RETRACTED ARTICLE: Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery

Polat, Reyhan; Peker, Kevser; Baran, İlkay; Aydın, Gülümser; Gülöksüz, Çiğdem Topçu; Dönmez, Aslı

doi:10.1007/s00101-015-0077-8

Cited by 43 publications

(69 citation statements)

References 33 publications

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“…In addition, in adult patients undergoing orthognathic surgery, the addition of a single dose of dexmedetomidine (1 μg/kg) to postoperative remifentanil infusion (0.02 μg/kg/min) did not reduce the incidence of EA compared with remifentanil infusion alone [85]. In adult patients undergoing nasal surgery with desflurane anesthesia, dexmedetomidine infusion (0.04 μg/kg/h) from the induction of anesthesia to extubation showed a better EA preventive effect than placebo (saline) infusion; however, it was inferior to remifentanil infusion (0.05 μg/kg/min) [121].…”

Section: α2-adrenoreceptor Agonistsmentioning

confidence: 83%

Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

114

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This article is protected by copyright of Korean Journal of Anesthesiology. All rights reserved. Emergence agitation (EA), which is also referred to as emergence delirium, can lead to clinically significant consequences. The mechanism of EA remains unclear. Proposed contributors to EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preor intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce the adverse consequences of EA. Several tools are available for assessing EA; however, its incidence varies considerably according to the assessment tool and definition of EA used, due to the absence of standardized clinical research practice guidelines. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may contribute to prevention of EA. However, it is difficult to identify patients at high risk for EA and to properly apply EA prevention methods in various clinical situations, because both risk factors and preventive strategies often show inconsistent results depending on the methodology of the study and the patients assessed. This review discusses the most important research topics related to EA and directions for future research.

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Section: α2-adrenoreceptor Agonistsmentioning

confidence: 83%

Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

114

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“…[ 6 , 13 ] However, despite the direct activation of NMDA receptors by remifentanil, [ 27 ] infusion of remifentanil resulted in smooth awakening from anesthesia and was also effective in decreasing the incidence of EA. [ 4 , 25 ] These findings suggest that potent analgesic activity may be more important in preventing EA than NMDA receptor inhibition. Previous studies support this suggestion.…”

Section: Discussionmentioning

confidence: 97%

“…[ 1 ] In particular, patients undergoing nasal surgery commonly complain of a sense of suffocation due to intranasal packing and manifest agitation during emergence. [ 2 – 4 ] EA can cause serious problems, such as reoperation due to bleeding of the surgical site, falling out of bed, injury to the patient or medical staff, and unplanned endotracheal tube extubation. [ 5 ] Several pharmacological methods, including opioid (fentanyl, remifentanil), propofol, benzodiazepine (midazolam), α 2 -aderenoreceptor agonist (clonidine, dexmedetomidine), and N -methyl- d -aspartate (NMDA) receptor antagonist (ketamine, magnesium sulfate) administration, have been introduced to mitigate EA.…”

Section: Introductionmentioning

confidence: 99%

Effects of nefopam on emergence agitation after general anesthesia for nasal surgery

Jee

You²,

Sung³

et al. 2017

Medicine

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Background:Emergence agitation (EA) occurs frequently after nasal surgery. N-methyl-d-aspartate (NMDA) receptor antagonists and analgesics, such as fentanyl, have been shown to prevent EA. Nefopam inhibits the NMDA receptor and shows a potent analgesic effect. We investigated the effects of nefopam on EA in patients undergoing nasal surgery.Methods:In this prospective, double-blind study, 100 adult patients were allocated randomly to 1 of 2 groups (each n = 50). Patients received 20 mg of nefopam in 98 mL of saline for 20 minutes immediately after induction of anesthesia (nefopam group) or 100 mL of saline (control group) in the same manner. After surgery, the incidence and degree of EA, time for extubation, hemodynamic parameters, and adverse events were evaluated by an observer blinded to the group allocation.Results:The overall incidence of EA was lower in the nefopam group than in the control group (34% [17/50] vs 54% [27/50], respectively; P = .044). The incidence of severe EA was also lower in the nefopam group than in the control group (8% [4/50] vs 38% [19/50], respectively; P = .001). Heart rate (HR) was higher in the nefopam group than in the control group from the end of surgery to 3 minutes after extubation (P = .008). Time for extubation and adverse events were similar between groups.Conclusions:Nefopam infusion is effective in preventing and reducing the severity of EA after nasal surgery without a delay in extubation. However, caution is required regarding the increase in HR.

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“…In addition, a previous study showed that the sedative characteristics of dexmedetomidine can suppress the sensitivity of tracheal stimulation, which then results in cough inhibition [23]. However, several studies have shown that a dexmedetomidine infusion, at a rate of 0.4 μg/kg/h during the operation period, did not inhibit cough [24,25]. Park et al [23].…”

Section: Discussionmentioning

confidence: 99%

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Li²,

Wang

et al. 2019

Preprint

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Background：Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery. Methods：One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 µg/kg loading, 0.4 µg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded. Results: The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) (P=0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P<0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation (P<0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 hours after surgery (P<0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery(P<0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group (P<0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group. Conclusion: Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed time to awareness when compared with lidocaine and normal saline.

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RETRACTED ARTICLE: Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery

Cited by 43 publications

References 33 publications

Emergence agitation: current knowledge and unresolved questions

Emergence agitation: current knowledge and unresolved questions

Effects of nefopam on emergence agitation after general anesthesia for nasal surgery

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

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