Comparative Evaluation of Dexmedetomidine and Propofol Along With Scalp Block on Haemodynamic and Postoperative Recovery for Chronic Subdural Haematoma Evacuation Under Monitored Anaesthesia Care

Dexmedetomidine Versus Fentanyl in Intraoperative Neuromuscular Monitoring Using A Propofol-based Total Intravenous Anaesthesia Regimen in Spine Surgeries

Objective

This prospective, double-blind, randomized study aimed to compare the effects of dexmedetomidine and fentanyl on the latency and amplitude of transcranial motor evoked potentials (TcMEPs) under propofol-based total intravenous anaesthesia (TIVA) in spine surgery. Secondarily, intraoperative hemodynamics, total propofol consumption, recovery profile, and surgical field quality were compared.

Methods

TcMEP amplitude and latency recordings of bilateral abductor pollicis brevis and abductor hallucis muscles posted for elective lumbar spine surgery under TcMEP monitoring randomly divided into two study groups. Throughout the surgery, TIVA was administered using intravenous propofol (100-150 μg kg-1 min-1) and dexmedetomidine (0.5-0.7 μg kg-1 h-1) in group D and intravenous propofol (100-150 μg kg-1 min-1) and fentanyl (1 μg kg-1 h-1) in group F. TcMEPs were recorded at various time points during the surgery. Immediately after extubation recovery from anaesthesia was noted. Additionally, hemodynamic parameters, total propofol consumption, and surgical field quality were assessed.

Results

Latency and amplitude were comparable between the groups. Time to extubation was significantly longer in group D, but the mean (standard deviation) duration of stay in recovery was shorter in group D [47.55 (7.51) 95% confidence interval (CI) (44.863-50.237)] (P=0.046). Total propofol consumption was reduced in group D [220 (38) 95% CI (206.402-233.598)] (P=0.025) and surgical field condition was better in group D.

Conclusions

Dexmedetomidine and fentanyl do not have any effect on TcMEP amplitude and latency. However, dexmedetomidine provides the additional advantage of reduced total propofol consumption, shorter stay in recovery, and better surgical field quality.

Comparison of the Effects of Intravenous Fentanyl and Intravenous Dexmedetomidine on Characteristics of Spinal Anesthesia

Introduction and aim Spinal anesthesia is a widely used technique for lower abdominal and lower limb surgeries, offering effective pain control and muscle relaxation. Various adjuvants have been explored to enhance the quality and duration of spinal anesthesia, with opioids and α-2 agonists being popular choices. Fentanyl, a potent opioid, and dexmedetomidine, a highly selective α-2 agonist, have both shown promising results when used as adjuvants. This study aimed to compare the effects of intravenous fentanyl versus intravenous dexmedetomidine on the characteristics of spinal anesthesia, including onset and duration of sensory block, hemodynamic stability, postoperative analgesia, and side effects. Methods This is a prospective, randomized, double-blind, comparative study involving sixty patients aged 18 to 65 years. The patients were classified as American Society of Anesthesiologists physical status I and II and were scheduled for elective infraumbilical surgery under subarachnoid block. The patients were randomly divided into two groups as follows: group D and group F. Patients of group D received IV dexmedetomidine 0.5 µg/kg and group F received IV fentanyl 1 µg/kg as premedication 5 minutes before spinal anesthesia over 10 minutes. Vital parameters, the onset of sensory and motor block, the highest level of sensory blockade achieved, regression time of spinal anesthesia by two segments, Ramsay sedation score, postoperative numerical rating scale, and time of requirement of first dose of postoperative rescue analgesic were recorded and analyzed. Results Both group D and group F were comparable in terms of age, gender distribution, BMI, American Society of Anesthesiologists (ASA) grading, and type of surgery. The time to achieve T10 sensory blockade was significantly faster in group F (5.5±1.27 minutes) compared to group D (6.5±1.6 minutes, p=0.01). However, the difference between the highest level of sensory blockade achieved and the time to achieve motor blockade was not statistically significant. Group D showed a significantly longer time to two-segment regression of spinal level (141.8±23.5 minutes vs. 94.33±13.6 minutes, p<0.001). Hemodynamic parameters were comparable between groups. Group D demonstrated higher Ramsay sedation scores from 10 minutes to 45 minutes postanesthesia with maximum difference at 15 minutes (p<0.001) and lower pain scores at 4 and 6 hours postsurgery (p=0.02 and p=0.008, respectively). The time to rescue analgesia was significantly longer in group D (6.9±1.5 hours vs. 5.5±0.63 hours, p<0.001). Side effects were minimal and comparable between the two groups. Conclusion While both fentanyl and dexmedetomidine are valuable intravenous adjuncts to spinal anesthesia, dexmedetomidine offers advantages in terms of prolonged sensory block, better postoperative analgesia, and longer time to rescue analgesia. Fentanyl, on the other hand, provides a faster onset of sensory block. Dexmedetomidine produced a slightly higher level of sedation, particularly in the early postanesthesia period. The choice between these two drugs should be tailored to the specific requirements of the surgical procedure and individual patient factors.

Sedation for Colonoscopy Procedures Using Dexmedetomidine Versus Propofol-Fentanyl Infusions: A Prospective Randomized Controlled Trial

Objective

Different anaesthetists for sedation or monitored anaesthesia care have been used for colonoscopy. The target of this research was the ability to perform colonoscopy under a painless degree of sedation and the prevalence of undesired proceedings.

Methods

A total of 60 patients were randomly divided into two groups: Group D received dexmedetomidine and Group PF received propofol-fentanyl. Patients in both groups received the same infusion ratio. The minimum infusion amount of dexmetatomidine is (0.1 to 0.4 μg kg-1 h-1) in Group D, whereas fentanyl is administered at a rate of 0.01 to 0.05 μg kg-1 min-1 in the PF group during the approximately 45-min colonoscopy.

Results

Group D exhibited significantly lower modified Observer's Assessment of Alertness/Sedation (OAA/S) scores at intraoperative time points T1-T12. Group D also exhibited significantly lower visual analog scale scores for pain at intraoperative time points T4 and T7. The mean arterial pressure was significantly lower in Group D at intraoperative times T6-T8 and T11-T12, as well as upon admission to the post-anaesthesia care unit (PACU) and 30 min after admission to the PACU. The results of the ANOVA tests revealed a significantly lower heart rate in Group D. The respiratory rate exhibited a notable decrease during time intervals T8 and T10 in the PF group.

Conclusion

The administration of dexmetatomidine and propofol-fentanyl during colonoscopy was found to be safe. In addition, dexmetatomidine may present significant benefits in this context because of its lower occurrence of adverse respiratory events.

Continuous infusion of intraoperative dexmedetomidine improves chronic pain after thoracotomy via the Toll-like receptor 4/nuclear factor kappa B signaling pathway

OBJECTIVES

To explore the role of continuous infusion of intraoperative dexmedetomidine in chronic pain after thoracotomy via the Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway.

METHODS

Seventy-five patients undergoing thoracotomy were randomized into the control group (CG, n=37) and the observation group (OG, n=38). After induction of anesthesia for 30 min and until the end of surgery, the OG was infused with 0.4 μg/(kg·h) dexmedetomidine, and the CG was infused with the same amount of normal saline.

RESULTS

After operation, the OG had lower mean arterial pressure, heart rate, visual analogue scale (VAS) scores, incidence of chronic pain and neuropathic pain, TLR4 and NF-κB expressions, and tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels as well as epinephrine and norepinephrine levels than the CG (P < 0.05). The number of times the patient pressed the button for pain medication and the dose administered in the OG were less than those in the CG (P < 0.05).

CONCLUSION

Continuous infusion of intraoperative dexmedetomidine can maintain perioperative hemodynamic stability in patients undergoing thoracotomy and reduce the stress response, postoperative pain, consumption of analgesic drugs, and the incidence of post-chronic and neuropathic pain, which is closely related to the reduction of inflammation via the TLR4/NF-κB signaling pathway.

Assessing the Antioxidant Activity of Dexmedetomidine by Measuring the Plasma Antioxidant Enzyme Activity of Catalase, Glutathione Peroxidase, and Superoxide Dismutase During Lumbar Spine Laminectomy

Background: Current knowledge on antioxidant properties of anesthetics is inconclusive. Nevertheless, experiments on different anesthesia-related drugs and techniques are growing. Objectives: The aim of this prospective blinded randomized study was to assess the effect of dexmedetomidine (Dex) infusion during anesthesia on oxidative stress resulting from lumbar laminectomy. Methods: The antioxidant activity of Dex compared to placebo (normal saline) was evaluated by measuring the antioxidant enzyme activity of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX). A total of 56 patients who underwent laminectomy surgery were allocated into two groups of intervention and control. Dex group received 0.6 µg.kg-1 dexmedetomidine infusion before induction of anesthesia over 15 minutes, followed by 0.4 µg.kg-1.hr-1 maintenance. Control group received the same volume and sequence of normal saline. Anesthesia protocol was similar in both groups. The antioxidant activity of the previously mentioned enzymes was measured at the beginning of the anesthesia (T1) and after surgery (T2). Propofol consumption, hemodynamic indices, shivering, bleeding volume, and pain numeric rating scale (NRS) were recorded. Results: Although the serum levels of CAT and GPX increased during the procedure, these changes were not significant (P-values 0.579 and 0.762, respectively). Also, the mean SOD level did not change over time in any of the groups, and it was not meaningfully different between the groups at any of the predetermined times (P-value 0.665). Conclusions: As expected, Dex decreased propofol consumption, mean heart rate, mean arterial pressure, and pain intensity allover the perioperative period. It seems that adding Dex to anesthesia regimen during laminectomy had no dominant antioxidant effects.

Effect of Different Factors on the Short-Term Outcome of Chinese Patients With Primary Chronic Subdural Hematoma at Different Age Groups: A Two-Center Retrospective Study

Background

The incidence of symptomatic chronic subdural hematoma (CSDH) is increasing in Chinese aging population, but its clinical and demographic knowledge is still lacking. This study sought to outline the clinical and demographic data of CSDH patients from two medical centers in Tianjin and Chongqing to provide a better understanding for CSDH treatment in China.

Methods

Age, sex, etiologies, conscious level on admission, treatment strategies, outcome at discharge, recurrence, and concomitant disease of enrolled patients were recorded. The data were further analyzed after the patients were sub-grouped into young/middle (less than 60 years old) and old (over than 60 years old) age groups.

Results

A total of 1281 CSDH patients were enrolled. Of these, 85.01% were male and 51.91% were aged between 60 and 80 years. 57.61% patients encountered head trauma before diagnosing CSDH. The top three clinical symptoms at admission were headache (58.55%), dyskinesia (36.92%), and dizziness (33.96%). Headache as well as dizziness often happened in young/middle age group, while dyskinesia often occurred in the old age group. The most common concomitant diseases were cardio-cerebrovascular system diseases (41.14%). The concomitant respiratory diseases in aged patients led to unfavorable outcomes (p = 0.049, OR:0.357). The prognosis of old age subgroup receiving conservative treatment was better than those who received burr-hole drainage treatment (p < 0.015, OR:4.091).

Conclusion

CSDH mostly occurs in aged and male population with a history a head trauma. The respiratory disease often results in unfavorable outcomes in aged patients. Conservative treatment might benefit some patients.