Dexmedetomidine decreased the post-thyroidectomy bleeding by reducing cough and emergence agitation - a randomized, double-blind, controlled study

Effect-site concentrations of remifentanil for smooth emergence from combined epidural-general anesthesia or general anesthesia in patients using video double-lumen tube: A randomized trial

Objective

The present study aimed to determine the effect-site concentration of remifentanil of 90% (EC90) for smooth emergence in patients with a video DLT (VDLT) under sevoflurane-maintained general anesthesia and to investigate whether the EC90 was affected by epidural anesthesia.

Methods

One hundred and twenty patients who underwent video-assisted thoracic surgery (VATS) were enrolled. Patients received either general anesthesia combined with epidural anesthesia (PEA group, n = 60) or general anesthesia (GA group, n = 60). The primary outcome was the EC90 for smooth emergence in both groups. The secondary outcomes were intraoperative emergence, smooth emergence, recovery, and hemodynamic profiles in both groups.

Result

The EC90 values for smooth emergence in patients using VDLT were 3.5 ng/ml (95% confidence interval [CI], 3.3-4.4 ng/ml) in the PEA group and 2.7 ng/ml (95% CI, 2.5-3.2 ng/ml) in the GA group. The total amount of remifentanil infusion during emergency was significantly higher in the PEA group (164.6 ± 47.9 μg) than in the GA group (127.1 ± 30.4 μg) (P < 0.001). The number of patients who experienced hypotension during emergency in the PEA group was higher than that in the GA group (46.7% versus 13.3%, P < 0.001).

Conclusion

The EC90 of remifentanil for smooth emergence in patients with VDLT under general anesthesia combined with epidural anesthesia (3.5 ng/ml) was higher than that under general anesthesia (2.7 ng/ml).

Trial registration

Chinese Clinical Trial Registry, ChiCTR2100054230.

Sugammadex and blood loss during cervical spine fusion surgery

Background and Aims

Sugammadex (SUG) has been associated with changes in coagulation studies. Most reports have concluded a lack of clinical significance based on surgical blood loss with SUG use at the end of surgery. Previous reports have not measured its use intraoperatively during ongoing blood loss. Our hypothesis was that the use of SUG intraoperatively may increase bleeding.

Material and Methods

This was a single site retrospective study. Inclusion criteria were patients undergoing a primary posterior cervical spine fusion, aged over 18 years, between July 2015 and June 2021. The primary outcomes compared were intraoperative estimated blood loss (EBL) and postoperative drain output (PDO) between patients receiving SUG, neostigmine (NEO) and no NMB reversal agent. The objective was to determine if there was a difference in primary endpoints between patients administered SUG, NEO or no paralytic reversal agent. Primary endpoints were compared using analysis of variance with a P value of 0.05 used to determine statistical significance. Groups were compared using the Chi-squared test, rank sum or student's t test. A logistic regression model was constructed to account for differences between the groups.

Results

There was no difference in median EBL or PDO between groups. The use of SUG was not associated with an increase in odds for >500 milliliters (ml) of EBL. Increasing duration of surgery and chronic kidney disease were both associated with an increased risk for EBL >500 ml.

Conclusion

Intraoperative use of SUG was not associated with increased bleeding. Any coagulation laboratory abnormalities previously noted did not appear to have an associated clinical significance.

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review

BACKGROUND

Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation.

METHODS

This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool.

RESULTS

Six RCTs and 1 non-randomized controlled study were included in this systematic review (N = 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and re-intubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias.

CONCLUSIONS

The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.

Global Research and Scientific Publications on Dexmedetomidine Use in Adults for Anesthesia Care between 2001 and 2021: A Bibliometric Analysis

Background

An increasing number of studies on dexmedetomidine use in adults have been published, but the effectiveness of dexmedetomidine remains contentious.

Objective

This study aimed to describe the changing trends and structural relationships of scientific achievements regarding dexmedetomidine over the past 2 decades and provide researchers with information to help them explore better research opportunities.

Methods

Quantitative data of publications were retrieved from the Scopus database. Analyses of co-occurrence and collaboration among authors, countries, and key words were conducted using VOSviewer 1.6.17 software. Weighted occurrence and average publications per year were calculated.

Results

The 1868 publications retrieved showed an increasing trend of annual publications on dexmedetomidine use in adults between 2001 and 2021. China accounted for the largest contribution to publications in the world (n = 577 [30.89%]). Four key word clusters indicating research hotspots were identified using VOSviewer. The number of articles published in the top 10% of journals in the United States was the highest among all publications from the country (97 out of 201 [48.26%]). Journals from the United Kingdom obtained the highest CiteScore (16.56). Journal of Anaesthesiology Clinical Pharmacology published the highest number of articles on this topic (n = 56). Wang authored the highest number of published articles (n = 42). Recent publications focused on the theme of cytokines and immunomodulation. Sufentanil attracted particular interest as a drug-related key word. Moreover, meta-analysis is becoming an increasingly popular research method in this field.

Conclusions

The increasing number of publications on dexmedetomidine use reflects growing interest in this topic. Future research should focus on meta-analyses to identify the most effective therapeutic methods. The immunomodulatory effect of dexmedetomidine on health and disease is of particular interest.