Effect of epidural dexmedetomidine on intraoperative awareness and post‐operative pain after one‐lung ventilation

Elhakim, M.; Abdelhamid, Dalia; Abdelfattach, H.; Magdy, Hadil; Elsayed, Asmaa Mohamed; Elshafei, Mohamed

doi:10.1111/j.1399-6576.2009.02199.x

Cited by 76 publications

(79 citation statements)

References 34 publications

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“…Its sedative effects have also been well-studied, and its use in paediatric populations, cardiovascular anaesthesia, and regional anaesthesia is increasing. Elhakimand colleagues have reported that the use of epidural dexmedetomidine during OLV resulted in significant decreases in anaesthetic requirement, prevented awareness during anaesthesia, and improved intraoperative oxygenation and post-operative analgesia [6].…”

Section: Discussionmentioning

confidence: 99%

“…It is a widely used anaesthetic adjunct, and there has been a growing interest in its use in different patient populations, regional anaesthesia, critical care, and thoracic surgery [4]- [6]. Dexmedetomidine has all of the features of clonidine but has not been associated with respiratory depression, which can make it a beneficial supplement in the clinical setting [7] [8].…”

Section: Introductionmentioning

confidence: 99%

“…Dexmedetomidine has all of the features of clonidine but has not been associated with respiratory depression, which can make it a beneficial supplement in the clinical setting [7] [8]. The effects of clonidine on oxygenation during OLV [9], as well as the effects of epidural dexmedetomidine administration on intraoperative awareness and post-op pain after OLV [6], have been examined in previous studies. Regarding the effect of intravenously administered dexmedetomidine on oxygenation during OLV, there is only one study with lower doses showing that there is no significant change in PaO 2 [10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

Büget¹,

Sungur²,

Özkan³

et al. 2015

OJAnes

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

Büget¹,

Sungur²,

Özkan³

et al. 2015

OJAnes

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“…12,13 It is observed in various studies that dexmedetomidine as an epidural adjuncts prolong the motor/ sensory block duration time and post-operative analgesia without any additional morbidity.14,15 Clinical studies exhibit potentiation of neuraxial local anaesthetics, decrease in intraoperative anaesthetic requirement with prevention of intraoperative awareness, improved intra-operative oxygenation, and postoperative analgesia when epidural or caudal dexmedetomidine was used in conjunction with general anaesthesia. [16][17][18] Most of the clinical experience gained in the use of intrathecal alpha2 adrenoreceptor agonists has been described with clonidine. [19][20][21][22] In our study, the intrathecal dose of dexmedetomidine selected was based on previous human studies wherein no neurotoxic effects have been observed.…”

Section: Discussionmentioning

confidence: 99%

A comparison of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine for gynecological surgery

Anandani

Shelat

Vaniya

et al. 2015

Int J Basic Clin Pharmacol

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INTRODUCTIONThe anesthesia of choice most commonly used for gynecological surgery is regional anesthetic technique. Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operative analgesia.Most of the clinical studies about the intrathecal alpha2 adrenergic agonist are related to clonidine. 1 Dexmedetomidine, the highly selective alpha2 adrenergic agonist, is used for various procedures in the perioperative period.2 Based on earlier human studies, intrathecal 5 mcg dexmedetomidine would produce longer duration of analgesic effect in spinal anesthesia with minimal side effects. [4][5][6][7] Where gradually evolving studies can build the evidence for its safe use in central neuraxial blocks. ³We explore its usefulness and also compare this new alpha2 adrenergic agonist with the previously established and widely used adjuncts. METHODSWe select 60 adult females belonging to ASA Grades 1 and 2 scheduled for gynecological surgery under subarachnoid block, were enrolled in this prospective and randomized study. Patients with contraindication to regional anesthesia, history of signifi cant co-existing diseases, such as ischemic ABSTRACT Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective alpha2 adrenergic agonist, is a new neuraxial adjuvant gaining popularity. The purpose of this study was to compare the onset, duration of sensory and motor block, hemodynamic effects, post-operative analgesia, and adverse effects of dexmedetomidine and clonidine with hyperbaric 0.5% bupivacaine for spinal anesthesia. Methods: 60 patients belonging to ASA Grade 1 and 2 undergoing elective gynecological surgery under spinal anesthesia were studied in this prospective. The patients were allocated in two groups (30 patients each). Group bupivacaine + clonidine (BC) received 17.5 mg of bupivacaine supplemented 45 mcg clonidine and Group bupivacaine + dexmedetomidine (BD) received 17.5 mg bupivacaine supplemented 5 mcg dexmedetomidine. The onset time of sensory and motor level, time to reach peak sensory and motor level, the regression time of sensory and motor level, hemodynamic changes, and side effects were recorded. Results: Patients in Group BD had signifi cantly longer sensory and motor block time than patients in Group BC. The onset time to reach dermatome T4 and modifi ed Bromage3 motor block were not significantly different between two groups. Dexmedetomidine group showed signifi cantly less and delayed requirement of rescue analgesic. Conclusion: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability and reduced demand of rescue analgesic in 24 hrs as compared to clonidine.

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“…DM Elhakim et al (2010) compared the effects of a dexmedetomidine-bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with light isoflurane anaesthesia (<0.05 maximum alveolar concentration) in patients undergoing thoracic surgery with One-Lung Ventilation (OLV). They concluded that in thoracic surgery with OLV, the use of epidural dexmedetomidine decreases the anaesthetic requirements significantly, prevents awareness during anaesthesia and improves intraoperative oxygenation and post-operative analgesia.…”

mentioning

confidence: 99%

Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation

Agarwal

Singh

et al. 2015

Int J Res Med Sci

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INTRODUCTIONFor thoracic, abdominal and major orthopaedic surgery epidural anaesthesia and analgesia can provide pain relief for a longer duration and the facility of further top-ups and continuous infusion of the analgesic drugs through epidural catheter thus provides an uneventful and smooth recovery. Almost without exception epidural analgesia regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patientcontrolled analgesia. Bupivacaine is a local anaesthetic drug belonging to the amino amide group and is indicated for nerve block, epidural and intrathecal anaesthesia. It is markedly cardiotoxic but adverse reactions are rare when it is administered correctly.2 Epidural bupivacaine is equally safe and significantly more potent and more economical than epidural ropivacaine. ABSTRACTBackground: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. Methods: Our study had 45 patients, all patients belonged to ASA Grade-I or II, between 20 and 55 years of age with an average height of 150 and 170 cm and have ideal body weight requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups Group-I: Epidural bupivacaine 0.5% (16 ml) + clonidine 75 µgm (1 ml) Group-II: Epidural bupivacaine 0.5 % (16 ml) + Dexmedetomidine 50 µgm (1 ml) Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia, sedation and adverse effects in perioperative period. Results: The time of onset of sensory block at T 10 and time to reach maximum sensory block (T6) in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3) was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia.

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Effect of epidural dexmedetomidine on intraoperative awareness and post‐operative pain after one‐lung ventilation

Abstract: In thoracic surgery with OLV, the use of epidural dexmedetomidine decreases the anaesthetic requirements significantly, prevents awareness during anaesthesia and improves intraoperative oxygenation and post-operative analgesia.

Cited by 76 publications

References 34 publications

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

A comparison of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine for gynecological surgery

Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation

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