Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia

Eskandr, Ashraf M.; Metwally, Ahmed A.; Ahmed, Abd-Elrahman Ahmed; El-Feky, Elham M; Eldesoky, Islam M.; Obada, Manar A; Abd-Elmegid, Osama A

doi:10.1097/eja.0000000000000776

Cited by 18 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Administration of dexmedetomidine, a sedative affecting the α2 adrenaline receptor, which is commonly used in intensive care, has been shown to improve survival and to preserve eGC in a rat heatstroke model [119]. There is some evidence that administration of dexmedetomidine in pre-eclamptic patients was associated with hemodynamic and hormonal stability, without causing severe adverse neonatal outcomes [120][121][122][123].…”

Section: Metforminmentioning

confidence: 99%

Can Endothelial Glycocalyx Be a Major Morphological Substrate in Pre-Eclampsia?

Ziganshina

Yarotskaya

Bovin

et al. 2020

IJMS

View full text Add to dashboard Cite

Today pre-eclampsia (PE) is considered as a disease of various theories; still all of them agree that endothelial dysfunction is the leading pathogenic factor. Endothelial dysfunction is a sequence of permanent immune activation, resulting in the change of both the phenotype and the functions of an endothelial cell and of the extracellular layer associated with the cell membrane—endothelial glycocalyx (eGC). Numerous studies demonstrate that eGC mediates and regulates the key functions of endothelial cells including regulation of vascular tone and thromboresistance; and these functions are disrupted during PE. Taking into account that eGC and its components undergo alterations under pathological conditions leading to endothelial activation, it is supposed that eGC plays a certain role in pathogenesis of PE. Envisaging the eGC damage as a key factor of PE, might be a new approach to prevention, treatment, and rehabilitation of patients with PE. This approach could include the development of drugs protecting eGC and promoting regeneration of this structure. Since the issue of PE is far from being solved, any effort in this direction might be valuable.

show abstract

Section: Metforminmentioning

confidence: 99%

Can Endothelial Glycocalyx Be a Major Morphological Substrate in Pre-Eclampsia?

Ziganshina

Yarotskaya

Bovin

et al. 2020

IJMS

View full text Add to dashboard Cite

show abstract

“…In ICU patients, similar values were found, with half-lives ranging from 2.2 to 3.7 h (ref. 16,17 ). In this study, dexmedetomidine enhanced analgesia, decreased VAS, and reduced tramadol consumption at 3 h postoperatively.…”

Section: The Effects Of Dexmedetomidine On Maternal Postoperative Anamentioning

confidence: 49%

Effects of dexmedetomidine versus remifentanil on mothers and neonates during cesarean section under general anesthesia

Yu¹,

Zhang²,

Wang³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Background and Aims. Dexmedetomidine and remifentanil use in obstetric general anesthesia is controversial. This study aimed to compare the effects of remifentanil and dexmedetomidine on mothers and neonates during cesarean section under general anesthesia. Methods. A total of 120 patients scheduled for elective cesarean section under general anesthesia were randomly allocated to dexmedetomidine (D), remifentanil (R), and control (C) groups. Anesthesia was induced with propofol and muscle relaxants in all groups. Anesthesia in groups D and R was induced with dexmedetomidine (induction, 0.5 µg/ kg; maintenance, 0.5 µg/kg•h) and remifentanil (induction, 0.5 µg/kg; maintenance, 2 µg/kg•h), respectively, until birth. Group C received equivalent volumes of normal saline. Mean arterial blood pressure (MAP), heart rate (HR), plasma catecholamine, visual analog pain score (VAS), and total tramadol consumption at 1, 2, and 3 hours after extubation were recorded. Neonatal effects were assessed by Apgar scores and umbilical blood gas analysis. Results. Post induction, MAP was significantly higher in group D compared to groups C and R, and significantly lower in group R than in group C. At intubation/skin incision and delivery, MAP, HR, and plasma epinephrine and norepinephrine concentrations were significantly lower in groups D and R than in group C. Compared to group R, MAP was significantly higher, and HR, plasma epinephrine, and norepinephrine concentrations were significantly lower in group D. Compared with groups C and D, the percentage of neonates with Apgar score < 7 was higher in group R at 1 min after delivery. Compared with groups C and R, the VAS was significantly lower in group D at 1 and 2 h postoperatively. Total tramadol consumption was significantly lower in group D at 3 hours postoperatively. Conclusion. During general anesthesia for cesarean section, remifentanil demonstrated better control of hemodynamic stability, while dexmedetomidine demonstrated better neonatal Apgar scores, postoperative analgesia, and decreased catecholamine release.

show abstract

“…Furthermore, studies demonstrated that the complications, such as maternal bradyarrhythmia and hypotension, were not reported during cesarean section 1,5. Likewise, in the trail of Eskandr et al,11 no patients required ephedrine but four required atropine (three in dexmedetomidine group, one in control group); however, these differences were not statistically significant. However, Yu et al13 described one patient in the dexmedetomidine group and two patients in the control group were treated with ephedrine.…”

Section: Resultsmentioning

confidence: 95%

“…Adequate blinding of outcome assessment was found in four trials,10,13,21,22 while it was inadequate in two trials 12,23. Seven trials10–12,20–23 had low risk of incomplete outcome data, and there was also a low risk of reporting bias in seven trials 11–13,20–23. (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

<p>Effectiveness and safety of intravenous application of dexmedetomidine for cesarean section under general anesthesia: a meta-analysis of randomized trials</p>

Shi

Bai

et al. 2019

DDDT

View full text Add to dashboard Cite

Objective The meta-analysis was conducted to assess the effectiveness and safety of intravenous administration of dexmedetomidine for cesarean section under general anesthesia, as well as neonatal outcomes. Materials and methods We searched PubMed, Embase, Cochrane Central Register of Controlled Trials and the China National Knowledge Infrastructure database for relevant randomized controlled trials (RCTs) about the application of intravenous dexmedetomidine under general anesthesia for cesarean section. RevMan 5.3 was used to conduct the meta-analysis of the outcomes of interest. Results Eight RCTs involved 376 participants were included in this study. The meta-analysis showed that the mean blood pressure at the time of intubation (weighted mean difference [WMD]: −15.67, 95% CI: −21.21, −10.13, P<0.00001), skin incision (WMD: −12.83, 95% CI −20.53, −5.14, P=0.001), and delivery (WMD: −11.65, 95% CI −17.18, −6.13, P<0.0001) in dexmedetomidine group were significantly lower than that in the control group. The heart rate (HR) at the time of intubation (WMD: −31.41, 95% CI −35.01, −27.81, P<0.00001), skin incision (WMD: −22.32, 95% CI −34.55, −10.10, P=0.0003), and delivery (WMD: −19.07, 95% CI −22.09, −16.04, P<0.00001) were also lower than that in control group. For neonatal parameters, no differences existed in umbilical blood gases at delivery, and Apgar scores at 1 minute (WMD: −0.12, 95% CI −0.37, 0.12, P=0.33) and 5 minutes (WMD: −0.17, 95% CI −0.13, 0.46, P=0.27) among two groups. Conclusion Intravenous administration of dexmedetomidine could efficiently attenuate the maternal cardiovascular response during cesarean section, without affecting Apgar score of the neonate.

show abstract

Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia

Abstract: Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org).

Cited by 18 publications

References 24 publications

Can Endothelial Glycocalyx Be a Major Morphological Substrate in Pre-Eclampsia?

Can Endothelial Glycocalyx Be a Major Morphological Substrate in Pre-Eclampsia?

Effects of dexmedetomidine versus remifentanil on mothers and neonates during cesarean section under general anesthesia

<p>Effectiveness and safety of intravenous application of dexmedetomidine for cesarean section under general anesthesia: a meta-analysis of randomized trials</p>

Contact Info

Product

Resources

About