Assessment of different loading doses of dexmedetomidine hydrochloride in preventing adverse reaction after combined spinal-epidural anesthesia

Dexmedetomidine Combined with Low-Dose Norepinephrine Continuous Pumping to Prevent Hypotension after Cesaresan Section: A Randomized Controlled Trial

Objective

The aim of the study is to explore the clinical effect of dexmedetomidine combined with low-dose norepinephrine (NE) continuous pumping in preventing supine hypotension.

Methods

A total of 160 puerperaes who underwent elective cesarean section were selected. The puerperaes were equally divided into S group (saline), D group (dexmedetomidine), N group (norepinephrine), and DN group (dexmedetomidine combined with norepinephrine) by a random number table method. Apgar scores and umbilical cord venous blood gas values were recorded at 1 and 5 minutes.

Results

There were no statistically significant differences in the age, gestational age, body mass index, bleeding volume, fluid supplement volume, Apgar scores of new borns at the 1st and 5th minute, the blood gas values of umbilical cord arterial and venous in the four groups (P > 0.05). Compared with the S group, the incidence of supine hypotension, the number of NE supplements, the supplementary doses of NE, and the incidence of adverse reactions were significantly reduced in the D, N, and DN groups after spinal anesthesia (P < 0.05). Compared with group D, the incidence of supine hypotension, the number of additional NE, additional dose of NE, and the incidence of adverse reactions in the DN group after spinal anesthesia were significantly reduced (P < 0.05). Compared with the N group, the incidence of supine hypotension, the number of additional NE, the additional dose of NE, and the incidence of adverse reactions in the DN group after spinal anesthesia were significantly reduced (P < 0.05).

Conclusion

Dexmedetomidine combined with continuous pumping of low-dose norepinephrine can effectively prevent the occurrence of supine hypotension, reduce the occurrence of other adverse reactions, and have no obvious adverse effects on neonates. Registration. Chinese Clinical Trial Registry (https://www.chictr.org.cn/enIndex.aspx; ChiCTR2000040979).

Adoption of Dexmedetomidine in Different Doses at Different Timing in Perioperative Patients

Dexmedetomidine (Dex) is an alpha-2 agonist used for sedation during various procedures. Dex activates 2-adrenoceptors, and causes the decrease of sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; it reduces anesthetic and opioid requirements; and causes sedation and analgesia.

OBJECTIVE

it was to compare the perioperative effects of different doses of Dex at different timing in patients using Dex during the perioperative period adopting a medical data classification algorithm based on optimized semi-supervised collaborative training (Tri-training).

METHODS

495 patients requiring surgical treatment in Xingtai People's Hospital were randomly selected as the study subjects. The patients were divided into group A (used before induction), group B (used during induction), and group C (used after induction) according to different induction timing, with 165 cases in each group. Then, groups A, B, and C were divided into groups A1, B1, and C1 (0.4 μg/(kg·h) rate), groups A2, B2, and C2 (0.6 μg/(kg·h) rate), and groups A3, B3, and C3 (0.8 μg/(kg·h) rate) according to the dose used, with 55 cases in each group. Intraoperative anesthesia and postoperative adverse reactions were compared among the 9 groups.

RESULTS

the similarity between the Tri-training algorithm optimized by Naive Bayes (NB) classification algorithm and the actual classification (93.49%) was clearly higher than that by decision tree (DT) and K-nearest neighbor (kNN) classification algorithm (76.21%, 74.31%); heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) values decreased obviously after Dex used in groups B1, C1, B2, C2, B3, and C3 (P <0.05), but did not change significantly in groups A1, A2, and A3 (P >0.05); the proportion of patients with satisfactory Ramsay score in group A3 was distinctly superior than that in groups A1, A2, B1, B2, B3, C1, C2, and C3 (P <0.05); the incidence of adverse reactions in group A3 was significantly inferior than that in groups A1, A2, B1, B2, B3, C1, C2, and C3 (P <0.05).

CONCLUSION

the optimization effect of NB classification algorithm was the best, and the injection of Dex at the injection rate of 0.8 μg/(kg·h) before induction of anesthesia could apparently improve the fluctuation of HR, SBP, and DBP during perioperative period, and effectively reduce the occurrence of adverse reactions in patients, with better sedative effect on patients.

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

Objective

The present study is designed to study the analgesic and sedative effect of different doses of dexmedetomidine combined with butorphanol in continuous analgesia after a cesarean section.

Methods

A total of 60 puerperae undergoing a cesarean section recruited from a single center were divided into three groups according to the postoperative continuous analgesia protocol: control group (100 mL of normal saline containing 10 µg/kg fentanyl and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), DB1 group (100 mL of normal saline containing 1.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), and DB2 group (100 mL normal saline containing 2.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h). We compared the blood pressure, heart rate, oxygen saturation, VAS score, Ramsay score, and adverse reactions of puerperae among the three groups after surgery.

Results

The baseline data all have no significant difference in the three groups (p > 0.05). Compared with those in the control group, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB1 group and DB2 group were significantly decreased at 6, 24, and 48 h (P < 0.05), while the Ramsay scores of the puerperae in DB1 group and DB2 group were significantly increased at 6, 24, and 48 h (p < 0.05). At the same time, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB2 group were significantly lower than those in the DB1 group (P < 0.05), while the Ramsay scores of the puerperae in DB2 group were significantly higher than those in the DB1 group (P < 0.05). Also, there is no significant difference in oxygen saturation and adverse reactions of puerperae among the three groups after surgery (p > 0.05).

Conclusion

Dexmedetomidine combined with butorphanol can improve the analgesic and sedative effects in continuous analgesia after a cesarean section, and the analgesic and sedative effects of dexmedetomidine in the high-dose group are better than those in the low-dose group.

Comparison of the Efficacy and Safety of Dexmedetomidine Administered in Two Different Modes Under Procedural Sedation and Analgesia in Plastic Surgery

Background

Dexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is now widely used in procedural sedation and analgesia. This study was designed to observe and compare the efficacy and safety of DEX administered in two different modes.

Methods

In total, 100 patients were randomly divided into two groups to receive intravenous DEX 1 µg/kg over 15 min followed by 0.4–0.7 µg/kg/h infusion or DEX 1 µg/kg over 30 min followed by 0.4–0.7 µg/kg/h infusion. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), bispectral index (BIS), Ramsay Sedation Scores (RSS scores), the lowest respiratory rates (LRR), incidences of respiratory adverse events and frequencies of body movements were recorded. Recovery time, recall of intraoperative events, pain scores in PACU and satisfaction of patients and surgeons were assessed.

Results

The BIS at time points from 5 min after anesthesia to the end of surgery in the intervention group were significantly higher (p < 0.05). The RSS scores at time points from 5 min after anesthesia to immediately after induction with DEX were significantly higher in the intervention group (p < 0.05). The HR at time points from the beginning of surgery to 30 min after local anesthesia, the MAP at time points from 30 min after local anesthesia to the end of surgery, and the RR at time points from 5 min after anesthesia to the end of surgery were significantly higher in the intervention group (p < 0.05). Patients in the intervention group had higher LRR, lower incidences of respiratory adverse events, and shorter recovery time (p < 0.05).

Conclusions

Dexmedetomidine infused with a loading dose over 30 min had less impact on patients’ hemodynamics and respiration and could shorten the recovery time after anesthesia in procedural sedation and analgesia.

Clinical Trial Registration

ClinicalTrials.gov, identifier: ChiCTR1900027958.

Low-dose midazolam for anxiolysis for pregnant women undergoing cesarean delivery: a randomized trial

INTRODUCTION

Anxiety and fear are common among pregnant women undergoing cesarean delivery. In addition to psychologically unpleasant, they can elicit endocrine and metabolic changes. Administration of benzodiazepines in this patient group is uncommon and investigation focusing on the topic is rare. This study aimed to determine anxiolysis efficacy of low-dose midazolam administered preoperatively, right before cesarean delivery, and to evaluate whether its administration impacts neonatal vitality, maternal consciousness, and recall of the moment the baby was born.

METHODS

Fifty pregnant women with indication for cesarean delivery were included in this randomized, double-blind, placebo-controlled clinical study and allocated into two groups of 25 participants each (Midazolam and Control group). Midazolam (0.0125 mg.kg^-1) or a placebo solution was administered immediately before spinal anesthesia and the anxiolytic effect was assessed using a visual analogue scale before and after administration. We registered the Apgar score at 1 and 5 minutes, the Ramsay scale and recall of the moment of birth, that was assessed 90 minutes after birth.

RESULTS

Pregnant women from the Midazolam group presented a 1.3-point reduction in anxiety on the visual analogue scale, while the Control group showed virtually no change (p = 0.027). We observed no statistically significant changes in Apgar scores, level of maternal consciousness and recall of the moment of delivery.

CONCLUSIONS

Low-dose midazolam can provide anxiety management in pregnant women undergoing cesarean delivery with no significant undesirable effects.

Effect of different routes of administration on early cognitive function following inguinal hernia repair

PURPOSE

To analyze the effects of different routes of dexmedetomidine administration on early cognitive function following inguinal hernia repair.

METHODS

A total of 83 patients with pediatric inguinal hernias admitted to our hospital from January 2018 to October 2020 were divided into control group (CNG, n = 41) and observation group (OG, n = 42) by random number table. The OG was given 2 μg/kg of dexmedetomidine hydrochloride by intranasal administration, and the CNG was treated with 0.5 μg/kg of dexmedetomidine hydrochloride via intravenous (IV) infusion pump. The hemodynamics, condition of anesthesia, awakening, and safety were compared between the two groups.

RESULTS

Systolic blood pressure and oxygen saturation levels at T1 and T2 in the OG were not different from those in the CNG (P > 0.05), and heart rates in the OG were all higher than those in the CNG (P < 0.05). The incidence of emergence agitation during awakening was 4.76% in the OG, which was lower than 21.95% compared with the CNG (P < 0.05). Ramsay sedation scores at 15 and 30 min after awakening in the OG were higher than those in the CNG, and PAED scores in the OG were lower than those in the CNG (P < 0.05). Cognitive, language, and motor scores in the OG were higher than those in the CNG at 3 days after surgery (P < 0.05), and the incidence of cognitive dysfunction was 4.76% in the OG at 3 days after surgery, which was lower compared with 21.95% in the CNG (P < 0.05).

CONCLUSION

Application of dexmedetomidine hydrochloride by intranasal administration or intravenous infusion before induction can ensure rapid postoperative awakening of the children without causing significant fluctuations in blood pressure and oxygen saturation, and both methods have a high safety profile. However, intranasal administration results in more satisfactory sedation, less postoperative agitation upon awakening, and reduces postoperative cognitive dysfunction.

The Effectiveness and Safety of Intravenous Dexmedetomidine of Different Concentrations Combined with Butorphanol for Post-Caesarean Section Analgesia: A Randomized Controlled Trial

Purpose

The present study aimed to determine the effectiveness of intravenous dexmedetomidine of different concentrations and to evaluate its maternal and neonatal safety when combined with butorphanol in parturients undergoing cesarean section.

Patients and Methods

A total of 114 parturients between 24 and 43 years of age, with singleton pregnancy who underwent elective cesarean section under epidural anesthesia, were randomly allocated to four groups: group C received 0.9% sodium chloride after delivery, followed by butorphanol (3 μg·kg^-1·h^-1); patients in groups D1, D2, and D3 received 0.5 μg·kg^-1·h^-1 dexmedetomidine after delivery, followed by butorphanol (3 μg·kg^-1·h^-1) combined with dexmedetomidine 0.03, 0.05, and 0.08 μg·kg^-1·h^-1, respectively. The primary outcome was the visual analogue scale (VAS) score at 6 h after delivery when patients were at rest. Secondary outcome measures included VAS after delivery when patients were on movement and uterine cramping, Ramsay sedation scale (RSS), relative infant dose (RID) of dexmedetomidine, satisfaction with analgesia after surgery and symptoms of CNS depression in neonates.

Results

There were no significant differences in patient characteristics among the groups (P > 0.05). The VAS at all timepoints after delivery in groups D2 and D3 were significantly lower than in groups C and D1 (P < 0.001). RSS scores were clearly higher in group D3 than in the other three groups at 6 h and 12 h (P < 0.0001). RID in groups D1, D2, and D3 was 0.171%, 0.197%, and 0.370%, respectively. Compared with group D1, RID was higher in group D3 (P = 0.0079). Degree of satisfaction with analgesia was higher in groups D2 and D3 (P < 0.005).

Conclusion

Continuous intravenous infusion of 0.05 μg·kg^-1·h^-1 dexmedetomidine combined with 3 μg·kg^-1·h^-1 butorphanol could be safely applied in healthy parturients with satisfactory analgesia after cesarean section without changes in sedation.

Brain protective effect and hemodynamics of dexmedetomidine hydrochloride in patients with intracranial aneurysm

The purpose of the study was to investigate the effect of dexmedetomidine hydrochloride (Dex) on the recovery of cognitive function, hemodynamics, and postoperative analgesia in patients undergoing intracranial aneurysm craniotomy. Methods: general anesthesia was performed on patients undergoing intracranial aneurysm craniotomy in neurosurgery. Patients were randomly divided into three groups: Dex 1 group (Dex dose: 1 μg/kg), Dex 2 group (Dex dose: 0.5 μg/kg), and blank control group (normal saline). The changes of heart rate, arterial pressure, intraoperative brain function index, and postoperative pain score were recorded and compared. Results: in Dex 1 group and Dex 2 group, the heart rate of T1 and T2 phase was significantly lower than that of T3-T7 phases (P < 0.05); compared with the control group, the heart rate of Dex 1 group and Dex 2 group was significantly lower (P < 0.05). The average arterial pressure of the control group and Dex groups was significantly different (P < 0.05). Compared with the control group, there were significant differences between Dex 1 group and Dex 2 group: S100 β protein in T7-T10, NSE (neuron specific enolase) in T9 and T10, pain score in T8, T9 and T10 after operation. Conclusion: the application of Dex in the resection of intracranial aneurysms can protect the brain of patients, minimize the influence of operation on hemodynamics, and relieve postoperative pain, which is worthy of clinical application.

Effect of intrathecal dexmedetomidine on cesarean section during spinal anesthesia: a meta-analysis of randomized trials

Objective

Intrathecal dexmedetomidine has been used in spinal anesthesia during cesarean sections. The purpose of this meta-analysis was to investigate the effect of intrathecal dexmedetomidine on the adverse reactions of spinal anesthesia during cesarean section.

Methods

We searched for relevant studies using PubMed, Web of Science, and the Cochrane library. After screening studies and extracting data, we performed a meta-analysis on the effect of intrathecal dexmedetomidine during cesarean section.

Results

A total of 278 patients from 4 studies were included in this meta-analysis. The incidence of shivering in the dexmedetomidine groups was significantly lower than that in the placebo groups during cesarean section (RR=0.40, 95% CI [0.25, 0.65], P=0.0002). Intrathecal dexmedetomidine had no effect on nausea and vomiting (RR=1.08, 95% CI [0.68, 1.71], P=0.74), bradycardia (RR=1.33, 95% CI [0.31, 5.76], P=0.70), and hypotension during cesarean section (RR=0.78, 95% CI [0.59, 1.03], P=0.08).

Conclusion

Intrathecal dexmedetomidine can effectively reduce the occurrence of shivering during cesarean section, but it does not affect the occurrence of nausea and vomiting, bradycardia or hypotension.

Dexmedetomidine sedation combined with epidural anesthesia for laparoscopy in a patient with suspected tuberculosis: A case report

RATIONALE

We herein present a case in which satisfactory analgesia and sedation were provided by the combination of epidural anesthesia with dexmedetomidine for exploratory laparoscopy in a patient who was highly suspected to have tuberculosis. This is an optimal anesthesia method to minimize the risk of nosocomial infection, especially in developing countries that lack sterilizers for anesthesia machines.

PATIENT CONCERNS

A 45-year-old woman suspected to have active tuberculosis was scheduled to undergo laparoscopy for definitive diagnosis of a pelvic mass.

DIAGNOSES

Tuberculosis was diagnosed by exploratory laparoscopy.

INTERVENTIONS

The surgery was performed under general anesthesia to prevent pain and discomfort during the procedure. However, ventilation machine used by patients with tuberculosis may have a potential risk of nosocomial infection and need disinfection by a special sterilizer machine even when using a bacterial/viral filter-heat and moisture exchanger. Therefore, the surgery was performed under continuous epidural anesthesia combined with dexmedetomidine.

OUTCOMES

The surgery was successfully completed, and pelvic tubercles were confirmed to be caseous necrotic tissue by pathologic examination. The patient began regular antituberculosis treatment after discharging from the gynecology department.

LESSONS

We conclude that administration of dexmedetomidine combined with epidural anesthesia can provide comfortable sedation for short laparoscopic procedures in patients with suspected tuberculosis. This technique can minimize the risk of nosocomial infection.