Effect of dexmedetomidine infusion on hemodynamic responses in microsurgery of larynx

Basantwani, Shakuntala; Patil, Mayuresh; Govardhane, Balasaheb Tukaram; Magar, Jyoti; Tendolkar, Bharati A

doi:10.4103/joacp.joacp_136_16

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…Our results were supported by those of the study by Basantwani et al (16), who observed the effect of dexmedetomidine bolus (1 µg/kg) and continued infusion (0.5 µg/kg) on hemodynamic responses in microsurgery of the larynx and found a decrease in HR from that at baseline starting from loading dose infusion to the end of surgery.…”

Section: Discussionsupporting

confidence: 92%

“…Microlaryngoscopy consists of a sequence of stressfilled continuous suspension laryngoscopies that activate the deep pressure receptors in the larynx (16). In highrisk patients, uncontrolled hemodynamic changes during laryngoscopy and intubation produce an increase in HR and MAP, which can result in lethal arrhythmias and myocardial ischemia (17).…”

Section: Discussionmentioning

confidence: 99%

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Dexmedetomidine vs. Fentanyl-Midazolam Combination to Mitigate the Stress Response in Microlaryngoscopy: A Randomized Double-blind Clinical Trial

Oriby,

Elrashidy,

Khafagy

et al. 2023

Anesth Pain Med

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Background: Laryngoscopy is the most painful noxious stimulus during anesthesia and surgery. Dexmedetomidine is increasingly used as a sedative in surgeries involving microlaryngoscopy. Objectives: This study aimed to evaluate the effect of dexmedetomidine and a combination of fentanyl and midazolam on mitigating the stress response in patients scheduled for microlaryngoscopy. Methods: This randomized, double-blind clinical trial enrolled 60 patients (28 males and 32 females) aged 18 - 65 years with the American Society of Anesthesiologists (ASA) physical status I - III. The patients were scheduled for microlaryngoscopy and equally divided into 2 groups. Group D received 1 μg/kg of dexmedetomidine and saline bolus dose over 10 minutes before general anesthesia (GA) induction, followed by 0.5 μg/kg/h of dexmedetomidine and saline infusions after GA induction. Group MF received 0.8 μg/kg of fentanyl plus 0.05 mg/kg of midazolam over 10 minutes before GA induction, followed by 1 μg/kg/h of fentanyl plus 0.05 mg/kg/h of midazolam as an infusion. The heart rate (HR) and mean arterial blood pressure (MAP) pressure were recorded from baseline until the end of surgery. Infusions were stopped at the end of the surgery. Results: The number of patients requiring propofol and intraoperative supplemental propofol was significantly lower in group D than in group MF. The heart rate was significantly lower in group D than in group MF (P = 0.022, 0.048, 0.032, 0.045, 0.041, 0.026, 0.030, and 0.036) from induction until the end of surgery; in addition, it was comparable between both groups at baseline and before induction. MAP was comparable between both groups for all measurements. Conclusions: Dexmedetomidine mitigates the hemodynamic changes related to microlaryngoscopy more effectively than the fentanyl-midazolam combination.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine vs. Fentanyl-Midazolam Combination to Mitigate the Stress Response in Microlaryngoscopy: A Randomized Double-blind Clinical Trial

Oriby,

Elrashidy,

Khafagy

et al. 2023

Anesth Pain Med

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“…[25][26][27] In addition, various drugs have been used to suppress the cardiovascular response of MLS, including intravenous infusion drugs (including propofol, dexmedetomidine, lidocaine, β-blockers or esketamine), inhalation sevoflurane, and oral drugs (such as clonidine and gabapentin). 17,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] However, propofol could delay anesthesia recovery, β-blockers could increase perioperative cardiac complications, and oral administration has a slow onset of action. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Therefore, the efficacy of these techniques seems to be unreliable based on the variable outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…17,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] However, propofol could delay anesthesia recovery, β-blockers could increase perioperative cardiac complications, and oral administration has a slow onset of action. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Therefore, the efficacy of these techniques seems to be unreliable based on the variable outcomes.…”

Section: Introductionmentioning

confidence: 99%

Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta‐Analysis

Wang,

Du,

Chen

et al. 2024

The Laryngoscope

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ObjectivesTo assess the safety and efficacy of superior laryngeal nerve block (SLNB) for microlaryngoscopic surgery (MLS).Data SourcesPubMed, Embase, Web of Science, Ovid Medline, Cochrane Library, CNKI database, VIP database, Wanfang database, and trial registry databases.MethodsPICOS principles were performed: adults undergoing MLS receiving SLNB compared with no‐SLNB in randomized controlled trials were included. Primary outcome included the incidence of severe postoperative sore throat (POST). Secondary outcomes included perioperative mean arterial pressure (MAP) and heart rate (HR), incidence of severe postoperative cough, and anesthesia recovery time.ResultsEleven articles with 728 patients were included. Results indicated that SLNB provides lower incidence of severe POST in post‐extubation 30 min (relative ratio [RR] = 0.13; 95% confidence intervals [CIs]: 0.05 ~ 0.34), 2 h (RR = 0.09; 95% CI: 0.02 ~ 0.36), 4–6 h (RR = 0.11; 95% CI: 0.03 ~ 0.41), and 24 h (RR = 0.15; 95% CI: 0.03 ~ 0.83); lower MAP (tracheal intubation: standardized mean difference [SMD] = −1.59; 95% CI: −1.69 to −0.42); suspension laryngoscope insertion: (SMD = −0.98; 95% CI: −1.49 to −0.46); tracheal extubation: (SMD = −0.78; 95% CI:−1.24 to −0.31); post‐extubation 5 min: (SMD = −0.95; 95% CI: −1.41 to −0.49); lower HR (tracheal intubation: mean difference [MD] = −9.71; 95% CI: −17.16 to −2.27); suspension laryngoscope insertion: (MD = −8.64; 95% CI: −16.79 to −0.49); tracheal extubation: (MD = −10.13; 95% CI: −17.86 to −2.39); post‐extubation 5 min: (MD = −13.44; 95% CI: −22.53 to −4.35); lower incidence of severe postoperative cough in post‐extubation 30 min (RR = 0.18; 95% CI: 0.06 ~ 0.57) and 2 h (RR = 0.13; 95% CI: 0.02 ~ 0.69); and shorter anesthesia recovery time (MD = −5.34; 95% CI: −8.81 to −1.86) compared to controls.ConclusionsSLNB could provide lower incidence of severe POST, more stable perioperative MAP and HR, lower incidence of severe postoperative cough, and shorter anesthesia recovery time for MLS.Level of EvidenceI Laryngoscope, 2024

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“…Perioperative use of dexmedetomidine as an adjunct to general anaesthesia has been shown to have a smooth and haemodynamically stable intraoperative and post-operative course because of its analgesic and anaesthetic sparing effect and cardiovascular stabilising effects without respiratory depression. [ 1 , 2 ] However, the slow onset and offset of action of dexmedetomidine is the major limitation of its use. [ 3 ] Hence, several drugs have been studied to be used as adjuvant to perioperative dexmedetomidine infusion.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia

Sulakshana

Lodhi

Singh

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. Methods: A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 μg/kg/h along with intravenous dexmedetomidine 0.5 μg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Results: Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Conclusion: Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl.

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Effect of dexmedetomidine infusion on hemodynamic responses in microsurgery of larynx

Cited by 6 publications

References 21 publications

Dexmedetomidine vs. Fentanyl-Midazolam Combination to Mitigate the Stress Response in Microlaryngoscopy: A Randomized Double-blind Clinical Trial

Dexmedetomidine vs. Fentanyl-Midazolam Combination to Mitigate the Stress Response in Microlaryngoscopy: A Randomized Double-blind Clinical Trial

Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta‐Analysis

A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia

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