Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis. Objective It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol. Conclusion This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.
Background Transcatheter Aortic Valve Implantation (TAVI) procedure is being performed under general anesthesia (GA), conscious sedation associated with local anesthesia (CSLA) and local anesthesia alone. There have been limited studies to determine which plan of anesthesia is associated with better results. Aim We aimed in this study to assess the role of CSLA in outcome, complications, mortality and to assess quality of life in immediate post-procedural period (ICU and hospital stay). Methodology After approval of ethical committee, seventy cases of moderate to severe aortic stenosis planned for TAVI were randomized into two groups. Group-GA: received general anesthesia and Group-CSLA: received conscious sedation combined with local anesthesia. We measured intraoperative hemodynamic changes, pH, PaO2, PaCO2, need for inotropic support and need for blood products. Post-operative variables were need for inotropic support, prolonged respiratory support, need for renal dialysis, and incidence of stroke, heart block, aortic regurge as well as mortality. Results The CSLA group showed more incidence of respiratory acidosis with increase in PaCO2 (p=0.024), less decrease in mean arterial blood pressure (p=0.028), less need for inotropic support both intraoperative (p=0.001) and post-operative (p=0.005). The CSLA patients showed less hospital length of stay (LOS) (p=0.006) and less prolonged respiratory support more than 24h (p=0.001) compared to the GA group patients. However, there was no significant difference between the two groups as regards need for blood products (p=0.587) and incidence of complications in the form of renal failure (p=0.113), heart block (p=0.756), aortic regurge (paravalvular leak) (p=0.168) and mortality (p=0.238). There was no incidence of stroke in either group. Conclusion CSLA for TAVI patients in the current study showed better intraoperative hemodynamic stability, less need for inotropic support whether intaoperative or postoperative and less hospital LOS despite the presence of mild acceptable respiratory acidosis. So we can recommend to consider CSLA in such patients.
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