Neurocognitive performance under combined regimens of ketamine-dexmedetomidine and ketamine-fentanyl in healthy adults: A randomised trial

Hayley, Amie C.; Green, Maja; Downey, Luke A.; Keane, Michael; Kenneally, Michaela; Adams, Mark B.; Shehabi, Yahya

doi:10.1016/j.pnpbp.2019.109647

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…With the advancement of medical technology and the improvement of living standards, people's requirements for clinical anesthesia e ects and safety have become more stringent. At present, epidural anesthesia, as a common anesthesia method for cesarean section, is characterized by small impact on the fetus and an excellent controllability [2][3][4]. Most parturients are susceptible to a variety of factors during cesarean section, which can cause dramatic mood swings, and due to the lack of knowledge of the operation process and the unfamiliarity to relevant delivery experience, parturients who are to rst experience cesarean section are also prone to anxiety, depression, and other negative emotions, which will seriously reduce the quality of delivery [5,6].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section

Huang

Niu

2022

Evidence-Based Complementary and Alternative Medicine

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Objective: To study the effects of epidural anesthesia with different doses of dexmedetomidine and ropivacaine on postoperative hemodynamics and neonatal outcome of cesarean section parturients. Methods. A total of 90 parturients who underwent cesarean section admitted to our hospital from January 2019 to January 2020 were selected as the research objects and were divided into groups A, B, and C according to different dosages of dexmedetomidine, with 30 cases in each group. Groups A, B, and C were given dexmedetomidine 0.5 μg/kg, 0.8 μg/kg, 1.0 μg/kg, respectively, combined with 0.2% ropivacaine. The anesthesia effect, traction response, hemodynamic indexes, and neonatal Apgar score of the three groups were compared; the “Numerical Rating Scale (NRS) Score” was used to assess the postoperative pain of the parturients, and the “Ramsay Sedation Scale” was used to assess the sedation state of the parturients. Results. The superior anesthesia effect of group B was obtained compared with groups A and C ( P < 0.05 ). Group B witnessed a lower degree of grade III stretching response, as compared to group A ( P < 0.05 ). In comparison with groups A and C, superior results of the heart rate and mean artery pressure (MAP) of group B at T1 and T2 were obtained ( P < 0.05 ). The neonatal Apgar score in group B was lower than those in groups A and C ( P < 0.05 ), and the NRS score of group B was also lower than that of group A ( P < 0.05 ). Compared with groups A and C, group B yielded a more favorable outcome in terms of the Ramsay score ( P < 0.05 ). Conclusion. The use of medium-dose dexmedetomidine in cesarean section parturients is safer and can effectively reduce the impact on maternal hemodynamics, which is worthy of promotion and application.

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Section: Introductionmentioning

confidence: 99%

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section

Huang

Niu

2022

Evidence-Based Complementary and Alternative Medicine

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“…A number of other factors could also be involved, such as physiological sleep observed with dexmedetomidine (in comparison with the other sedative drugs usually used in anesthesia, i.e., propofol and/or halogenated analogs), which could also reduce the POCD [ 27 , 38 – 40 ]. As previously discussed, in our experience, patients with a better postoperative cognitive function are more able to tolerate a higher level of pain compared to patients with POCD.…”

Section: Discussionmentioning

confidence: 99%

Lessons from the Analysis of a Retrospective Cohort of Patients Who Underwent Large Open Abdominal Surgery Under Total Intravenous Opioid-Free Anesthesia

Estèbe

Morel

Daouphars

et al. 2020

Drugs - Real World Outcomes

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Background Opioid-free anesthesia (OFA) is a new method of anesthesia based on a paradigm shift. Under general anesthesia, the physiology and/or the pathophysiological variations clinically observed are more a reflection of a systemic reaction to the stress (surgical and anesthesia stresses) than a true reflection of pain. Objective To report the results of a large monocenter, retrospective, non-interventional observational study of all consecutive patients who received a total intravenous (IV)-OFA protocol for the surgical management of major open abdominal and urological surgery. Patients and Methods We retrospectively extracted the anesthesia files of 311 consecutive patients (regional anesthesia excluded). No opioids were administered to any of these patients during the surgery. IV morphine administered in the recovery room was the primary endpoint of the study. The secondary endpoints included the amount of opioid required during the first two postoperative days, as well as the maximum pain intensity. Results Only very small doses of IV morphine were administered. The mean total morphine titration was 2 mg (1.9 ± 2.9 mg), corresponding to control of the maximal level of pain to 2.1 ± 2.6 as evaluated with a numerical scale in the postoperative care unit. Similarly, we observed a very low level of morphine consumption during the first two postoperative days. Conclusions These results highlight the safety and the feasibility of our total IV-OFA protocol, thus confirming this new paradigm. Under general anesthesia, the cardiovascular and inflammatory response to the stress could be reliably managed through a multimodal approach without a need for opioids. In the postoperative period, very low doses of opioids were required. Key Points Anesthesia without opioids during large open abdominal surgery does not increase the pain and/or the postoperative opioid requirement. The benefits of opioid-free anesthesia include faster rehabilitation. Pain is probably best prevented by a multimodal approach rather than focusing on an opioid prescription.

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“…Ketamine is widely applied in numerous clinical fields despite its mixed effects as it is safe and effective as a short-term analgesic, while an excessive dose can be associated with psychodysleptic consequences [8]. From the perspective of PND mitigation, different doses of ketamine are known to influence alterations of neurocognition [9]. As an n-methyl-D-aspartate (NMDA) receptor antagonist which safeguards neurons, ketamine (subanesthetic dose) was previously shown to diminish PND following a heart operation [10].…”

Section: Introductionmentioning

confidence: 99%

Role of Different Doses of Ketamine in Postoperative Neurocognitive Function in Aged Mice Undergoing Partial Hepatectomy by Regulating the Bmal1/NMDA/NF-Κb Axis

et al. 2021

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Background: The current study set out to probe the function of different doses of ketamine in postoperative neurocognitive disorder (PND) in aged mice undergoing partial hepatectomy (PH) with the involvement of the brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 (Bmal1)/n-methyl-D-aspartate (NMDA)/nuclear factor-kappa B (NF-κB) axis. Methods: First, aged mice were intraperitoneally injected with different doses of ketamine prior to surgery, followed by hepatic lobectomy. Afterward, mice cognitive function was assessed. In addition, Bmal1 mRNA expression patterns were quantified, while NMDA 2B receptor, NF-κB p65, synapsin 1, and postsynaptic density 95 (PSD95) levels were determined; the release of inflammatory factors was detected, and ionized calcium-binding adapter molecule-1 expression was measured to quantify microglia activation. In addition, Bmal1-knockout (Bmal1-KO) mice were intraperitoneally injected with a subanesthetic dose of ketamine to verify the mechanism of Bmal1 in regulating the NMDA 2B subunit (NR2B)/NF-κB axis to affect PH in aged patients. Results: After PH, hippocampal-dependent memory was impaired, and synapsin 1 and PSD95 levels were downregulated. On the other hand, PH diminished Bmal1 expression but elevated NR2B and NF-κB p65 levels and anesthetic doses of ketamine further regulated the Bmal1/NMDA/NF-κB axis. In Bmal1-KO mice, the NMDA/NF-κB axis was activated, the release of inflammatory cytokines was promoted, and hippocampus-dependent memory was impaired, which were reversed by a subanesthetic dose of ketamine. Conclusion: Altogether, findings obtained in our study indicated that a subanesthetic dose of ketamine activated Bmal1, downregulated the NMDA/NF-κB axis, and reduced inflammation and microglia activation to alleviate PND in aged mice undergoing PH.

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Neurocognitive performance under combined regimens of ketamine-dexmedetomidine and ketamine-fentanyl in healthy adults: A randomised trial

Cited by 4 publications

References 33 publications

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section

Lessons from the Analysis of a Retrospective Cohort of Patients Who Underwent Large Open Abdominal Surgery Under Total Intravenous Opioid-Free Anesthesia

Role of Different Doses of Ketamine in Postoperative Neurocognitive Function in Aged Mice Undergoing Partial Hepatectomy by Regulating the Bmal1/NMDA/NF-Κb Axis

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