Hemodynamic Impact of Dexmedetomidine Administration in 15,656 Noncardiac Surgical Cases

Klinger, Rebecca Y.; White, William D.; Hale, Betsy; Habib, Ashraf S.; Bennett‐Guerrero, Elliott

doi:10.1097/01.sa.0000425550.59990.25

Cited by 9 publications

(12 citation statements)

References 2 publications

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“…A large‐sample retrospective study by Rebecca et al . showed that patients who had received dexmedetomidine at a dose range of 0.2–0.7 μ g/kg/hour did not report a greater incidence of hypotension and bradycardia . For hypertensive patients in long‐term standard treatment (e.g.…”

Section: Discussionmentioning

confidence: 99%

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Huang

Chen

et al. 2017

BJOG

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Objective To compare the effects of dexmedetomidineremifentanil with the traditional analgesia and sedation regimen midazolam-remifentanil during HIFU treatment of uterine fibroids.Design A randomised controlled trial.Setting Department of Anesthesia in a single hospital. Population Patients with uterine fibroids.Methods A total of 80 patients diagnosed with uterine fibroids and scheduled for selective HIFU treatment were randomly divided into the dexmedetomidine group (the D group) and midazolam group (the M group). At 20 minutes before the HIFU procedure, patients in the D group received a loading dose of 0.8 lg/kg dexmedetomidine, followed by a continuous intravenous infusion of 0.2 lg/kg/hour until the end of the operation. Patients in the M group were given a corresponding amount of 0.9% saline. Patients in the M group received a slow intravenous infusion of 0.03 mg/kg midazolam before the procedure, an intravenous injection of 0.02 mg/kg 30 minutes later, another 0.02 mg/kg 60 minutes later, followed by 0.02 mg/kg at 40-minutes intervals. Patients in the D group were given a corresponding amount of 0.9% saline. During the HIFU procedure, patients in both groups were administered remifentanil at an effect site concentration of 1.0 ng/ml. Sedation and analgesia were rated using the Ramsay Sedation Scale (RSS) and Visual Analogue Scale (VAS) before drug administration (T1), after drug administration but before HIFU (T2), at the beginning of HIFU (T3), 15 minutes later (T4), 45 minutes later (T5), 75 minutes later (T6), and at the end of HIFU (T7). Patient satisfaction score and Steward recovery score survey were conducted 30 minutes after surgery.Main outcome measures Different effects of the traditional midazolam-remifentanil regimen and dexmedetomidineremifentanil.Results All patients in both groups underwent a successful HIFU procedure without developing serious complications during the postoperative period. However, the D group reported significantly fewer cases of respiratory depression than the M group during HIFU treatment (P < 0.05). The pause during HIFU ablation in the D group was significantly shorter than that in the M group. HIFU ablation intensity, the number of patients with an RSS of 3 or 4 measured at different time points, and the number of patients with an RSS of 3 or 4 measured at arousal were significantly greater in the D than the M group (P < 0.05). Likewise, the D group scored significantly higher in the evaluation of patient satisfaction, recovery score, and surgeon satisfaction (P < 0.05).Conclusions Both dexmedetomidine-remifentanil and midazolamremifentanil met the requirements and ensured the safety of HIFU treatment of uterine fibroids. However, compared with the traditional midazolam-remifentanil regimen, dexmedetomidineremifentanil was associated with more stable sedation in patients, more efficient HIFU treatment and higher degree of patient comfort.Keywords Dexmedetomidine, high-intensity focused ultrasound, remifentanil, uterine fibroids.Tweetable abstract Dexmedetomidine-re...

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Section: Discussionmentioning

confidence: 99%

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Huang

Chen

et al. 2017

BJOG

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“…Dexmedetomidine is a more recently approved agent that enables sedation whilst minimizing the risk of respiratory depression and haemodynamic complications. The impact of dexmedetomidine on outcomes after IAMT for AIS needs ongoing research [16,[29][30]. There are 3 major concerns with the use of CS and airway protection in the acute stroke patient: Patients are unlikely to be have been adequately fasted which places them at high risk of pulmonary aspiration and most patients with large cerebral artery occlusion have a degree of dysphagia and may be unable to protect their airway after stroke [31][32].…”

Section: Conscious Sedationmentioning

confidence: 99%

Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? A review of the literature

et al. 2012

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“…A large cohort study included 15,656 non-cardiac surgical cases, of whom 2688 received dexmedetomidine preoperatively or intraoperatively and 12,968 did not receive dexmedetomidine. There was no significant intraoperative hypotension or bradycardia with dexmedetomidine [16].…”

Section: Discussionmentioning

confidence: 85%

Assessment of the effect of dexmedetomidine in high risk cardiac patients undergoing laparoscopic cholecystectomy

Soliman

Zohry

2016

Egyptian Journal of Anaesthesia

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Background: Laparoscopy results in pathophysiologic changes and potentiates a neurohormonal stress response which increases systemic vascular resistance, mean arterial blood pressure, and heart rate and the aim of present study was to evaluate the effect of dexmedetomidine in high risk cardiac patients undergoing laparoscopic cholycystectomy. Methods: The study included 80 patients [cardiac patient with ASA physical status III-IV], and scheduled for elective laparoscopic cholycystectomy. The patients were classified randomly into two groups: Group D: The patients received a loading dose of 1 lg/kg dexmedetomidine over 15 min before induction and maintained with 0.3 lg/kg/h infusion during the procedure. Group C: The patients received an equal volume of normal saline. Results: The heart rate increased greatly after induction in the control group compared to the group D (P < 0.05) and the heart rate remained elevated during the procedures and postoperatively. There was an attack of tachycardia affected 4 patients in group D and 10 patients in group C and the comparison was significant (P = 0.044). The mean arterial blood pressure increased greatly after induction in the control group compared to the group D (P < 0.05) and the mean arterial blood pressure remained elevated during the procedures and post-anesthesia care unit The total fentanyl dose was higher in the group C patients more than group D (P < 0.001). The end-tidal sevoflurane was lower in group D patients than group C patients (P < 0.001). Conclusion: Dexmedetomidine is safe for cardiac patients undergoing laparoscopic cholycystectomy. It minimized the changes in heart rate and blood pressure and decreased the total dose of fentanyl and end-tidal sevoflurane and the requirement for medications in high risk cardiac patients.

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Hemodynamic Impact of Dexmedetomidine Administration in 15,656 Noncardiac Surgical Cases

Cited by 9 publications

References 2 publications

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Application of dexmedetomidine‐remifentanil in high‐intensity ultrasound ablation of uterine fibroids: a randomised study

Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? A review of the literature

Assessment of the effect of dexmedetomidine in high risk cardiac patients undergoing laparoscopic cholecystectomy

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