Effect of dexmedetomidine on consumption of anesthetic agents, duration of surgery, time to extubation and post-operative emergence during endoscopic nasal surgeries: a pilot study

Kaur, Harpreet; Tiwari, Rajeev Lochan; Bhargava, Jyotsna; Kasliwal, Neeraj

doi:10.21276/sjams.2016.4.6.64

Cited by 4 publications

(7 citation statements)

References 18 publications

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“…Nevertheless, using a high dose of inhaled anesthetics is associated with hepatic or renal injury and a prolonged recovery from anesthesia leading to delayed patient discharge. 9 Recently, dexmedetomidine was identified to attenuate stress-induced hemodynamic responses and produce relatively stable hemodynamics throughout the surgery. Bhagat et al and Gupta et al reported that the intraoperative consumption of fentanyl and isoflurane was significantly less in the dexmedetomidine group.…”

Section: Discussionmentioning

confidence: 99%

“…An increased amount of inhaled anesthetics can also be administrated to decrease blood pressure. Nevertheless, using a high dose of inhaled anesthetics is associated with hepatic or renal injury and a prolonged recovery from anesthesia leading to delayed patient discharge 9 . Recently, dexmedetomidine was identified to attenuate stress‐induced hemodynamic responses and produce relatively stable hemodynamics throughout the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Randomized controlled trials that met the following inclusion criteria were eligible for review: participants underwent nasal surgery (septoplasty, rhinoplasty, or endoscopic sinus surgery) and intraoperative administration of dexmedetomidine via a systemic route. Outcomes analyzed were surgical time, 7,9-13 mean operative blood loss, 2,7,11,12,14,15 surgical field score, 3,15,16 dose of inhaled anesthetic gas, 9,11 dose of fentanyl, 7,9,11 postoperative pain, 3,17,18 the occurrence of postoperative nausea and vomiting (PONV; incidence or percentage of patients), 3,10,15,17-19 intraoperative hypotension, 2,7,12,17 intraoperative bradycardia, 10,12,16-19 residual sedation in recovery room, 12,17,19 and EA. 10,12,17,19 These outcomes were compared preoperatively between the dexmedetomidine group, in which there was intravenous administration, and the control group.…”

Section: Methodsmentioning

confidence: 99%

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Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Lee

Yoon

Jin

et al. 2017

Otolaryngol.--head neck surg.

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Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017. Studies were selected that compared perioperative dexmedetomidine administration (dexmedetomidine groups) with a placebo or remifentanil (control groups) with regard to intraoperative morbidity, including surgical time, bleeding amount, hypotension, and bradycardia during operation, and postoperative morbidity, such as emergence agitation, nausea and vomiting, and sedation after operation. Results Surgical time, intraoperative blood loss, dose of inhaled anesthetic gas, dose of fentanyl, postoperative pain, and incidence of emergence agitation were significantly lower in the dexmedetomidine group versus the placebo group. In contrast, there were no significant differences in intraoperative hemodynamic stability and postoperative residual sedation and nausea and vomiting between groups. Additionally, compared with remifentanil (a currently widely used agent), dexmedetomidine was superior in view of postoperative pain and intraoperative blood pressure control. Conclusion This meta-analysis shows that the systemic administration of dexmedetomidine can decrease surgical time, intraoperative blood loss, and doses of intraoperative inhaled anesthetic gas and fentanyl as compared with placebo. It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Lee

Yoon

Jin

et al. 2017

Otolaryngol.--head neck surg.

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“…This derivative of fentanyl reduces blood pressure by triggering the release of histamine and centrally deactivating vasoconstriction [ 22 ]. In comparison to other opioids, it enhances hemodynamic stability and maintains cerebral blood flow during demanding surgical procedures [ 23 ]. Remifentanil administered via patient-controlled analgesia has shown inhibitory effects on apoptotic pathways and oxidative stress, thereby providing organ protection and reducing inflammatory responses [ 24 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis

Janipour,

Bastaninejad,

mohebbi

et al. 2024

BMC Anesthesiol

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Background Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Methods Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Results Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. Conclusion In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.

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“…Data from the included studies were extracted using standardized forms and independently examined by the two authors. The evaluated outcomes consisted of operative time [1,3,6,, mean intraoperative bleeding [1,6,9,[12][13][14][15]17,22,[25][26][27]33,34,36,37], dose of intraoperative fentanyl administered [1,6,13,15,19,22,30,32,38], postoperative pain [3,7,10,11,22,33,36,39], the occurrence of postoperative nausea and vomiting (incidence or percentage of patients) [3,7,10,11,13,19,22,27,29,31,33,39,40], and intraoperative hypotension…”

Section: Data Extraction and Risk Of Bias Assessmentmentioning

confidence: 99%

The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis

Kim

Lee

Kim

et al. 2021

Clin Exp Otorhinolaryngol

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Objectives. A systematic review of the literature was conducted to evaluate hypotensive agents in terms of their adverse effects and associations with perioperative morbidity in patients undergoing nasal surgery. Methods. Two authors independently searched databases (Medline, Scopus, and Cochrane databases) up to February 2020 for randomized controlled trials comparing the perioperative administration of a hypotensive agent with a placebo or other agent. The outcomes of interest for this analysis were intraoperative morbidity, operative time, intraoperative bleeding, hypotension, postoperative nausea/vomiting, and postoperative pain. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results. Our analysis was based on 37 trials. Treatment networks consisting of six interventions (placebo, clonidine, dexmedetomidine, beta-blockers, opioids, and nitroglycerine) were defined for the network meta-analysis. Dexmedetomidine resulted in the greatest differences in intraoperative bleeding (−0.971; 95% confidence interval [CI], −1.161 to −0.781), intraoperative fentanyl administration (−3.683; 95% CI, −4.848 to −2.518), and postoperative pain (−2.065; 95% CI, −3.170 to −0.960) compared with placebo. The greatest difference in operative time compared with placebo was achieved with clonidine (−0.699; 95% CI, −0.977 to −0.421). All other agents also had beneficial effects on the measured outcomes. Dexmedetomidine was less likely than other agents to cause adverse effects. Conclusion. This study demonstrated the superiority of the systemic use of dexmedetomidine as a perioperative hypotensive agent compared with the other five tested agents. However, the other agents were also superior to placebo in improving operative time, intraoperative bleeding, and postoperative pain.

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Effect of dexmedetomidine on consumption of anesthetic agents, duration of surgery, time to extubation and post-operative emergence during endoscopic nasal surgeries: a pilot study

Cited by 4 publications

References 18 publications

Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis

The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis

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