Dexmedetomidine as an adjuvant during general anesthesia

Obara, Shinju

doi:10.1007/s00540-018-2509-5

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…3 Dexmedetomidine is a highly selective central presynaptic α2-adrenergic receptor agonist providing sedation and analgesia. 4,5 Previous studies have shown that dexmedetomidine provides effective postoperative early analgesia and reduced postoperative opioid requirements for different types of surgeries. [6][7][8][9] Furthermore, a meta-analysis indicated that dexmedetomidine relieved postoperative acute pain intensity and reduced perioperative analgesic consumption in neurosurgery, but the impact of dexmedetomidine on chronic pain needs further study.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Zeng,

Xu,

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain. METHODS: This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg −1 dexmedetomidine bolus followed by a 0.4 μg kg −1 h −1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy. RESULTS: From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38-0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory (P = .01) and neuropathic pain descriptor (P = .023) scores in the dexmedetomidine group were lower than those in the placebo group. CONCLUSIONS: Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections. (Anesth Analg 2024;138:839-47) KEY POINTS• Question: Did intraoperative administration of dexmedetomidine prevent chronic incisional pain after craniotomy? • Findings: Compared with placebo, prophylactic intraoperative dexmedetomidine infusion reduced the incidence of chronic incisional pain after elective brain tumor resections. • Meaning: Our data suggest that prophylactic intraoperative dexmedetomidine may reduce chronic incisional pain after craniotomy. GLOSSARYASA = American Society of Anesthesiologists; ASD = absolute standard difference; BIS = bispectral index; CAD = coronary artery disease; CI = confidence interval; CONSORT = Consolidated Standards of Reporting Trials; Etco 2 = end-tidal carbon dioxide; IQR = interquartile range; NA = not applicable; NRS = numerical rating scale; PACU = postanesthesia care unit; RR = risk ratio; SD = standard deviation; SF-MPQ-2 = Short-Form McGill Pain Questionnaire-2; TED = tumor equivalent diameter

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Section: Anesthesia and Analgesiamentioning

confidence: 99%

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Zeng,

Xu,

et al. 2023

Anesthesia &Amp; Analgesia

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“…11,12 However, dexmedetomidine infusion doses vary from 0.2 to 0.7 mcg/kg/h. [2][3][4][5][6][7][8][9][10][11][12] Therefore, we aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate doses (0.5 mcg/kg/h) of dexmedetomidine during maintenance of anesthesia on the amount of blood loss (primary objective) and compare the hemodynamics and operative times (secondary objectives) of patients undergoing transsphenoidal pituitary tumor removal with the aforementioned doses.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic properties, inducing anesthetic-and opioid-sparing effects. [6][7][8] Owing to its properties of early postoperative pain prevention, reduction of nausea and vomiting events, and decreased shivering, it has been widely accepted as an adjunct to general anesthesia in various surgical procedures and intensive care. 9 The hemodynamic effects of dexmedetomidine cover both central and peripheral mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study

Muangman

Raksakietisak

Akavipat

et al. 2023

J Neuroanaesth Crit Care

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Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg/kg, followed by 0.2 mcg/kg/h, and to group II at the same loading dose, followed by 0.5 mcg/kg/h. Comparative analyses were performed using the Student's t-test, repeated-measures analysis of variance, and Mann–Whitney U test; p-values < 0.05 were considered statistically significant. Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension (p = 0.034). Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg/kg/h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.

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“…Dexmedetomidine (Dex) is a highly selective α 2 receptor agonist with sedative, analgesic, anti-anxiety, sympathetic inhibitory, and less respiratory inhibitory effects ( Song et al, 2016 ). As an auxiliary drug for general anesthesia, Dex can activate the vagal efferent system and inhibit inflammation ( Wang et al, 2015 ; Obara 2018 ; Bao and Tang, 2020 ). Animal studies showed that the anti-inflammatory effect of Dex is better at a high dose than at a low dose, and the effect of “pre-empty” treatment is better than that of the “post-empty” treatment ( Yeh et al, 2016 ; Bao and Tang, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Extra Loading Dose of Dexmedetomidine Enhances Intestinal Function Recovery After Colorectal Resection: A Retrospective Cohort Study

et al. 2022

Front. Pharmacol.

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Importance: Postoperative gastrointestinal dysfunction (POGD) may be caused by postoperative vagus nerve tension inhibition and systemic inflammation. Dexmedetomidine (Dex) increases vagus nerve tone and affords an anti-inflammatory property, which may play a role in pathogenesis.Objective: To investigate whether a higher dose of Dex enhances gastrointestinal function recovery.Design: In this retrospective study, patients receiving colorectal surgery at the First Affiliated Hospital of Xi’an Jiaotong University from 2017 to 2019 were included. We evaluated the postoperative flatus time between recipients who received loading plus maintenance dose of DEX (LMD group, 237 recipients) and those who recieved maintenance dose of DEX (MD group, 302 recipients). Data were analyzed by logical regression and stratified and interaction analyses. The simulated pharmacokinetics of two DEX regimens was compared using the Tivatrainer software. Thirty paired blood samples from patients whose propensity scores matched with POGD-related factors at 24 h postoperatively were randomly selected, and their tumor necrosis factor-α (TNF-α), cyclooxygenase-2 (COX-2), d-lactate (DLA), acetylcholine (Ach), interleukin (IL)-10, lipopolysaccharide (LPS), IL-6, and inducible nitric oxide synthase (iNOS) levels were measured.Setting: Operating rooms and general surgery wards.Participants: Among the 644 patients undergoing colorectal surgery, 12 who had a colostomy, 26 without Dex infusion, 20 whose Dex administration mode cannot be classified, and 47 with a history of intestinal surgery were excluded. A total of 539 patients were included.Result: Compared with the MD group, the LMD group had a shorter recovery time to flatus; lower incidences of nausea, vomiting, abdominal distension, and abdominal pain (p < 0.05); and a slightly decreased heart rate. The LMD group was the independent factor of POGD (OR = 0.59, 95% CI = 0.41–0.87, p = 0.007) without being reversed in stratified and interaction analyses and had higher Dex plasma concentration from skin incision to 8 h postoperatively. The LMD group had a 39% and 43% increase in Ach and IL-10 levels, respectively, and a 33%–77% decrease in TNF-α, IL-6, COX-2, iNOS, LPS, and DLA levels (p < 0.05).Conclusion: Adding an extra loading dose of Dex can increase parasympathetic tone and decrease inflammation; hence, it can enhance postoperative gastrointestinal function recovery following colorectal surgery.

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Dexmedetomidine as an adjuvant during general anesthesia

Cited by 7 publications

References 21 publications

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study

Extra Loading Dose of Dexmedetomidine Enhances Intestinal Function Recovery After Colorectal Resection: A Retrospective Cohort Study

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