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Yang J, Wu X, Nie J. Comparative study between remifentanil (or fentanyl) and dexmedetomidine for the analgesia of rhinoplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e37020. [PMID: 38640315 PMCID: PMC11029972 DOI: 10.1097/md.0000000000037020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Remifentanil (or fentanyl) and dexmedetomidine may have some potential to improve the analgesia of rhinoplasty, and this meta-analysis aims to compare their efficacy for the analgesia of rhinoplasty. METHODS PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the analgesic effect of remifentanil (or fentanyl) versus dexmedetomidine for rhinoplasty. RESULTS Four RCTs were finally included in the meta-analysis. In patients undergoing rhinoplasty, remifentanil (or fentanyl) infusion and dexmedetomidine infusion resulted in similar good patient satisfaction (odd ratio [OR] = 2.71; 95% confidence interval [CI] = 0.63 to 11.64; P = .18), good surgeon satisfaction (OR = 1.68; 95% CI = 0.02 to 181.40; P = .83), extubation time (mean difference [MD] = 7.56; 95% CI = -11.00 to 26.12; P = .42), recovery time (MD = -2.25; 95% CI = -23.41 to 18.91; P = .83), additional analgesic requirement (OR = 0.16; 95% CI = 0 to 8.65; P = .37) and adverse events (OR = 8.50; 95% CI = 0.47 to 153.30; P = .15). CONCLUSIONS Remifentanil (or fentanyl) and dexmedetomidine may have comparable analgesia for patients undergoing rhinoplasty.
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Affiliation(s)
- Jiao Yang
- Department of Anesthesia Operation, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Xuejun Wu
- Department of Anesthesia Operation, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jinfeng Nie
- Department of Anesthesia Operation, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, China
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Calim M, Karaaslan K, Yilmaz S, Senturk E, Deniz H, Akbas S. The Effects of Hypocapnia and Hypercapnia on Intraoperative Bleeding, Surgical Field Quality, and Surgeon Satisfaction Level in Septorhinoplasty: A Prospective Randomized Clinical Study. Aesthetic Plast Surg 2024; 48:167-176. [PMID: 37407709 DOI: 10.1007/s00266-023-03433-9] [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: 12/23/2022] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Septorhinoplasty (SRP) is one of the most commonly performed procedures in the world for functional and aesthetic purposes. The present study was aimed to compare the effects of hypocapnia and hypercapnia regarding the total amount of intraoperative bleeding, surgical field quality, and surgeon satisfaction level. METHODS In this randomized prospective clinical study, eighty patients with American Society of Anesthesiologists I-II and were 18-45 years old scheduled for septorhinoplasty were randomly allocated to group hypocapnia [end-tidal carbon dioxide (EtCO2) 30 ± 2 mmHg] and group hypercapnia (EtCO2 40 ± 2 mmHg). We evaluated the total amount of intraoperative bleeding, the surgical field quality, surgeon satisfaction level, hemodynamics and peri- and postoperative adverse events. RESULTS Group hypocapnia significantly reduced the total amount of intraoperative bleeding (p < 0.001). The surgical field quality and surgeon satisfaction level in group hypocapnia were significantly better than group hypercapnia (p < 0.001). EtCO2 levels of group hypocapnia were significantly lower than group hypercapnia at all time points (p < 0.001 for all time points). There were no significant differences between the groups in terms of heart rate and mean arterial pressure at all time points. There were no significant differences between the groups in terms of adverse events CONCLUSIONS: The results of this double-blind randomized clinical trial showed that reducing the amount of intraoperative bleeding for patients with hypocapnia undergoing SRP through known methods (e.g., reverse Trendelenburg head-up position, positive end-expiratory pressure limiting, controlled hypotension, and use of topical vasoconstrictors, corticosteroids, and tranexamic acid) would improve the quality of the surgical field and raise the surgeon satisfaction level. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sinan Yilmaz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hilal Deniz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Aldosari N, Alrashid S, Alshareeda AH, Alenezi A, Alenezi MY, Almutairi A, Aldweesan Y, Almajed F, Alshakhri A, Alwahhabi F, Almehmadi SA, Albzea W, Alsakka MA, Alhajaji R. Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Cureus 2023; 15:e44132. [PMID: 37641722 PMCID: PMC10460480 DOI: 10.7759/cureus.44132] [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] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Dexmedetomidine has been widely studied in many surgical settings, with possible benefits in lowering anesthetic requirements, improving perioperative hemodynamic stability, and improving postoperative outcomes. This systematic review aims to evaluate the effects of dexmedetomidine in patients undergoing transsphenoidal resection of pituitary adenoma, shedding light on its potential as an adjunctive agent in anesthesia for this specific surgical population. In this review, we searched PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar from inception to July 20, 2023. A total of six randomized clinical trials (RCTs) investigating the effects of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenoma were included in this review. The outcomes of interest were extracted from the included studies as mean difference (MD) and standard deviation (SD), then analyzed using the Review Manager (RevMan, RevMan International Inc., New York, USA) software. Our literature search process retrieved 274 records. Of them, six studies were included in the meta-analysis. There was a significant difference between the dexmedetomidine group compared to the placebo group in terms of heart rate at the end of the surgery (MD = -16.5; CI = [-25.36 to -7.64]; P value = 0.0003) and after extubation (MD = -16.81; CI = [-23.18 to -10.43]; P values < 0.00001). Furthermore, dexmedetomidine significantly reduced the mean arterial blood pressure (MAP) at after both intubation and extubation (MD = -9.11 and -21.5; CI = [-13.56 to -4.65] and [-30.93 to -12.06]; P values < 0.00001). This systematic review and meta-analysis demonstrated that dexmedetomidine appears to have several potential benefits in patients undergoing transsphenoidal resection of pituitary adenoma. The use of dexmedetomidine was associated with reductions in heart rate, mean arterial blood pressure, blood loss, and duration of surgery, while showing no significant difference in propofol dose or time to extubation of the trachea.
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Affiliation(s)
- Nasser Aldosari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Shahad Alrashid
- Pediatrics, Alsabah Hospital, Ministry of Health, Kuwait City, KWT
| | - Anwar H Alshareeda
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulaziz Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Mohammad Y Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrahman Almutairi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Yousef Aldweesan
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fay Almajed
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrazzaq Alshakhri
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fai Alwahhabi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | | | - Wardah Albzea
- Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mahmoud A Alsakka
- Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Kuwait City, KWT
| | - Raghad Alhajaji
- Family Medicine, Alhajj Primary Health Care, Ministry of Health, Makkah, SAU
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Dehghanpisheh L, Sahmeddini MA, Kaboodkhani R, Samadi K, Khademi S, Rafati Z, Abbasi S, Abbasi R. Efficacy of Isoflurane-Remifentanil versus Propofol-Remifentanil on Controlled Hypotension and Surgeon Satisfaction in Rhinoplasty: A Single-Blind Clinical Trial Study. Iran J Med Sci 2023; 48:379-384. [PMID: 37456209 PMCID: PMC10349152 DOI: 10.30476/ijms.2022.94781.2608] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/15/2022] [Accepted: 07/10/2022] [Indexed: 07/18/2023]
Abstract
Background Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Results Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Conclusion Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.
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Affiliation(s)
- Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Kaboodkhani
- Otolaryngology Research Center, Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Samadi
- Department of Anesthesiology, Shahid Dastgheib Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Khademi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rafati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wujtewicz M, Twardowski P, Jasiński T, Michalska-małecka K, Owczuk R. Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine. Pharmaceuticals (Basel) 2023; 16:354. [PMID: 36986456 PMCID: PMC10052810 DOI: 10.3390/ph16030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Dexmedetomidine, a central α-2 agonist, is used for procedural sedation and for conscious sedation influences on heart rate and blood pressure. Authors verified whether it is possible to predict bradycardia and hypotension with the use of heart rate variability (HRV) analysis for an autonomic nervous system (ANS) activity assessment. The study included adult patients of both sexes with an ASA score of I or II scheduled for ophthalmic surgery to be performed under sedation. The loading dose of dexmedetomidine was followed by a 15 min infusion of the maintenance dose. The frequency domain heart rate variability parameters from the 5-min Holter electrocardiogram recordings before dexmedetomidine administration were used for the analysis. The statistical analysis also included pre-drug heart rate and blood pressure as well as patient age and sex. The data from 62 patients were analysed. There was no relationship between the decrease in heart rate (42% of cases) and initial HRV parameters, haemodynamic parameters or sex and age of patients. In multivariate analysis, the only risk factor for a decrease in mean arterial pressure (MAP) > 15% from the pre-drug value (39% of cases) was the systolic blood pressure before dexmedetomidine administration as well as for a >15% decrease in MAP sustained at more than one consecutive time point (27% of cases). The initial condition of the ANS did not correlate with the incidence of bradycardia or hypotension; HRV analysis was not helpful in predicting the abovementioned side effects of dexmedetomidine.
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Chen S, Wei A, Min J, Li L, Zhang Y. A Response to: Letter to the Editor Regarding "Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial". Pain Ther 2023; 12:319-20. [PMID: 36447042 DOI: 10.1007/s40122-022-00461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022] Open
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Meenakshi Sundaram VT, Krishnagopal V, Chellappa R, Sethuraman RM, Meenakshi Sundaram S. Letter to the Editor Regarding "Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial". Pain Ther 2023; 12:317-8. [PMID: 36447044 DOI: 10.1007/s40122-022-00460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
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Uludag Yanaral T, Karaaslan P, Gungor H, Atalay YO, Tobias JD. Rhinorrhea due to Infusion of Dexmedetomidine during Rhinoplasty: A Case Report and Current Literature Review. Haseki 2022. [DOI: 10.4274/haseki.galenos.2022.8389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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