Single‐dose dexmedetomidine attenuates airway and circulatory reflexes during extubation

Güler, Gülen; Akın, Aynur; Tosun, Zeynep; Eskitascoglu, E.; Mızrak, Ayşe; Boyacı, Adem

doi:10.1111/j.1399-6576.2005.00780.x

Cited by 197 publications

(196 citation statements)

References 26 publications

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“…Dexmedetomidine combined with remifentanil delayed the time to awakening and extubation; this is contrary to a previous report using dexmedetomidine alone at the same dose of 0.5 lgÁkg -1 . 23 Nevertheless, a single dose of dexmedetomidine did not prolong the PACU LOS in accordance with a previous study of intraoperative dexmedetomidine infusion. 12 The incidence of coughing in our study was relatively high (64% in Group D and 91% in Group P, respectively) compared with previous studies (up to 74%, even in a placebo control group) in patients after thyroidectomy under sevoflurane and remifentanil.…”

Section: Discussionsupporting

confidence: 89%

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Lee

Choi

Kang

et al. 2014

Can J Anesth/J Can Anesth

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Purpose Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia. Methods American Society of Anesthesiologists physical status I-II adults undergoing elective thyroidectomy under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5 lgÁkg -1 iv (Group D, n = 70) or saline (Group S, n = 71), each combined with a low-dose remifentanil infusion ten minutes before the end of surgery. Coughing was assessed using a four-point scale. The respiratory rate (RR), heart rate (HR), and mean arterial pressure were also recorded. Results The incidence of coughing was lower in Group D than in Group S (64% vs 91%, respectively; mean difference 27%; 95% confidence interval [CI] 13 to 41; P \ 0.001). The median cough grade at extubation was also lower in Group D. Mean arterial pressure and HR were elevated in Group S during tracheal extubation but were similar to baseline values in Group D. There was no difference in RR between the two groups throughout the study. A small delay in extubation was observed in Group D (3 minutes longer than Group S; 95% CI 2 to 4; P \ 0.001). Conclusion Compared with an infusion of low-dose remifentanil alone, the addition of a single dose (0.5 lgÁkg -1 ) of dexmedetomidine during emergence from sevofluraneremifentanil anesthesia was effective in attenuating coughing and hemodynamic changes and did not exacerbate respiratory depression after thyroid surgery. This trial was registered at Clinicaltrial.gov, identifier: NCT01774305. RésuméObjectif Il a été rapporté que le maintien d'une perfusion de remifentanil pendant l'émergence anesthésique diminuait This study was presented as a scientific poster at the

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Section: Discussionsupporting

confidence: 89%

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Lee

Choi

Kang

et al. 2014

Can J Anesth/J Can Anesth

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“…This correlate with study done by Guler G et al and Turan G et al as they found no significant difference between the dexmedetomidine group and control group in respect to complications. 16,17 …”

Section: Discussionmentioning

confidence: 99%

“…15 Guler G et al used same dose of dexmedetomidine as was used in present study and found similar results which correlate with our findings. 16 Dexmedetomidine produces dose dependent decrease in heart rate and blood pressure associated with a decrease in serum norepinephrine concentration. In CNS, activation of α-2 receptor leads to decrease in sympathetic outflow and an increase in vagal activity.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of intravenous dexmedetomidine on haemodynamic responses during tracheal extubation in patients undergoing craniotomies

Goyal

Bandil²,

Bansal

2017

Int J Res Med Sci

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Background: Dexmedetomidine an α2 agonist reduces heart rate and blood pressure due to sympatholytic activity. The aim of this study was to evaluate the effect of dexmedetomidine on haemodynamic response during endotracheal extubation in patients undergoing craniotomies for intracranial space occupying lesion (ICSOL).Methods: Sixty patients of ASA grade I and II, age 18-50 years scheduled for craniotomy for nonvascular ICSOL were selected after randomization into 2 groups with 30 patients in each group. Group D and C received an IV infusion of dexmedetomidine 0.5 mg/kg and normal saline 100 ml respectively over 10 min at the time of skin closure in a double-blind manner. Heart rate, systolic and diastolic blood pressure were recorded just before drug administration, 3 and 5 minutes after drug administration, during extubation and at 3, 5, 10 and 15 minutes after extubation. Respiratory rate and oxygen saturation were analyzed at 3, 5, 10 and15 minutes after extubation. Any laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension and bradycardia was noted.Results: Heart rate, systolic and diastolic blood pressure increased during emergence time in both groups (p<0.05) but this increase was more significant in control group than group D. SBP and heart rate were significantly lower in group D from 3 minutes after drug administration to 15 minutes after extubation. DBP was lower in group D during extubation till 15 minutes after extubation (p<0.01). No significant differences were observed in the respect of adverse events between the groups.Conclusions: Intravenous dexmedetomidine 0.5 mg/kg before extubation is attenuates haemodynamic response during endotracheal extubation in craniotomies.

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“…We identified 425 studies between 1988 and July 2007, of which 20 studies [13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] fulfilled our inclusion criteria ( Fig. 1).…”

Section: Included Studiesmentioning

confidence: 99%

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Biccard¹,

Goga²,

Beurs³

2007

Anaesthesia

122

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SummaryWe conducted a systematic review of the effects of dexmedetomidine on cardiac outcomes following non-cardiac surgery. We included prospective, randomised peri-operative studies of dexmedetomidine that reported mortality, cardiac morbidity or adverse drug events. A PubMed Central and EMBASE search was conducted up to July 2007. The reference lists of identified papers were examined for further trials. Of 425 studies identified, 20 were included in the metaanalysis (840 patients). Dexmedetomidine was associated with a trend towards improved cardiac outcomes; all-cause mortality (OR 0.27, 95% CI 0.01-7.13, p = 0.44), non-fatal myocardial infarction (OR 0.26, 95% CI 0.04-1.60, p = 0.14), and myocardial ischaemia (OR 0.65, 95% CI 0.26-1.63, p = 0.36). Peri-operative hypotension (26%, OR 3.80, 95% CI 1.91-7.54, p = 0.0001) and bradycardia (17%, OR 5.45, 95% CI 2.98-9.95, p < 0.00001) were significantly increased. An anticholinergic did not reduce the incidence of bradycardia (p = 0.43). A randomised placebocontrolled trial of dexmedetomidine is warranted. Major peri-operative cardiac events (cardiac death, nonfatal myocardial infarction and non-fatal cardiac arrest) have been reported in 1.4% of unselected patients undergoing elective non-cardiac surgery [1,2] and between 2.6 and 5.8% in selected patients considered to be at risk of cardiac disease [1]. Peri-operative cardiac events are approximately evenly distributed between myocardial oxygen supply demand imbalance and plaque rupture [3,4]. In addition, these cardiac events may be precipitated by a number of potential triggers in the perioperative period, including inflammation, surgical stress, hypercoagulable states and peri-operative hypoxic episodes [1]. It has therefore been estimated that, at best, a single medical therapy could be expected to result in a relative risk reduction of 20-35% for the composite endpoint of cardiac death, non-fatal myocardial infarction and non-fatal cardiac arrest in the peri-operative period [2].There has been considerable interest in the utility of adrenergic antagonists in decreasing peri-operative cardiac events. Beta-adrenergic antagonists decrease peri-operative myocardial ischaemia, although it is controversial whether this results in an improved cardiac outcome [5,6]. In addition, beta-adrenergic antagonists significantly increase the incidence of drug-associated hypotension and bradycardia which require treatment [6]. It is unclear whether these side-effects adversely affect the cardioprotective efficacy of peri-operative beta-blockade.Unfortunately, some patients may not realise the potential cardioprotective benefits of peri-operative beta-blockade, as this may be either contra-indicated or difficult to initiate in the peri-operative period in patients with active bronchospasm, conduction disorders or decompensated cardiac failure. Alpha-2 agonists may be an alternative anti-adrenergic therapy in these patients. Alpha-2 agonists decrease central noradrenergic activity of the locus coeruleus [7] with a decrease in...

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Single‐dose dexmedetomidine attenuates airway and circulatory reflexes during extubation

Abstract: These findings suggest that a single-dose bolus injection of dexmedetomidine before tracheal extubation attenuates airway-circulatory reflexes during extubation.

Cited by 197 publications

References 26 publications

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

The effectiveness of intravenous dexmedetomidine on haemodynamic responses during tracheal extubation in patients undergoing craniotomies

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

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