1
|
Chen H, Wang X, Zhang Y, Liu W, Zhou C, Zheng D. Effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery. Perioper Med (Lond) 2024; 13:42. [PMID: 38755633 PMCID: PMC11100160 DOI: 10.1186/s13741-024-00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE This research aimed to ascertain the effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery. METHODS Obese patients undergoing laparoscopic surgery under general anesthesia were separated into the control group (group C) and the dexmedetomidine group (group D) (n = 30). Patients in group D were infused with dexmedetomidine (1 μg/kg) intravenously for 10 min and then at a rate of 0.5 mg/kg h until 30 min before the end of the surgery, and those in group C were infused with an equal volume of saline. The surgery time points were divided into: before anesthesia induction (T0), 5 min after intubation (T1), 30 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum release (T3), at the time of extubation (T4), 3 min after extubation (T5), and 24 h after surgery (T6). Arterial blood was collected for blood gas analysis to record arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). Dynamic lung compliance (Cdyn), oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (A-aDO2), and respiratory index (RI) were calculated. The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation were recorded. Plasma IL-8 and IL-10 levels were measured from T0 to T6. RESULTS The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation in group D were not statistically significant when compared with those in group C. Versus at the T1 time point, A-aDO2 and RI were higher and Cdyn and OI were lower in both groups at T2 and T3 time points. Versus group C, group D had higher Cdyn and OI and lower A-aDO2 and RI at T2 and T3 time points. Versus at the T0 time point, at each time point from T1 to T6, IL-8 and IL-10 levels were higher in both groups. Versus group C, group D had lower IL-8 and higher IL-10 levels at each time point from T1 to T6. CONCLUSION In obese patients undergoing laparoscopic surgery under general anesthesia, the use of dexmedetomidine can improve the lung compliance and OI of the patients, inhibit the inflammatory response of the lungs of the patients and thus have a certain protective effect on the lung function.
Collapse
Affiliation(s)
- Huan Chen
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Xin Wang
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Yawen Zhang
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Wei Liu
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Changhao Zhou
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Deli Zheng
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
| |
Collapse
|
2
|
Liu Z, Xiong Y, Min J, Zhu Y. Dexmedetomidine improves lung injury after one-lung ventilation in esophageal cancer patients by inhibiting inflammatory response and oxidative stress. Toxicol Res (Camb) 2024; 13:tfae041. [PMID: 38617713 PMCID: PMC11007265 DOI: 10.1093/toxres/tfae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/16/2024] Open
Abstract
Aim To explore the effect of Dexmedetomidine (DEX) on lung injury in patients undergoing One-lung ventilation (OLV). Methods Esophageal cancer patients undergoing general anesthesia with OLV were randomly divided into the DEX group and control group, with 30 cases in each group. Mean arterial pressure (MAP), heart rate (HR), arterial partial pressure of oxygen (PO2), and arterial partial pressure of nitrogen dioxide (PCO2) were recorded at the time points after anesthesia induction and before OLV (T1), OLV 30 min (T2), OLV 60 min (T3), OLV 120 min (T4), OLV end before (T5) and before leaving the room (T6) in both groups. Reverse Transcription-Polymerase Chain Reaction (RT-qPCR) was applied to detect the levels of CC16 mRNA. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum CC16 protein levels. The content of malondialdehyde (MDA) in serum was determined by thio barbituric acid (TBA) method. ELISA was used to measure the concentrations of TNF-α (tumor necrosis factor-alpha)/and IL-6 (interleukin 6). Results DEX treatment slowed down HR at time points T1-T6 and increased PO2 and PCO2 at time points T2-T5 compared with the control group. Moreover, at time points T2-T6, DEX treatment reduced the levels of club cell secretory protein-16 (CC16) mRNA and serum CC16 protein levels. Furthermore, DEX treatment caused the reduction of MDA, TNF-α and IL-6 concentrations in serum of patients. Conclusion During the OLV process, DEX could reduce serum CC16 protein levels, inhibit inflammatory reactions and oxidative stress, and improve oxygenation index, indicating a protective effect on lung injury during OLV.
Collapse
Affiliation(s)
- Zhen Liu
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi Province 330006, P.R. China
| | - Yingfen Xiong
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi Province 330006, P.R. China
| | - Jia Min
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi Province 330006, P.R. China
| | - Yunsheng Zhu
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi Province 330006, P.R. China
| |
Collapse
|
3
|
Khddam A, Rostom F, Hajeer MY. Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial. Cureus 2024; 16:e56693. [PMID: 38523877 PMCID: PMC10958759 DOI: 10.7759/cureus.56693] [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] [Accepted: 03/21/2024] [Indexed: 03/26/2024] Open
Abstract
Background One-lung ventilation (OLV) is a common ventilation technique used during thoracic surgery. It can cause serious complications in children, and hypoxic pulmonary vasoconstriction (HPV) is a protective mechanism against the resulting hypoxia. Dexmedetomidine does not affect HPV, so we will investigate its impact on the partial pressure of oxygen in arterial blood (PaO2) and pulmonary shunt fraction (Qs/Qt). Methods Children who underwent OLV were divided into two equal groups. The Dex group received 0.4 μg/kg/h of dexmedetomidine intravenously. The placebo group received normal saline. Two blood samples were taken to analyze arterial and central venous blood gasses during four time periods: T1, 10 minutes after anesthesia; T2, 10 minutes after OLV; T3, 60 minutes after OLV; and T4, 20 minutes after the end of OLV. Heart rate, mean arterial pressure (MAP), PaO2, Qs/Qt, and peak inspiratory pressure (PIP) values were recorded at these time points. Results Regarding heart rate, the Dex group remained relatively stable, whereas the placebo group showed a slight increase in T3 and T4. Concerning MAP, the Dex group had a reduction at T1 compared with the placebo group and remained similar for other points. PaO2 decreased with OLV. However, the Dex group consistently maintained higher PaO2 values than the placebo, especially in T3 and T4. Concerning Qs/Qt, the Dex group maintained lower time values than the placebo group at OLV. Regarding PIP, the Dex group had significantly lower T2 and T3 than the placebo group. Conclusion Administration of dexmedetomidine in children with OLV improves PaO2 and reduces pulmonary shunt fraction (Qs/Qt), thereby improving oxygen transport. It reduces the maximum PIP values, thereby reducing pressure-related complications.
Collapse
Affiliation(s)
- Ayham Khddam
- Department of Anesthesia and Resuscitation, Children's Hospital, Damascus University, Damascus, SYR
| | - Faten Rostom
- Department of Anesthesia, Faculty of Medicine, Damascus University, Damascus, SYR
| | - Mohammad Y Hajeer
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, SYR
| |
Collapse
|
4
|
Yang L, Cai Y, Dan L, Huang H, Chen B. Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial. Korean J Anesthesiol 2023; 76:586-596. [PMID: 36924790 PMCID: PMC10718632 DOI: 10.4097/kja.22787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the pulmonary function of patients receiving OLV. METHODS The Embase, PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, and Chinese Clinical Trial Registry databases were systematically searched. The primary outcome was oxygenation index (OI). Other outcomes including the incidence of postoperative complications were assessed. RESULTS Fourteen randomized controlled trials involving 845 patients were included in this meta-analysis. Dexmedetomidine improved the OI at 30 (mean difference [MD]: 40.49, 95% CI [10.21, 70.78]), 60 (MD: 60.86, 95% CI [35.81, 85.92]), and 90 min (MD: 55, 95% CI [34.89, 75.11]) after OLV and after surgery (MD: 28.98, 95% CI [17.94, 40.0]) and improved lung compliance 90 min after OLV (MD: 3.62, 95% CI [1.7, 5.53]). Additionally, dexmedetomidine reduced the incidence of postoperative pulmonary complications (odds ratio: 0.44, 95% CI [0.24, 0.82]) and length of hospital stay (MD: -0.99, 95% CI [-1.25, -0.73]); decreased tumor necrosis factor-α, interleukin (IL)-6, IL-8, and malondialdehyde levels; and increased superoxide dismutase levels. However, only the results for the OI and IL-6 levels were confirmed by the sensitivity and trial sequential analyses. CONCLUSIONS Dexmedetomidine improves oxygenation in patients receiving OLV and may additionally decrease the incidence of postoperative pulmonary complications and shorten the length of hospital stay, which may be related to associated improvements in lung compliance, anti-inflammatory effects, and regulation of oxidative stress reactions. However, robust evidence is required to confirm these conclusions.
Collapse
Affiliation(s)
- Lin Yang
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongheng Cai
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Dan
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Chen
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Joe YE, Lee CY, Kim N, Lee K, Kang SJ, Oh YJ. Effect of permissive hypercarbia on lung oxygenation during one-lung ventilation and postoperative pulmonary complications in patients undergoing thoracic surgery: A prospective randomised controlled trial. Eur J Anaesthesiol 2023; 40:691-698. [PMID: 37455644 DOI: 10.1097/eja.0000000000001873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The effect of hypercarbia on lung oxygenation during thoracic surgery remains unclear. OBJECTIVE To investigate the effect of hypercarbia on lung oxygenation during one-lung ventilation in patients undergoing thoracic surgery and evaluate the incidence of postoperative pulmonary complications. DESIGN Prospective randomised controlled trial. SETTING A tertiary university hospital in the Republic of Korea from November 2019 to December 2020. PATIENTS Two hundred and ninety-seven patients with American Society of Anaesthesiologists physical status II to III, scheduled to undergo elective lung resection surgery. INTERVENTION Patients were randomly assigned to Group 40, 50, or 60. An autoflow ventilation mode with a lung protective ventilation strategy was applied to all patients. Respiratory rate was adjusted to maintain a partial pressure of arterial carbon dioxide of 40 ± 5 mmHg in Group 40, 50 ± 5 mmHg in Group 50 and 60 ± 5 mmHg in Group 60 during one-lung ventilation and at the end of surgery. MAIN OUTCOME MEASURES The primary outcome was the arterial oxygen partial pressure/fractional inspired oxygen ratio after 60 min of one-lung ventilation. RESULTS Data from 262 patients were analysed. The partial pressure/fractional inspired oxygen ratio was significantly higher in Group 50 and Group 60 than in Group 40 (269.4 vs. 262.9 vs. 214.4; P < 0.001) but was not significantly different between Group 50 and Group 60. The incidence of postoperative pulmonary complications was comparable among the three groups. CONCLUSION Permissive hypercarbia improved lung oxygenation during one-lung ventilation without increasing the risk of postoperative pulmonary complications or the length of hospital stay. TRIAL REGISTRATION NCT04175379.
Collapse
Affiliation(s)
- Young-Eun Joe
- From the Department of Anaesthesiology and Pain Medicine, and Anaesthesia and Pain Research Institute (Y-EJ, NK, KL, SJK, YJO) and Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea (CYL)
| | | | | | | | | | | |
Collapse
|
6
|
Zhao W, Li J, Wang N, Wang Z, Zhang M, Zhang H, Liu M, He J, Yu D. Effect of dexmedetomidine on postoperative nausea and vomiting in patients under general anaesthesia: an updated meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e067102. [PMID: 37527891 PMCID: PMC10394554 DOI: 10.1136/bmjopen-2022-067102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To explore the effect of dexmedetomidine (DEX) on postoperative nausea and vomiting (PONV) in adult patients after general anaesthesia. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials (RCTs) comparing the efficacy of DEX with placebo or a single drug on PONV in adult patients after general anaesthesia. DATA SOURCES We searched the PubMed, the Web of Science, the Cochrane Library and Embase (1 January 2000 to 30 June 2022) to select the relevant RCTs. DATA ANALYSIS All the relevant data were analysed by using RevMan V.5.4. Heterogeneity was tested for each outcome, and random-effect or fixed-effect models was selected according to the level of heterogeneity. The primary outcome was the incidence of PONV. The secondary outcomes were the incidence of bradycardia, perioperative opioid consumption, extubation time and the length of hospitalisation. RESULTS A total of 18 trials involving 2018 patients were included in this meta-analysis. Notably, 15 updated studies were not involved in the previous meta-analysis. The incidence of PONV in DEX group was lower than that in the control group (OR=0.49, 95% CI: 0.36 to 0.67) and the perioperative opioid consumption in DEX group was also decreased significantly (standard mean difference (SMD)=-1.04, 95% CI: -1.53 to -0.54). Moreover, the length of hospitalisation (SMD=-2.29, 95% CI: -4.31 to -0.28) and the extubation time (SMD=-0.75, 95% CI: -1.26 to -0.25) in DEX group were shorter. Whereas, more number of patients receiving DEX might increase the occurrence of bradycardia (OR=1.60, 95% CI: 1.13 to 2.27). CONCLUSIONS DEX could decrease the occurrence of PONV in adult patients under general anaesthesia and promote the recovery after surgery. However, DEX might increase the occurrence of bradycardia. PROSPERO REGISTRATION NUMBER CRD 42022341548.
Collapse
Affiliation(s)
- Weihong Zhao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Na Wang
- Department of Rheumatology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Zhibin Wang
- Department of Anesthesiology, The Fifth People's Hospital of Hengshui, Hengshui, Hebei Province, China
| | - Meng Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| |
Collapse
|
7
|
Zhao X, Song Q, Wang Y, Zhang Q, Sun C. Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33661. [PMID: 37083765 PMCID: PMC10118338 DOI: 10.1097/md.0000000000033661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The improvement of oxygenation and pulmonary mechanics in patients under general anesthesia can be achieved by dexmedetomidine (DEX) infusion. However, its role in patients undergoing lateral supine shoulder arthroscopy has not been thoroughly studied. This study aimed to evaluate the effect of DEX on lung compliance in patients undergoing shoulder arthroscopic surgery in a lateral decubitus position. METHODS The patients who underwent lateral recumbent shoulder arthroscopy under general anesthesia were randomly divided into the DEX group (group D) and the control group (group N). At the start of the trial, group D was given 0.5 μg/kg/hours continuous pumping until 30 minutes before the end of anesthesia; Group N was injected with normal saline at the same volume. The patients were recorded at each time point after intubation: supine position for 5 minutes (T0), lateral position for 5 minutes (T1), lateral position for 1 hour (T2), lateral position for 2 hours (T3), airway peak pressure, platform pressure, dynamic lung compliance, and static lung compliance, etc. RESULTS At the end of the drug infusion, the DEX group showed significant improved pulmonary mechanics and higher lung compliance than the control group. Compared with group N, group D's heart rate and mean arterial pressure were lower at all time points; there was no statistical difference in Tidal volume and Pressure end-tidal carbon dioxide data at each time point in Group D. CONCLUSION DEX can improve lung compliance and reduce airway pressure and platform pressure of patients undergoing shoulder arthroscopy in the lateral position under general anesthesia.
Collapse
Affiliation(s)
- Xiujie Zhao
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Qianqian Song
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Yewen Wang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Chao Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| |
Collapse
|
8
|
Ke HH, Liou JY, Teng WN, Hsu PK, Tsou MY, Chang WK, Ting CK. Opioid-sparing anesthesia with dexmedetomidine provides stable hemodynamic and short hospital stay in non-intubated video-assisted thoracoscopic surgery: a propensity score matching cohort study. BMC Anesthesiol 2023; 23:110. [PMID: 37013487 PMCID: PMC10069055 DOI: 10.1186/s12871-023-02032-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted thoracic surgery (VATS) may reduce opioid-related complications such as postoperative nausea and vomiting (PONV), dyspnea, constipation, dizziness, skin itching, and cause minimal respiratory depression, and stable hemodynamic status. METHODS Patients who underwent non-intubated VATS lung wedge resection with propofol combined with dexmedetomidine (group D) or alfentanil (group O) between December 2016 and May 2022 were enrolled in this retrospective propensity score matching cohort study. Intraoperative vital signs, arterial blood gas data, perioperative results and treatment outcomes were analyzed. Of 100 patients included in the study (group D, 50 and group O, 50 patients), group D had a significantly lower degree of decrement in the heart rate and the blood pressure than group O. Intraoperative one-lung arterial blood gas revealed lower pH and significant ETCO2. The common opioid-related side effects, including PONV, dyspnea, constipation, dizziness, and skin itching, all of which occurred more frequently in group O than in group D. Patients in group O had significantly longer postoperative hospital stay and total hospital stay than group D, which might be due to opioid-related side effects postoperatively. CONCLUSIONS The application of dexmedetomidine in non-intubated VATS resulted in a significant reduction in perioperative opioid-related complications and maintenance with acceptable hemodynamic performance. These clinical outcomes found in our retrospective study may enhance patient satisfaction and shorten the hospital stay.
Collapse
Affiliation(s)
- Hui-Hsuan Ke
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jing-Yang Liou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Nung Teng
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Hsu
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Kun Ting
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
| |
Collapse
|
9
|
Zhang W, Wang R, Li B, Zhao Y, Liu X, Yuan J. The Effect of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients Undergoing Thoracic Surgery-A Meta-Analysis of a Randomized Controlled Trial. Front Surg 2022; 9:863249. [PMID: 35433815 PMCID: PMC9008250 DOI: 10.3389/fsurg.2022.863249] [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: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dexmedetomidine reduces the occurrence of postoperative nausea and vomiting (PONV); however, the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery remains inconclusive. In addition, the effect of different dexmedetomidine application methods, anesthetics, and surgical procedures on the effects of dexmedetomidine on PONV remains unclear. Therefore, the purpose of this meta-analysis was to study the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery. Methods Electronic databases were searched to identify randomized controlled trials studying the effects of dexmedetomidine on nausea and vomiting after thoracic surgery. In total, 12 articles that met the inclusion criteria were obtained. The primary outcome of this comprehensive analysis was the incidence of PONV; secondary outcomes included the incidence of postoperative nausea, the incidence of postoperative vomiting, postoperative visual analog score (VAS), the amount of intraoperative sufentanil, and the number of times postoperative salvage analgesia was administered. Results Twelve trials involving 905 participants undergoing thoracic surgery were included. Compared with placebo, dexmedetomidine reduced the incidence of nausea and vomiting after thoracic surgery [12 trials; 905 participants; risk ratio (RR) = 0.32; 95% CI (0.23, 0.44); P < 0.00001, I2 = 0%]. The subgroup analysis revealed that dexmedetomidine reduces the occurrence of PONV in both thoracotomy and thoracoscopic surgery. In addition, both intravenous and local infusion of dexmedetomidine can reduce the occurrence of PONV, and intravenous or inhaled anesthetics do not affect the effect of dexmedetomidine on reducing PONV. Dexmedetomidine can reduce the postoperative resting VAS of patients, and no statistically significant differences in the amount of intraoperative sufentanil and the number of salvage analgesia procedures after surgery were noted. Conclusion Compared with placebo, dexmedetomidine can reduce the occurrence of PONV in patients undergoing thoracic surgery, and this effect is not affected by the method of dexmedetomidine administration, use of minimally invasive surgery, and use of a combination of intravenous or inhalation anesthetics. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, PROSPERO, identifier: CRD42021269358.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ruohan Wang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Zhao
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinmin Liu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingli Yuan
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| |
Collapse
|
10
|
Yousefian M, Mohammadian Erdi A, Haghshenas N. A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage. Anesth Pain Med 2022; 11:e121527. [PMID: 35291404 PMCID: PMC8909531 DOI: 10.5812/aapm.121527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Dilatation and curettage (D & C) is one of the relatively common surgeries among women. Familiarity with the analgesics, along with their different uses and specific characteristics, can help to determine the best and most appropriate drug to control pain in the patients. Objectives This study aimed to compare the effects of ketofol, dexmedetomidine, and isofol in anesthesia of candidates for D & C. Methods In this double-blind clinical trial, 150 candidates for D & C surgeries with ASA class 1 and 2 were included. Patients were randomly divided into three groups. The first group received ketamine + propofol, the second group received dexmedetomidine, and the third group received isofol (isoflurane + propofol). Any hemodynamic changes or respiratory disorders, including apnea or hypoventilation, drop in the level of blood oxygen saturation, and the need for respiratory support, were recorded and compared. Results Hypoventilation was observed in 47 patients in isofol group, 18 in the dexmedetomidine group, and 42 in ketofol group. Also, 48 patients in the isofol group, eight in the dexmedetomidine group, and 33 in the ketofol group experienced apnea. Moreover, 17 patients in the dexmedetomidine group, 35 in the ketofol group, and eight in the isofol group experienced bradycardia. The rate of bradycardia was significantly higher in the dexmedetomidine group (70%) compared to the other two groups, and the rate of hypotension was significantly higher in the isofol group (P = 0.001). Conclusions According to the results, dexmedetomidine was associated with fewer complications during general anesthesia in D & C surgery.
Collapse
Affiliation(s)
- Mahzad Yousefian
- Department of Anesthesiology, Alavi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
- Corresponding Author: Department of Anesthesiology, Alavi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Ali Mohammadian Erdi
- Department of Anesthesiology, Alavi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Negin Haghshenas
- Department of Anesthesiology, Alavi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
11
|
Eghtedari F, Fooladi S, Mohammadian Erdi A, Shadman A, Yousefian M. Investigating the Effect of Expiratory Time Constant on Outcome in Intubated Patients with Acute Respiratory Failure Caused by COVID-19 in Critical Care Unit: A Research Study. Anesth Pain Med 2021; 11:e119572. [PMID: 35291411 PMCID: PMC8908787 DOI: 10.5812/aapm.119572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/23/2021] [Accepted: 11/27/2021] [Indexed: 01/24/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has a high prevalence and mortality worldwide. Thousands of patients with acute respiratory failure caused by COVID-19 are daily hospitalized in intensive care units (ICUs) around the world. Many of these patients require full mechanical respiratory support and long-term ventilator use. Using different ventilators and calculating important variables can be helpful in meeting therapeutic needs of patients. Objectives The aim of present study was to investigate the effect of expiratory time constant (RCEXP) on the course of treatment and duration of mechanical ventilation in patients with acute respiratory failure hospitalized in ICU. Methods The present cross-sectional study was conducted on 60 patients with acute respiratory failure who were hospitalized in the ICU and underwent mechanical ventilation due to COVID-19 in the first six months of 2020. The variables of RCEXP, lung compliance and lung resistance in all patients were recorded daily and analyzed. Then, based on clinical outcome, the patients were divided into two groups: the patients with wean outcome (N = 40) and those with death outcome (N = 20). Results The mean ± SD of lung compliance in patients who were separated from ventilator and patients with death outcome were 74.73 (18.58) mL/cm H2O and 36.92 (10.56) mL/cm H2O, respectively, which was statistically significant (P = 0.001). The mean ± SD of lung resistance in patients who were separated from ventilator and patients with death outcome were calculated at 9.25 (4.62) and 14 (6.5), respectively, which was statistically significant (P = 0.015). Also, there was a statistically significant difference between the two groups in terms of mean ± SD of RCEXP (0.67 (0.23) vs. 0.49 (0.19), P = 0.010). Conclusions According to the results of this study, there was a significant difference between high resistance, low compliance, RCEXP, and weaning success of intubation in patients hospitalized in the ICU.
Collapse
Affiliation(s)
- Fatemeh Eghtedari
- Department of Anesthesiology, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran
| | - Shahnaz Fooladi
- Department of Anesthesiology, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran
| | - Ali Mohammadian Erdi
- Department of Anesthesiology, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran
| | - Atefeh Shadman
- Determinations of Health Research Center, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran
| | - Mahzad Yousefian
- Department of Anesthesiology, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran
- Corresponding Author: Department of Anesthesiology, School of Medicine, Adabil University of Medical Scienes, Ardabil, Iran.
| |
Collapse
|
12
|
Ghomeishi A, Mohtadi AR, Behaeen K, Nesioonpour S, Bakhtiari N, Khalvati Fahlyani F. Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery. Anesth Pain Med 2021; 11:e119446. [PMID: 35075417 PMCID: PMC8782195 DOI: 10.5812/aapm.119446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 12/19/2022] Open
Abstract
Background General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient. Objectives The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. Methods Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method. Results Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001). Conclusions Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.
Collapse
Affiliation(s)
- Ali Ghomeishi
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Mohtadi
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kaveh Behaeen
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sholeh Nesioonpour
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nima Bakhtiari
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Farzad Khalvati Fahlyani
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
13
|
Hadipourzadeh F, Mousavi S, Heydarpur A, Sadeghi A, Ferasat-Kish R. Evaluation of the Adding Paracetamol to Dexmedetomidine in Pain Management After Adult Cardiac Surgery. Anesth Pain Med 2021; 11:e110274. [PMID: 34540629 PMCID: PMC8438704 DOI: 10.5812/aapm.110274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/29/2021] [Accepted: 05/30/2021] [Indexed: 12/30/2022] Open
Abstract
Background Postoperative pain control after cardiac surgery is usually based on Opioids. These drugs are associated with side effects, and the use of drugs with fewer side effects is important for analgesia. Dexmedetomidine and paracetamol have fewer side effects than opioids. Objectives The aim of the study was to evaluate the adding paracetamol to dexmedetomidine continuous infusion pump for pain management after adult cardiac surgery. Methods In this study, 100 patients were divided into two groups. One group received a continuous infusion of dexmedetomidine and paracetamol (DP), and the other received dexmedetomidine (D). These two groups were evaluated for MAP, HR, and the need for prescribing opioids before and after extubation. Also, duration of intubation and pain before extubation and 36 hours after every 4 hours. Results Patients in the DP group had lower mean MAP and HR during intubation period than the D group and needed fewer opioids and doses of opioids in addition to drug study infusion pre- (P = 0.001) and post-extubation (P = 0.001 and P = 0.022, respectively). The DP group patients were extubated earlier (P = 0.001). After extubation, the DP group had less pain than the D group. Conclusions This study showed that adding paracetamol to the dexmedetomidine infusion pump can provide better analgesia.
Collapse
Affiliation(s)
- Fatemehshima Hadipourzadeh
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Street, Tehran, Iran. Tel: +98-2123923740, Fax:+98-21 22663293,
| | - SeyedMehdi Mousavi
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Avaz Heydarpur
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghi
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Ferasat-Kish
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Elsonbaty M, Abdullah S, Elsonbaty A. Lung Ultrasound Assisted Comparison of Volume Effects of Fluid Replacement Regimens in Pediatric Patients Undergoing Penile Hypospadias Repair: A Randomized Controlled Trial. Anesth Pain Med 2021; 11:e115152. [PMID: 34540641 PMCID: PMC8438712 DOI: 10.5812/aapm.115152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Effective perioperative fluid therapy is a great consideration. Objectives Using lung ultrasound (LUS), this study evaluated the preference of the conventional and restrictive fluid replacement regimens for their volume impact in pediatric patients undergoing a relatively long procedure with limited volume loss (hypospadias repair). Methods Eighty pediatric patients scheduled for hypospadias repair surgery were enrolled for conventional (CG) or restrictive fluid management groups (RG). The CG obtained Ringer's lactate at the conventional calculated doses, while the RG obtained infusion of Ringer's lactate at a rate of 3 mL/kg/h. B-line numbers in the LUS, recovery score, urine output, blood pressure (BP), heart rate HR, and oxygen saturation (SpO2) were recorded. Results As evidenced by the LUS, RG showed a higher incidence of normal lung morphology with a mean and SD of 1.3 ± 2.2 for B-line numbers, whereas, in CG, they were 3.1 ± 2.2 with a P-value < 0.001. Urine output was 3.2 ± 0.8 and 2.9 ± 0.7 for CG and RG, respectively, with a P-value equal to 0.07. HR, BP, and SpO2 differences between groups were statistically insignificant. The recovery score was higher in RG (5.8 ± 0.4) than in CG (5.1 ± 0.8) at the first postoperative 20 minutes, with a P-value < 0.001. Conclusions In lengthy procedures with limited volume loss, using a moderately restrictive regimen is preferred over the conventional intraoperative fluid regimen considering both respiratory dysfunctions and recovery score.
Collapse
Affiliation(s)
- Mohamed Elsonbaty
- Anesthesiology Department, Faculty of Medicine of Cairo University, Cairo, Egypt
| | - Sherif Abdullah
- Lecturer of Anesthesia, Anesthesiology Department, Faculty of Medicine of Cairo University, Cairo, Egypt
- Corresponding Author: Lecturer of Anesthesia, Anesthesiology Department, Faculty of Medicine of Cairo University, 12511, Cairo, Egypt.
| | - Ahmed Elsonbaty
- Lecturer of Anesthesia, Anesthesiology Department, Faculty of Medicine of Cairo University, Cairo, Egypt
| |
Collapse
|
15
|
Soltani F, Tabatabaei S, Jannatmakan F, Nasajian N, Amiri F, Darkhor R, Moravej M. Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit. Anesth Pain Med 2021; 11:e113802. [PMID: 34540634 PMCID: PMC8438711 DOI: 10.5812/aapm.113802] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.
Collapse
Affiliation(s)
- Farhad Soltani
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedkamalaldin Tabatabaei
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farahzad Jannatmakan
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nozar Nasajian
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fereshteh Amiri
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roya Darkhor
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | |
Collapse
|
16
|
Ibrahim IM, Hassan R, Mostafa RH, Ibrahim MA. Efficacy of Dexmedetomidine Infusion Without Loading Dose on Hemodynamic Variables and Recovery Time During Craniotomy: A Randomized Double-blinded Controlled Study. Anesth Pain Med 2021; 11:e113410. [PMID: 34336625 PMCID: PMC8314083 DOI: 10.5812/aapm.113410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Maintaining hemodynamic stability during intracranial surgery is one of the most important tasks. There is no general agreement regarding which anesthetics are optimal for craniotomy. Propofol and short-acting opioids are usually used, but their use is not without side effects. Recently, dexmedetomidine has been considered a safe alternative in different surgeries. Objectives We aimed to assess the efficacy of 0.5 µg/kg/h dexmedetomidine infusion without loading dose as an adjunct to general anesthesia for craniotomy. Methods A prospective, randomized, double-blinded, parallel-group, placebo-controlled trial was conducted. Setting: Single university teaching hospital’s operating rooms and postoperative intensive care unit. Patients: A total of 50 patients scheduled for elective supratentorial craniotomy participated in this study. Interventions: Patients were randomly divided into either control group (group C) and Dexmedetomidine group (group D). Main outcome measure: Intraoperative hemodynamics measurements at specific timings. Results We found that dexmedetomidine had significantly maintained mean arterial blood pressure and heart rate (P-value < 0.001); with lower intraoperative fentanyl and propofol consumption in group D (132 ± 35 µg and 14 ± 30 mg, respectively) when compared to group C (260 ± 38 µg and 534 ± 66 mg, respectively). Finally, a lesser sedation level was noticed in the dexmedetomidine group, together with a significantly lesser recovery time of 10.3 ± 4 min. Conclusions Dexmedetomidine infusion without loading dose could be an efficacious and safe agent in achieving hemodynamic stability with intraoperative opioid-sparing effect and lesser recovery time.
Collapse
Affiliation(s)
- Ismail Mohammed Ibrahim
- Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Hassan
- Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Raham Hasan Mostafa
- Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Corresponding Author: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Mayada Ahmed Ibrahim
- Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
17
|
Zhu L, Zhang Y, Zhang Z, Ding X, Gong C, Qian Y. Activation of PI3K/Akt/HIF-1α Signaling is Involved in Lung Protection of Dexmedetomidine in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Pilot Study. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:5155-5166. [PMID: 33262576 PMCID: PMC7699453 DOI: 10.2147/dddt.s276005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Background Lung resection and one lung ventilation (OLV) during video-assisted thoracoscopic surgery (VATS) may lead to acute lung injury. Dexmedetomidine (DEX), a highly selective α2 adrenergic receptor agonist, improves arterial oxygenation in adult patients undergoing thoracic surgery. The aim of this pilot study was to explore possible mechanism related to lung protection of DEX in patients undergoing VATS. Patients and Methods Seventy-four patients scheduled for VATS were enrolled in this study. Three timepoints (before anesthesia induction (T0), 40 min after OLV (T1), and 10 min after two-lung ventilation (T2)) of arterial blood gas were obtained. Meanwhile, lung histopathologic examination, immunohistochemistry analysis (occludin and ZO-1), levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in lung tissue and plasma, and activation of phosphoinositide-3-kinase (PI3K)/AKT/hypoxia-inducible factor (HIF)-1α signaling were detected. Postoperative outcomes including duration of withdrawing the pleural drainage tube, length of hospital stay, hospitalization expenses, and postoperative pulmonary complications (PPCs) were also recorded. Results Sixty-seven patients were randomly divided into DEX group (group D, n=33) and control group (group N, n=34). DEX improved oxygenation at T1 and T2 (group D vs group N; T1: 191.8 ± 49.8 mmHg vs 159.6 ± 48.1 mmHg, P = 0.009; T2: 406.0 mmHg [392.2–423.7] vs 374.5 mmHg [340.2–378.2], P = 0.001). DEX alleviated the alveolar capillary epithelial structure damage, increased protein expression of ZO-1 and occludin, inhibited elevation of the expression of TNF-α and IL-6 in lung tissue and plasma, and increased protein expression of p-PI3K, p-AKT and HIF-1α. Dex administered had better postoperative outcomes with less risk of PPCs and hospitalization expenses as well as shorter duration of withdrawing the pleural drainage tube and length of hospital stay. Conclusion Activation of PI3K/Akt/HIF-1α signaling might be involved in lung protection of DEX in patients undergoing VATS.
Collapse
Affiliation(s)
- Linjia Zhu
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yang Zhang
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Zhenfeng Zhang
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Xiahao Ding
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Chanjuan Gong
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yanning Qian
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, People's Republic of China
| |
Collapse
|