infusion, the mean decrease in total benzodiazepine and opiate dose as compared with the 24 hours prior was 42% and 36%, respectively. Most patients were able to reduce their benzodiazepine and opiate dose by at least 20% with the dexmedetomidine infusion (70% and 73% of patients, respectively). After discontinuing dexmedetomidine, the average change in total benzodiazepine and opiate dose as compared with the 24 hours before infusion was an increase of 14% and 1.5%, respectively. Fewer patients were able to maintain at least a 20% reduction in benzodiazepine and opiate after cessation of dexmedetomidine compared with the 24 hours before initiation (38% and 40% of patients, respectively). Hypotension and/or bradycardia requiring clinical intervention occurred in 33 of 121 (27%) patients. Discontinuation secondary to clinical concern was necessary in 12 of 121 (10%) patients. CONCLUSIONS Our study suggests that many, although not all, mechanically ventilated children may be able to reduce their need for other sedation medications with the use of dexmedetomidine. However, the potential side effects of dexmedetomidine necessitates close hemodynamic monitoring with its use.
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