with propofol or propofol/fentanylPurpose: To observe the changes in EEG bispectral index (BIS), 95% spectral edge frequency (95% SEF) and median frequency (MF)with haemodynamic changes to intubation during induction with propofol or propofol and 2 ~ug.l,,g -I fentanyl/v. Methods: Twenty four ASA I-II patients were randomized to receive either propofol infusion preceded by normal saline (group P, n= 12) or propofol preceded by 2/./g.kg -I fentanyl (group PF, n= 12). Intubation was performed five minutes after maintenance of BIS within 45 ---S. EEG and haemodynamic variables were recorded at before induction, and before and after intubation. Results: l-laemodynamiC responses to intubation were greater in group P than in group PF (P < 0.05). Postintubation SBP, DBP and HR increased, compared with preinduction values, more in group P than in group PE Postintubation BIS values increased from 45.5 ___ 3.5 and 44.2 ___ 4. I to 51. I ___ 4. I and 50.9 +_ 5.3 in groups P and PF, respectively, compared with preintubation values. The BIS values were not different between treatment groups before and after intubation, and 95% SEF and MF values did not increase after intubation. Conclusion: Fentanyl, 2/dg.kg -~/v, blunted the haemodynamic responses to intubation, but failed to attenuate the arousal of cerebral cortical activity. The different haemodynamic responses postintubation but similar BIS and 95% SEF changes in the two groups suggest that BIS or 95% SEF cannot predict the haemodynamic responses to intubation during anaesthesia induction with propofol and fentanyl.Objectif : Observer les alt6rations de rindex I~EG bispectral (BIS), sur la fr~quence spectrale de marge (95% SEF) et la fr&luence moyenne (FM) caus~es par les changements h~modynamiques de l'intubation pendant l'induction au propofol ou au propofol associ~ au fentanyl 2/./g.kg -i iv.M&hodes : Vingt-quatre patients ASA I -I I ont re~u al~atoirement soit une perfusion de propofol pr&~d~e de sol. phys. (groupe P, n = 12) ou de propofol pr&~d,6 de fentanyl 2 jug'kg -I (groupe PF, n = 12). On intubait cinq minutes apr& la stabilisation du BIS entre 45 _+ S. I'EEg et les variables h~modynamiques ~taient enregistr~es avant l'induction, et avant et apr~s l'intubation. R~sultats : Les r~ponses h~modynamiques ~ l'intubation &aient plus importantes dans le groupe P que dans le groupe PF (P<0,05). Apt& l'intubation, la pression art&ielle systolique et diastolique et la Fc augmentaient comparativement aux valeurs de pr~induction, mais plus dans le groupe P que dans le groupe PE Apr~s l'intubation, les valeurs du BIS augmentaient de 45 ___ 3,5 ~ 51 +__ 4. I dans le groupe Pet de 44 _+ 4, I ~ 50,9 ---5,3 dans les groupes PF comparativement aux valeurs pr&~dant l'intubation ; les valeurs SEF 95% et MF n'augmentaient pas apt& l'extubation.Conclusion : Le fentanyl 2 pg.kg-% att~nue les r~ponses h~modynamiques ~ l'intubation mais ne parvient pas att~nuer l'~veil de l'activit~ corticale c&~brale. La diff&ence des r~ponses h~modynamiques postintubation mais la similarit~ des cha...

Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery that frequently occurs in patients ≥65 years. PND includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). To investigate whether intravenous dexmedetomidine (DEX) is able to improve neurocognitive function in elderly male patients following thoracoscopic lobectomy, a randomized, double-blinded, placebo-controlled trial was performed at the Affiliated Hospital of Inner Mongolia Medical University (Hohhot, China). Patients aged ≥65 years were enrolled and were subjected to thoracic surgery under general anesthesia. A computer-generated randomization sequence was used to randomly assign patients (at a 1:1 ratio) to receive either intravenous DEX (0.5 µg/kg per h, from induction until chest closure) or placebo (intravenous normal saline). The primary endpoint was the result of the Mini-Mental State Examination (MMSE). The secondary endpoints were the results of the Montreal Cognitive Assessment (MoCA) and those obtained with the Confusion Assessment Method (CAM), as well as the incidence of POCD and POD during the first 7 postoperative days. Other observational indexes included sleep quality at night, self-anxiety scale prior to the operation and 7 days following the operation and the visual analogue scale (VAS) score at rest and during movement on the first and third day following the operation. Furthermore, at 6 h following surgery, the MMSE score in the DEX group was significantly higher than that in the saline group. At 6 h and on the first day postoperatively, the MoCA score in the DEX group was significantly higher than that in the saline group. The incidence of POCD and POD in the DEX group was 13.2 and 7.5%, respectively, while that in the saline group was 35.8 and 11.3%, respectively. There was a significant difference in the incidence of POCD between the two groups (P<0.01). In the DEX group, mean sleep quality was increased, whereas the mean VAS was decreased compared with the corresponding values in the saline group. In conclusion, elderly male patients who underwent thoracoscopic lobectomy under continuous infusion of DEX (0.5 µg/kg/h) exhibited a reduced incidence of POCD during the first 7 postoperative days as compared with the placebo group. Furthermore, DEX improved the subjective sleep quality in the first postoperative night, reduced anxiety and alleviated postoperative pain. In addition, it increased the incidence of bradycardia. The present study was registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ; registration no. ChiCTR-IPR-17010958).

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The authors performed a meta-analysis to compare the characteristics of clonidine and dexmedetomidine as adjuvants to local anesthetic in intravertebral anesthesia. Four investigators independently searched electronic databases for randomized trials comparing the characteristics of clonidine vs dexmedetomidine as adjuvants to local anesthetic on adults. The endpoints were onset of analgesia, sensory and motor block, and duration of analgesia. A random-effects model was used to perform quantitative analysis. Seven studies comprising 354 subjects were included in this meta-analysis. The onset of sensory block was significantly 40 seconds shorter when dexmedetomidine was added as an adjuvant in the intrathecal injection. The duration of stable sensory block, duration of overall sensory block, and the time before the need for analgesic requirements were significantly extended, 10.8 minutes, 22.3 minutes, and 38.6 minutes, respectively, when dexmedetomidine was used as an adjuvant to local anesthetics (bupivacaine or ropivacaine). No significant differences were detected in the motor block characteristics and the time to achieve peak sensory level between dexmedetomidine and clonidine as adjuvants to local anesthetics. Compared to clonidine, the addition of dexmedetomidine as an adjuvant to local anesthetics is associated with earlier, prolonged sensory block characteristics and later need for analgesic requirements.