Effects of dexmedetomidine versus remifentanil on mothers and neonates during cesarean section under general anesthesia

Yu, Zhiqiang; Zhang, Peijun; Wang, Haiyun; Zhang, Li; Wei, Wei; Fang, Wenqian; Mu, Xingbo

doi:10.5507/bp.2019.055

Cited by 10 publications

(23 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The subsequent resumption of spontaneous breathing allows the patient to be removed early after surgery without causing respiratory depression. However, the increase of blood pressure during endotracheal intubation and surgical stimulation can be inhibited by remifentanil and mainly manifested as dose-dependent decline in blood pressure and heart rate [ 14 , 15 ]. The effect of using remifentanil commonly occurs dilating blood vessels and slowing heart rate resulting in bradycardia during anesthesia, while the symptoms of bradycardia disappear after anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Qin

2021

Journal of Healthcare Engineering

View full text Add to dashboard Cite

In this study, we have investigated feasibility of remifentanil and sufentanil anesthesia in children with congenital heart disease surgery and its effects on cardiac function and serological parameters. For this purpose, a retrospective study was conducted on 120 children with congenital heart disease who underwent repair of ventricular septum or atrial septum in our hospital, specifically from January 2016 to January 2018, and 60 patients in each group were randomly divided into the control and treatment groups, respectively. The control group was anesthetized with sufentanil, and the treatment group was anesthetized with remifentanil. The heart function, serological indexes, and adverse reactions were observed and compared. We have observed that there was no significant difference in HR levels between these groups ( P > 0.05 ), but SDP and DBP values of the two groups were decreased after anesthetic induction ( P < 0.05 ). ACH, cortisol, and lactic acid in the treatment group were significantly lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). The incidence of bradycardia, nausea and vomiting, hypotension, muscle rigidity, and respiratory depression in the treatment group was 16.67% lower than that in the control group ( P < 0.05 ). Remifentanil has less influence on hemodynamics and a better analgesic effect than fentanyl in inhibiting stress response in congenital heart surgery, which provides reference and basis for children congenital heart surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Qin

2021

Journal of Healthcare Engineering

View full text Add to dashboard Cite

show abstract

“…However, cTnI is a highly sensitive and specific biomarker in the diagnosis of myocardial injury in the clinic (31). In addition, Dex inhibits the release of catecholamines to reduce HR (32), which prolongs coronary perfusion and simultaneously reduces myocardial oxygen consumption, thus improving the maintenance of the myocardial oxygen supply-demand balance (33,34). Dex is also able to increase the ischemic to non-ischemic myocardial blood flow ratio during myocardial ischemia in the perioperative period (35,36).…”

Section: Discussionmentioning

confidence: 99%

Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

et al. 2021

View full text Add to dashboard Cite

The aim of the present study was to compare the effects of two methods of dexmedetomidine (Dex) administration on myocardial injury, inflammation and stress in ischemic myocardium during rheumatic heart valve replacement. In total, 90 patients were included in the present study and were divided into the following three groups: i) Dex group (1.0 µg/kg Dex pre-administered 10 min prior to anesthesia, then 0.5 µg/kg/h Dex for maintenance); ii) Dex pre-conditioning group (Pre-Dex; 1.0 µg/kg Dex administered 10 min prior to anesthesia, then saline for maintenance); and iii) control group (saline 10 min prior to anesthesia and saline during maintenance), with 30 patients in each group. Heart rate (HR) and mean artery pressure (MAP) were recorded at eight time-points: i) T1, pre-medication; ii) T2, 10 min post-medication; iii) T3, immediately post-intubation; iv) T4, upon skin incision; v) T5, upon sawing the sternum; vi) T6, immediately post-cardiopulmonary bypass; vii) T7, immediately post-operation; and viii) T8, 24 h post-operation. The serum cardiac troponin I (cTnI), interleukin (IL)-8, IL-10 and malondialdehyde (MDA) levels were also detected at T1, T6, T7 and T8. Blood glucose levels were detected at T1, T5, T6 and T7. In comparison with the control group, patients in the Dex group exhibited a significant increase in cardiac function, as indicated by an increase in HR, MAP and IL-10 levels, and a significant decrease in cTnI, IL-8, MDA and glucose levels. Both Dex perfusion and Dex preconditioning were able to reduce myocardial injury, inflammation, oxidative stress and stress response in rheumatic heart valve replacement surgery. However, Dex perfusion during the whole surgery was more effective than Dex preconditioning treatment. The study was registered with the Chinese Clinical Trial Registry (ChiCTR; no. ChiCTR-INR-17011955).

show abstract

“… 152 Another report indicated that during general anesthesia for cesarean section, although remifentanil demonstrated better control of hemodynamic stability, dexmedetomidine rather demonstrated better neonatal Apgar scores, postoperative analgesia, and decreased catecholamine release. 139 However, other studies have reported no significant difference in the effect of dexmedetomidine and remifentanil on maternal hemodynamics and bi-spectral index, and neonatal outcomes in elective cesarean delivery, although remifentanil still has the potential to cause neonatal transient respiratory depression. 153 …”

Section: Comparative Studies With Other Agentsmentioning

confidence: 97%

“… 138 An assessment of its effect on both the mothers and neonates during cesarean section under general anesthesia indicates that dexmedetomidine presents better neonatal Apgar scores, postoperative analgesia, and decreased catecholamine release. 139 Moreover, the use of dexmedetomidine in the perioperative period of cesarean section is not only conducive to the early conversion of infant feeding to exclusive breastfeeding but can also enhance the recovery quality and comfort of the parturient, optimize analgesia, reduce the time to the first lactation, and increase lactation. 140 …”

Section: Key Surgical Applicationsmentioning

confidence: 99%

“… [ 151 ] Dexmedetomidine vs propofol Phase I clinical trial Study of brain functional connectivity during sleep There is the rapid recovery of oriented responsiveness to external stimulation under dexmedetomidine sedation compared to propofol [ 157 ] Dexmedetomidine vs fentanyl Systematic review and meta-analysis Compare effects as adjuvants to local anesthetics in spinal anesthesia Dexmedetomidine performs better by prolonging the duration of spinal anesthesia, improving postoperative analgesia, reducing the incidence of pruritus, and not increasing the incidence of hypotension and bradycardia. [ 152 ] Dexmedetomidine vs propofol Randomized controlled trial Compare the effect on delirium after cardiac surgery Dexmedetomidine reduces incidence, delays onset, and shortens the duration of postoperative delirium [ 131 ] Dexmedetomidine vs remifentanil Randomized controlled trial Compare the effects on mothers and neonates during cesarean section under general anesthesia Remifentanil was better in controlling hemodynamic stability, but dexmedetomidine was better in neonatal Apgar scores, postoperative analgesia, and decreasing catecholamine release [ 139 ] Dexmedetomidine vs remifentanil Comparative study Evaluate the effects on maternal and neonatal outcomes in elective cesarean delivery Both drugs are effective to blunt hemodynamic responses to intubation and also seem safe for neonates, but remifentanil still has the potential to cause neonatal transient respiratory depression. [ 153 ] Dexmedetomidine vs propofol Randomized Trial To assess which will lower postoperative opioid analgesic consumption after total knee arthroplasty Dexmedetomidine sedation is associated with a small but clinically important reduction in postoperative opioid use [ 154 ] Dexmedetomidine vs fentanyl Randomized controlled trial …”

Section: Comparative Studies With Other Agentsmentioning

confidence: 99%

See 1 more Smart Citation

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Liu¹,

Li²,

Kang³

et al. 2021

JIR

View full text Add to dashboard Cite

Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

show abstract

Effects of dexmedetomidine versus remifentanil on mothers and neonates during cesarean section under general anesthesia

Cited by 10 publications

References 27 publications

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Contact Info

Product

Resources

About