Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

Ramsay, Michael A. E.; Newman, Kate B.; Leeper, Barbara; Hamman, Baron L.; Hebeler, Robert F.; Henry, Albert; Kourlis, Harry; Wood, Richard E.; Stecher, Jack; Hein, H. A. Tillmann

doi:10.1080/08998280.2014.11929035

Cited by 25 publications

(45 citation statements)

References 42 publications

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“…DEX, an α2-adrenoceptor agonist having analgesic and anxiolytic activity, is widely used for anesthesia and intensive care ( 19 - 21 ). Salman et al ( 22 ) reported that 0.5 µg/kg DEX could be used for pretreatment with etomidate without significant cardiovascular side effects, especially in patients with low cardiac reserve.…”

Section: Discussionmentioning

confidence: 99%

Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

Luan¹,

Zhao²,

Feng³

et al. 2015

Braz J Med Biol Res

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Myoclonus induced by etomidate during induction of general anesthesia is undesirable. This study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate-induced myoclonus. Ninety patients undergoing elective surgical procedures were randomly allocated to three groups (n=30 each) for intravenous administration of 10 mL isotonic saline (group I), 0.5 µg/kg DEX in 10 mL isotonic saline (group II), or 1.0 µg/kg DEX in 10 mL isotonic saline (group III) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous push injection. The incidence and severity of myoclonus were recorded for 1 min after etomidate administration and the incidence of cardiovascular adverse events that occurred between the administration of the DEX infusion and 1 min after tracheal intubation was recorded. The incidence of myoclonus was significantly reduced in groups II and III (30.0 and 36.7%), compared with group I (63.3%). The incidence of severe sinus bradycardia was significantly increased in group III compared with group I (P<0.05), but there was no significant difference in heart rate in groups I and II. There were no significant differences in the incidence of low blood pressure among the 3 groups. Pretreatment with 0.5 and 1.0 µg/kg DEX significantly reduced the incidence of etomidate-induced myoclonus during anesthetic induction; however, 0.5 µg/kg DEX is recommended because it had fewer side effects.

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Section: Discussionmentioning

confidence: 99%

Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

Luan¹,

Zhao²,

Feng³

et al. 2015

Braz J Med Biol Res

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“…Self-satisfaction scored (SSS) from 1 to 4 (1 = not satisfied, 2 = moderately satisfied, 3 = satisfied, 4 = very satisfied). [5,9] …”

Section: Methodsmentioning

confidence: 99%

The optimal dose of dexmedetomidine added to an sufentanil-based analgesic regimen for postoperative pain control in spine surgery

Dong

Lu²,

Zhang³

et al. 2016

Medicine

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Postoperative spinal patients remain a challenge for provision of postoperative analgesia. Patient-controlled intravenous analgesia (PCIA) is a major method in reducing the severe pain after the surgery in our institution, but some adverse effects prevent the use of adequate dosage opioids.This study was determined using the probit analysis to investigate the optimal dose of dexmedetomidine (DEX) infusion for postoperative analgesia combined with sufentanil (SUF) in spine surgery.The dose of DEX needed to produce satisfactory analgesia conditions following combination of 3.0 μg/kg SUF in PCIA pump, which was diluted to 250 mL with a 4 mL/h as background infusion. Patients were recruited with age 35 to 65 years. The satisfactory criteria of postoperative analgesia were determined with a average satisfaction level of pain control, sedation, self-satisfaction, and adverse effects, among others. The dose of DEX was determined using the modified Dixon's up-and-down method (0.5 μg/kg as a step size). The first patient was test at 3.0 μg/kg DEX. The patient was assessed at 6, 12, 36 hours, and termination of PCIA following the continuous infusion of DEX-SUF mixture in PCIA after surgery.Twenty-five patients were enrolled by predetermined criteria. The optimal dose of DEX required for satisfactory analgesic was 4.33 (SD, 0.38) μg/kg combined with 3.0 μg/kg SUF via a PCIA volume of 250 mL by background infusion of 4 mL/h. Using probit analysis, the ED50 of DEX was 4.12 μg/kg (95% confidence limits 3.74–4.52 μg/kg) for satisfactory postoperative analgesic in spine surgery, the ED95 of DEX was 4.85 μg/kg (95% confidence limits 4.48–7.13 μg/kg). There was no report of somnolence or respiratory depression, relevant bradycardia or hypotension, or over sedation in this study.The optimal dose of DEX was 4.33 (0.38) μg/kg−1 combined with 3.0 μg/kg−1 SUF diluted to 250 mL with a background infusion of 4 mL/h for satisfactory analgesic after spine surgery. From probit analysis, ED50 and ED95 of DEX were 4.12 μg/kg (95% confidence limits 3.74–4.52 μg/kg) and 4.85 μg.kg−1 (95% confidence limits 4.48–7.13 μg/kg), respectively.

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“…Additionally, five of 12 trials [20-23,25] were likely underpowered for the outcomes, since they did not power the sample size. Therefore, the optimal dosage, timing, and route of DEX administration remain to be elucidated in future studies.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Hassani¹,

Kiabi²,

Sharifi³

2018

Braz J Cardiovasc Surg

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IntroductionAcute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.

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Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

Cited by 25 publications

References 42 publications

Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

The optimal dose of dexmedetomidine added to an sufentanil-based analgesic regimen for postoperative pain control in spine surgery

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

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