Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol

Amin, Sabry Mohamed; Elmawy, Mohamed Gamal

doi:10.1016/j.egja.2016.05.003

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…However, this intervention had no effect on the intraoperative ESRT. TIVA using propofol and remifentanil anesthesia provides satisfactory surgical conditions as they can be titrated to the desired mean arterial blood pressure, not interfere with the ESRT testing, allows rapid emergence from anesthesia with a faster discharge from the PACU,[ 10 11 ] and less postoperative nausea and vomiting. [ 12 ] However, large doses of intraoperative remifentanil usually result in hyperalgesia and there is more need of postoperative opioid rescue[ 13 ] Opioid analgesics compound the problem of PONV, cause excessive sedation, and delay discharge.…”

Section: Discussionmentioning

confidence: 99%

“…The mean and standard deviation of the postoperative tramadol consumption from a previous study were respectively 18.25 mg and 11.57 mg.[ 10 ] A minimum sample size should be 30 patients per group was needed to detect a 8.5 mg reduction in tramadol consumption, with a significance level 5% and a power of 90%. A total sample size of, 70 patients were included to allow for a dropout rate of 15%.…”

Section: Methodsmentioning

confidence: 99%

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Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery

Bakhet

Wahba

Fiky

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA. Material and Methods: Prospective, randomized, double-blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, n = 35) or control (CT group, N = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well. Results: The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, P < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2–12] vs. 3 [0–8] h, P < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) μg/kg/min; P = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups. Conclusion: Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery

Bakhet

Wahba

Fiky

et al. 2020

J Anaesthesiol Clin Pharmacol

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“…Amin et al, concluded that, both dexmedetomidine and esmolol are safe and effective in inducing controlled hypotension which decrease the surgical area bleeding score and provide ideal surgical condition in children undergoing cochlear implant surgery under general anesthesia [11]. Shams et al reported that, both dexmedetomidine and esmolol were used in patients undergoing FESS and it was found to be safe agents for inducing controlled hypotension and effective in providing better surgical field.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Amin et al concluded that, dexmedetomidine decrease postoperative opioid consumption in children undergoing cochlear implant surgery when compared to patients received esmolol [11].…”

Section: Discussionmentioning

confidence: 99%

Controlled Hypotensive Anesthesia in Children Undergoing Nasal Surgery

Amin¹,

Elmawy²

2016

J Anesth Clin Res

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“…Amin and El-Mawy [35] studied optimizing surgical field during cochlear implant surgery in children by dexmedetomidine versus esmolol and found that the time to first analgesic request was statistically significant longer in dexmedetomidine group.…”

Section: Gao Et Al [19]mentioning

confidence: 99%

Comparison between Dexmedetomidine and Esmolol for Hypotensive Anaesthesia during Functional Endoscopic Sinus Surgery in Children

Sharaf¹,

Elnasr

Amin³

et al. 2018

The Medical Journal of Cairo University

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Background: The nasal surgery in pediatric patient's caries a major challenge to both anesthesiologist and surgeon. The surgeon faces small nostrils and narrow nasal passages. The anesthesiologist has to produce condition which facilitate the surgery, decrease the operative time by minimize the intraoperative bleeding to allow better visualization this can be achieved by controlled hypotensive anesthesia which is the key issue in the success of nasal surgery in pediatric age group. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Aim: The aim of this study is to compare between dexmedetomidine and esmolol for controlled hypotensive anaesthesia in children undergoing functional endoscopic sinus surgery. Methods and Material: This study was carried out on 60 children, 8-12 years, ASA I-II, scheduled for elective functional endoscopic sinus surgery under general anesthesia. Patients were randomized into two equal groups (30 patients in each group): Group D (I): (Precedex®, Meditera, 200µ g/2mL) patients received loading dose of dexmedetomidine 1 µg/kg diluted in 10ml 0.9% saline infused over 10min before induction of anesthesia, followed by continuous infusion of (0.4 µ g/kg/h). Group E (II): (Brevibloc®, Eczacibasi, 100mg/ 10mL) patients received esmolol as a loading dose 1mg/kg diluted in 10ml 0.9% saline was infused over 1min befor induction of anesthesia followed by continuous infusion of (50µ g/kg/h). In all patients, anaesthesia was induced with propofol 2 mg/kg and fentanyl (1 µg/kg) and cis-atracurium 0.15mg/kg. The lung was mechanically ventilated for 3 minutes then endotracheal intubation was done with suitable sized tube. The tidal volume and respiratory rates were adjusted to maintain end tidal CO 2 between (32-35mmHg). All patients were mechanically ventilated with 100% O 2. Anaesthesia was maintained with isofurane 1.2% and oxygen.

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Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol

Cited by 5 publications

References 33 publications

Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery

Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery

Controlled Hypotensive Anesthesia in Children Undergoing Nasal Surgery

Comparison between Dexmedetomidine and Esmolol for Hypotensive Anaesthesia during Functional Endoscopic Sinus Surgery in Children

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