ObjectiveTo observe the effects and security of dexmedetomidine in combined spinal epidural anesthesia (CSEA) for laparoscopic total extraperitoneal hernia repair (TEP). MethodsFrom January 2010 to January 2013, we selected 90 patients who were going to receive TEP surgery as our study subjects. The patients were divided into three groups:M1, M2 and M3 with 30 patients in each. The patients had left lateral position, and anesthesia was done between 3-4 lumbar epidural line. Injection of 0.5% bupivacaine 2 mL was carried out, and epidural catheter was 3-5 cm. Anesthesia plane was adjusted from the chest 4 or 6 vertebra to the sacral vertebra. The three groups of patients were treated with micro pump using dexmedetomidine given at a pre-charge of 0.5 μg/kg, and then group M1 was maintained by 0.3 μg/(kg·h), M2 by 0.5 μg/(kg·h), and M3 by 0.7 μg/(kg·h). The changes of mean arterial pressure (MAP), heart rate, respiration and pulse oximetry (SpO2) were observed at each time point, and bispectral index (BIS) monitor and Ramsay sedation score test were also conducted. ResultsThe changes of MAP, heart rate and respiration in group M1 were not obvious; the Ramsay score for group M1 was 2 to 3, and BIS value after pre-charge was 65-84. For group M2, MAP, heart rate and respiration had a slight decline; Ramsay score was 3-5 points, and BIS value was 60-79. In group M3, patients had a milder decline in their MAP and respiration; the heart rate declined obviously after receiving dexmedetomidine and one patient with severe decline of the heart rate alleviated after active treatment; Ramsay score was 5 to 6 points, and BIS value was between 55 and 75. There was little change in SpO2 in all the three groups, and the difference was not statistically significant (P>0.05). ConclusionContinuous injection of dexmedetomidine at 0.3-0.5 μg/(kg·h) in CSEA is an alternative way for anesthesia, which can effectively promote sedation and reduce pain and discomfort.
ObjectiveTo observe the effect of dexmedetomidine combined with etomidate on the clinical safety and the tracheal extubation response after general anesthesⅠa in elderly patient undergoing thyroidectomy. MethodsFifty patients (aged between 65 and 75 years, ASAⅠor Ⅱ) scheduled for thyroid surgery between July 2012 and January 2013 were randomly divided into two groups:dexmedetomidine group (group D) and control group (group C) with 25 patients in each group. Group D received dexmedetomidine of 0.5 μg/(kg·h) through intravenous infusion after anesthesia induction, and the intravenous infusion was stopped five minutes before the end of surgery. Normal saline was infused at the same volume in group C at the same time. Patients were induced with etomidate at 0.2 mg/kg for anesthesia, and etomidate and remifentanil were used for the anesthesia maintenance during the operation. Heart rate (HR), systolic blood pressure SBP), diastolic blood pressure (DBP) and bispectral index (BIS) were recorded 5 (T1), 15 (T2) and 30 (T3) minutes after the beginning of the operation, and 15 (T4) and 5 (T5) minutes before the end of the operation. Moreover, the time of eye opening, time of extubation, the number of patients with restlessness and etomidate requirement were recorded. ResultsCompared with group C, HR and MAP at the time points of T2 and T5 in group D did not obviously change, but the number of restlessness patients in group D was significantly less than in group C (P<0.05). There was no statistically significant difference in time of eye opening and time of extubation between the two groups (P>0.05). Etomidate requirement in group D was[(8.6±2.1) μg/(kg·min)], which was significantly lower than that in group C[(14.4±3.4) μg/(kg·min)] (P<0.05). ConclusionDexmedetomidine combined with etomidate is efficient and safe for elderly patients undergoing thyroidectomy, and this method can effectively reduce cardiovascular responses to tracheal extubation, decrease the incidence of postoperative restlessness, and reduce the requirement of etomidate during the operation.
Objective To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. Methods A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05). Conclusion For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
Objective To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods Randomized controlled trials (RCTs) were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database (up to December 2016). RevMan 5.3 software was used for meta-analysis. Results Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium (RR=0.28, 95% CI 0.18 to 0.44, P<0.000 01) and postoperative atrial fibrillation (RR=0.65, 95% CI 0.44 to 0.98, P=0.04) compared with the controls. The duration of intubation (RR=–1.96, 95% CI –2.07 to –1.86, P<0.000 01), length of ICU stay (RR=–0.49, 95% CI –0.74, –0.24, P=0.000 1) and hospital stay (RR=–1.24, 95% CI –2.26 to –0.22, P=0.02) in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment (RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2) compared to the control group. Conclusion Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.
ObjectiveTo evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. MethodsA total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D1), moderate-dose dexmedetomidine hydrochloride injection group (group D2), and high-dose dexmedetomidine hydrochloride injection group (group D3). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T1), immediately after administration (T2), extubation after administration (T3), one minute after extubation (T4), and 5 minutes after extubation (T5). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. ResultsCompared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1 (P<0.05), while the correspondent difference was not statistically significant in group D2 and D3 (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1 (P>0.05). However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1 (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3. ConclusionIntravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
Objective To evaluate the effectivity of dexmedetomidine on the early postoperative quality of recovery in patients undergoing ambulatory knee arthroscopy under general anesthesia. Methods Patients scheduled for knee arthroscopy at the Day Surgery Center of the First Affiliated Hospital of Anhui Medical University between June and September 2024 were selected. According to the computer-generated random allocation, patients were randomly divided into the dexmedetomidine group (Dex group) and the saline control group (NS group). The Dex group received a continuous infusion of dexmedetomidine at a rate of 0.04 µg/(kg·h) until discharge, whereas the NS group was administered a comparable volume of saline. The primary outcome measure was the EuroQol Five-Dimensional Five-Level (EQ-5D-5L) score for health-related quality of life measured at the postoperative 24 hours. Secondary outcome measures included the Athens Insomnia Scale score on the night of surgery and the incidence of adverse reactions such as nausea and vomiting within 24 hours postoperatively. Results A total of 60 patients were included, with 30 patients in each group. There were statistically significant differences in the EQ-5D-5L health scores at the postoperative 24 hours (0.857±0.081 vs. 0.721±0.098) and the Athens Insomnia Scale scores [2.00 (2.00, 3.00) vs. 4.00 (3.00, 5.25)] on the night of surgery between the Dex group and the NS group (P<0.05). The difference in the incidence of postoperative nausea and vomiting between the two groups was not statistically significant [1 case (3.3%) vs. 5 cases (16.7%); χ2=1.667, P=0.197]. No adverse reactions such as bradycardia, hypotension, urinary retention, respiratory depression, dizziness and lethargy occurred in both groups. Conclusion Dexmedetomidine can significantly improve the early postoperative quality of life and sleep in patients undergoing ambulatory knee arthroscopy, thereby facilitating early postoperative quality of recovery.
Objective To explore the influence of dexmedetomidine on wake-up test during spinal orthopaedic surgery. Methods All 80 patients taking spinal orthopaedic surgery were randomly divided into the trial group and the control group, with 40 cases in each group. The endotracheal intubation anesthesia was adopted in both groups with same anesthesia induction. Additionally, dexmedetomidine 0.8 μg/ (kg·h) was infused within 10 min in the trial group before anesthesia induction, and then another 0.5 μg/ (kg·h) was also infused from the intraoperation to suture of incision. For the control group, the same amount of normal saline was infused, and all the narcotics were stopped pumping 15 min before the wake-up test, but then were continued pumping after the wake-up test. Finally, the following indexes were analyzed: wake-up time, wake-up quality, hemodynamic changes at the time of 15 min before wake-up (T1), recovery of spontaneous breathing (T2), wake-up (T3) and 15 min after wake-up (T4), dosage of narcotics, and the incidence of adverse events. Results There was no significant difference in the operation time before wake-up between the two groups (P=0.07). For the trial group, the dosage of sevoflurane (P=0.03) and sufentanil (P=0.00) used before wake-up was significantly lower, the wake-up time (P=0.04) and bleeding amount during wake-up (P=0.00) were significantly less, the wake-up quality (P=0.03) was significantly higher, the blood pressure (P=0.00) and heart rate (P=0.00) when wake-up were significantly lower, and the incidence of adverse events (P=0.04) was significantly lower, compared with the control group. Conclusion Dexmedetomidine adopted in spinal orthopaedic surgery can significantly improve patient’s wake-up quality, shorten wake-up time, reduce bleeding amount when wake-up and adverse events after wake-up, and maintain the hemodynamic stability, so it has better protective effects.
ObjectiveTo evaluate the efficacy and safety of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia (PCIA) in patients after radical operation for abdominal tumor. MethodsBetween September 2012 and May 2013, 60 patients (aged 40-60, American Sociaty of Anesthesiologists physical statusⅠ-Ⅱ) undergoing abdominal tumor surgery and asking for PCIA pumps voluntarily were randomly divided into two groups (group D and group DF) with 30 in each group. Patients in group D were given sufentanil 0.25 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline, while in group DF, the patients received dexmedetomidine 1.5 μg/kg+ sufentanil 0.15 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline. The changes of mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), the visual analog scale (VAS), Ramsay sedation scale, Bruggrmann analgesia scale (BCS), the efficacy of postoperative analgesia and adverse effects were observed and recorded at the preoperative time (T0), and 2 (T1), 4 (T2), 8 (T3), 24 (T4) and 48 hours (T5) postoperatively. ResultsHemodynamics in group DF was more stable than that in group D (P<0.05). There were no statically significant differences in terms of VAS and BCS between the two groups at each time point (P>0.05). The Ramsay sedation scale of group DF was better than group D, and the difference was statistically significant (P<0.05). The efficient number of pressing within 48 hours in the two groups was not significantly different (P>0.05). The incidence of nausea, vomiting and drowsiness in group D was more than that of group DF (P<0.05). ConclusionDexmedetomidine combined with dezocine can provide effective postoperative analgesia with less adverse effects for patients after radical surgery of abdominal tumor, which provides higher satisfaction to the abdominal surgery patients.
ObjectiveTo investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. MethodsClinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. ResultsA total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ2=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.
ObjectiveTo investigate the effect of dexmedetomidine on systemic vascular resistance in patients undergoing cardiopulmonary bypass. MethodsThirty-one patients undergoing cardiac surgery with cardiopulmonary bypass from January to April, 2012 were randomized into experimental group (n=16) and control group (n=15). The flow rate was kept at 2.4 L/(min·m2) and moderate hypothermia was maintained. Equivalent dexmedetomidine and 0.9% sodium chloride solution were pumped for the experimental group and control group, respectively. The mean artery pressure (MAP), systemic vascular resistance (SVR), Cortisol, epinephrine and norepinephrine were determined before (T0) and at 10 and 20 minutes (T1,T2) after dexmedetomidine administration. ResultsCompared with T0, there were significant decreases in MAP and SVR at T1 and T2 (P<0.05). MAP and SVR were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05); cortisol, epinephrine and norepinephrine were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05). ConclusionDexmedetomidine reduces SVR and causes decrease in MAP. It can effectively inhibit the stress reaction in patients undergoing cardiopulmonary bypass.