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Bhalotra AR, Arya M, Singh R, Dhiman S. Comparative evaluation of nebulized versus intravenous dexmedetomidine on intubating conditions during awake fiberoptic nasotracheal intubation. J Clin Anesth 2024; 95:111461. [PMID: 38604048 DOI: 10.1016/j.jclinane.2024.111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/17/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND There is a search for an ideal agent to facilitate awake fiberoptic intubation (AFOI). Dexmedetomidine is a selective α2 agonist which can be administered through intravenous, intramuscular, buccal, intranasal & inhalational routes. It provides good intubation conditions without oxygen desaturation but may cause hypotension and bradycardia when administered intravenously. Hence, alternative routes of administering dexmedetomidine which may improve its safety profile are worth exploring. METHODS In this randomised, controlled, double-blind trial, 46 ASA I/II adult participants scheduled for elective ENT surgery were randomly allocated to Group ND (Nebulised Dexmedetomidine) (n = 23) to receive nebulisation with dexmedetomidine 1μg.kg-1 and Group ID (Intravenous Dexmedetomidine) (n = 23) to receive intravenous dexmedetomidine 1μg.kg-1 before AFOI. All the patients received injection midazolam 1 mg i.v. as premedication before anaesthesia was initiated. The primary outcome was the cough score. The secondary outcomes were the RSS, SAYGO boluses, post-intubation score, hemodynamic parameters, recall of the procedure, patient satisfaction score and any side effects. RESULTS The cough score was significantly lower in nebulized group (2.43 ± 0.992 vs 3.52 ± 1.082) with p = 0.001. RSS(3.30 ± 0.926 vs 4.22 ± 1.126; p = 0.004), number of SAYGO boluses required (2.74 ± 0.864 vs 3.57 ± 1.161; p = 0.009) & the post intubation score (1.48 ± 0.593 vs 2.17 ± 0.778; p = 0.001) were also significantly lower in nebulized group. CONCLUSIONS Nebulisation with dexmedetomidine results in desirable degree of sedation and better tolerance of the procedure with adequate attenuation of the haemodynamic responses to intubation.
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Affiliation(s)
- Anju Romina Bhalotra
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Mona Arya
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Shweta Dhiman
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
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Peganc Nunčič K, Neubauer D, Oražem Mrak J, Perković Benedik M, Mahne U, Bizjak N, Rener Primec Z, Šuštar N, Butenko T, Vrščaj E, Osredkar D. Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography. Front Pediatr 2024; 12:1362918. [PMID: 38725985 PMCID: PMC11079286 DOI: 10.3389/fped.2024.1362918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
Background and objectives In children requiring electroencephalography (EEG), sleep recording can provide crucial information. As EEG recordings during spontaneous sleep are not always possible, pharmacological sleep-inducing agents are sometimes required. The aim of the study was to evaluate safety and efficacy of melatonin (Mel) and dexmedetomidine (Dex; intranasal and sublingual application) for sleep induction prior to EEG. Methods In this prospective randomized study, 156 consecutive patients aged 1-19 years were enrolled and randomized by draw into melatonin group (Mel; n = 54; dose: 0.1 mg/kg), dexmedetomidine (Dex) sublingual group (DexL; n = 51; dose: 3 mcg/kg) or dexmedetomidine intranasal group (DexN; n = 51; dose: 3 mcg/kg). We compared the groups in several parameters regarding efficacy and safety and also carried out a separate analysis for a subgroup of patients with complex behavioral problems. Results Sleep was achieved in 93.6% of participants after the first application of the drug and in 99.4% after the application of another if needed. Mel was effective as the first drug in 83.3% and Dex in 99.0% (p < 0.001); in the subgroup of patients with complex developmental problems Mel was effective in 73.4% and Dex in 100% (p < 0.001). The patients fell asleep faster after intranasal application of Dex than after sublingual application (p = 0.006). None of the patients had respiratory depression, bradycardia, desaturation, or hypotension. Conclusions Mel and Dex are both safe for sleep induction prior to EEG recording in children. Dex is more effective compared to Mel in inducing sleep, also in the subgroup of children with complex behavioral problems. Clinical Trial Registration Dexmedetomidine and Melatonin for Sleep Induction for EEG in Children, NCT04665453.
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Affiliation(s)
- Katja Peganc Nunčič
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Neubauer
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Oražem Mrak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Urška Mahne
- Department of Pediatric Intensive Care, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neli Bizjak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zvonka Rener Primec
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Šuštar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tita Butenko
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eva Vrščaj
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
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Saxena P, Gill RK, Saroa R, Sidhu B, Alen J, Sood P. Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study. Saudi J Anaesth 2024; 18:31-39. [PMID: 38313724 PMCID: PMC10833030 DOI: 10.4103/sja.sja_391_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 02/06/2024] Open
Abstract
Background Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo.
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Affiliation(s)
- Puja Saxena
- Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India
| | - Ravneet Kaur Gill
- Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India
| | - Richa Saroa
- Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Bharti Sidhu
- Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India
| | - John Alen
- Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India
| | - Parul Sood
- Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India
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Chandrasekar S, Dwibedi B, Das RR, Padhy BM, Behera BK. Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial. Eur J Pediatr 2023; 182:1385-1391. [PMID: 36658444 PMCID: PMC9851899 DOI: 10.1007/s00431-022-04794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
The purpose of this study was to compare the efficacy of oral triclofos (TRI), intranasal midazolam (INM), and intranasal dexmedetomidine (IND) in achieving successful sedation in children undergoing MRI. This open-label, three-arm, randomized trial was conducted in a tertiary care teaching hospital over 18-month period. Children scheduled for MRI were enrolled. Rate of successful/adequate sedation was assessed using the Paediatric Sedation State Scale (PSSS). The primary outcome was the efficacy (successful sedation or sedation rate) of the three drugs. One-hundred and ninety-five children were included for the MRI procedure. IND was found to be superior in terms of achieving successful sedation. INM had a shorter onset and duration of sedation compared to IND and TRI, but with an increased failure rate (88.3%). Keeping INM as the reference group, it was found that the odds of sedation increased 4.1 times on changing from INM to IND (p < 0.01), and 2.26 times on changing from INM to TRI (p < 0.01). Adverse events included nasal discomfort (18.3%) in INM group; and self-limited tachycardia (4.6%) and hypotension (10.8%) in the IND group. CONCLUSION IND was more efficacious than INM or TRI for procedural sedation in children undergoing MRI without any significant adverse events. CLINICAL TRIAL REGISTRATION CTRI/2019/01/017257; date registered: 25/01/2019. WHAT IS KNOWN • Oral triclofos (TRI) and intranasal midazolam (INM) have been used for procedural sedation in children undergoing MRI with variable success; but the experience with intranasal dexmedetomidine (IND) is limited. WHAT IS NEW • IND provides more effective sedation compared to INM or TRI for procedural sedation in children undergoing MRI, without any significant adverse events.
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Affiliation(s)
- Shyam Chandrasekar
- Department of Pediatrics, Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India
| | - Bhagirathi Dwibedi
- Department of Pediatrics, Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India.
| | - Rashmi Ranjan Das
- Department of Pediatrics, Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India
| | - Biswa Mohan Padhy
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India
| | - Bikram Kishore Behera
- Department of Anesthesia & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India
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Hommuang K, Sattasathuchana P, Thengchaisri N. Effects of intranasal and intramuscular dexmedetomidine in cats receiving total intravenous propofol anesthesia. Vet World 2022; 15:1706-1713. [PMID: 36185505 PMCID: PMC9394123 DOI: 10.14202/vetworld.2022.1706-1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: The efficacy of intranasal (IN) dexmedetomidine in cats as a premedication remains elusive. Thus, this study aimed to compare the perioperative and sparing effects of IN and intramuscular (IM) dexmedetomidine administration on propofol requirements for anesthetic induction in cats. Materials and Methods: This study randomly assigned 16 cats into two groups of IN or IM dexmedetomidine at 20 μg/kg. Sedation scores and side effects were recorded at time points of 0, 5, 10, 15, and 20 min after the dexmedetomidine administration. Anesthesia was induced with intravenous (IV) 1% propofol by titrating a bolus of 2 mg every 45 s and the total dose of the administered IV propofol to achieve endotracheal intubation was recorded. Results: Cats receiving IM dexmedetomidine were significantly associated with higher sedation scores. All cats were sedated at 20 min after premedication; however, the average composite sedation scores in the IN group were significantly lower than those in the IM group during premedication. Pre-operative side effects, including vomiting, were more frequently observed in the IN group (5 cats, 62.5%) than in the IM group (3 cats, 37.5%; p < 0.05). Higher body temperature (>1°F compared to baseline) was more frequently observed in the IN group (6 cats, 75.0%) than in the IM group (1 cat, 12.5%; p < 0.05). The dosage of required propofol in the IN group was significantly higher (1.1 ± 0.3 mg/kg) than that in the IM group (0.7 ± 0.2 mg/kg; p < 0.05). The duration of general anesthesia was comparable between the groups. Conclusion: IN dexmedetomidine produces moderate sedation and cats may have side effects, including vomiting and higher body temperature. Higher sparing effects of propofol were identified in the IM group compared with the IN group. Nonetheless, IN administration of dexmedetomidine provides a noninvasive alternative to the IM route.
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Affiliation(s)
- Kewvaree Hommuang
- Department of Companion Animal Clinical Science, Graduate Student in Veterinary Clinical Studies, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Panpicha Sattasathuchana
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand; Tippimarn Veterinary Hospital, Chulabhorn Royal Academy, Nakhon Ratchasima, Thailand
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Abstract
OBJECTIVE To improve success rates of children requiring sedation for MRI. METHODS Audits of sedation success for children attending planned MRI using three different approaches: (1) National Institute for Health and Care Excellence (NICE) guidance (chloral hydrate if <15 kg and oral midazolam if ≥15 kg), (2) Chloral hydrate for all patients, (3) Chloral hydrate±intranasal dexmedetomidine if <15 kg and intranasal dexmedetomidine alone if ≥15 kg. RESULTS 74 patients had 85 MRI scan attempts. Overall success rates were significantly higher when using intranasal dexmedetomidine compared with following NICE guidance (81% vs 52% p=0.017). Dexmedetomidine performed better than oral midazolam for the same indication (76% vs 33% p=0.026). The side effect profile for dexmedetomidine was as reported in larger studies. CONCLUSIONS Intranasal dexmedetomidine is an effective alternative to oral midazolam for sedation for MRI and as a rescue medication where chloral hydrate has been ineffective.
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Affiliation(s)
- Thomas J Jackson
- Paediatrics, North Middlesex University Hospital, London, UK .,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Deborah Dawes
- Paediatrics, North Middlesex University Hospital, London, UK
| | - Shaista Ahmad
- Pharmacy, North Middlesex University Hospital, London, UK
| | - Darren Martin
- Pharmacy, North Middlesex University Hospital, London, UK
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