Postpartum hemorrhage and pregnancy induced hypertension during emergency lower segment cesarean section: dexmedetomidine to our rescue

Hariharan, Uma

doi:10.1016/j.bjane.2014.12.002

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Much of the evidence for dexmedetomidine use comes from trials where its use was preplanned and commenced at or before induction of anaesthesia; in this case, it was used a rescue medication. Another example of addition of a dexmedetomidine rescue infusion in the literature involves a challenging obstetric haemorrhage case in which dexmedetomidine was thought to facilitate reduced bleeding and improved haemodynamic control [8].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as a rescue agent during intracranial neurosurgery in the setting of opioid tolerance

Mackie

Chambers

Sebastian

2022

Anaesthesia Reports

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Dexmedetomidine is a versatile sedative agent widely used both in anaesthesia and intensive care. We present the case of a 32-year-old woman with a long-term history of non-prescribed intravenous opioid use who underwent elective resection of a skull base tumour. There was difficulty in achieving an adequate depth of anaesthesia despite the high levels of intravenous and volatile anaesthetic agent. Intra-operatively, a bolus and subsequent infusion of dexmedetomidine helped achieve an adequate depth of anaesthesia. This report highlights some of the benefits of dexmedetomidine for patients who are opioid tolerant, both intra-and postoperatively. It also demonstrates the wide range of beneficial effects dexmedetomidine could have when used as a rescue adjunct in neuroanaesthesia.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as a rescue agent during intracranial neurosurgery in the setting of opioid tolerance

Mackie

Chambers

Sebastian

2022

Anaesthesia Reports

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“…A previous study demonstrated that decrease in blood pressure is an easily seen sympatholytic effect caused by DXM (Bedirli et al, 2017). Moreover, DXM has been demonstrated to improve the prognosis of patients suffered from PIH and displayed the role in controlling blood pressure as well as uterine bleeding in the process of cesarean section (Hariharan, 2017). Opioids are most frequently applied for PCIA, and TMD has been determined to have analgesic effects for pain after surgery (Schnabel et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…It is important to identify the risk factors for PIH and relieve the burden of the illness. Dexmedetomidine (DXM) has been reported to have a positive role in helping control blood pressure as well as uterine bleeding in the process of cesarean section in patients with PIH (Li et al, 2016a;Hariharan, 2017;Kong et al, 2018). Tramadol (TMD) is a synthetic 4-phenylpiperidine analogue of codeine and possesses a centrally analgesic function (Memarian et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Combination of Dexmedetomidine and Tramadol in Patient-Controlled Intravenous Analgesia Strengthens Sedative Effect in Pregnancy-Induced Hypertension

Zhang

Zhao

et al. 2021

Front. Pharmacol.

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Objective: The aim of the present study is to explore the combination of dexmedetomidine (DXM) and tramadol (TMD) on sedative effect in patients with pregnancy-induced hypertension (PIH).Methods: A total of 356 patients with pregnancy-induced hypertension (PIH) were randomly divided into three groups: DXM, TMD and DXM + TMD groups. These patients were treated with different doses of DXM, TMD or combination of DXM and TMD by a patient-controlled intravenous injection device. The scores of static pain and dynamic pain, sedation degree, and adverse reaction were recorded. The plasma levels of inflammatory mediators IL-10 and C-reactive protein (CRP), and the serum level of p-p38-MAPK were evaluated.Results: It was found that administration with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg result in stronger sedative effect than single administration with DXM or TMD. The mean arterial pressure (MAP) and heart rate (HR) of patients with PIH were decreased with the combinational treatment of DXM and TMD. Interestingly, the PIH patients injected with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg showed stronger sedative effect. In addition, the plasma level of level of IL-10 was increased and CRP decreased. The serum level of p-p38/MAPK was decreased.Conclusion: Taken together, our study indicates that combination of DXM and TMD effectively lowers blood pressure and reduces inflammation through increasing the level of IL-10, reducing CRP and inhibiting p-p38/MAPK in patients with PIH. This study suggests that the combination of DXM and TMD could be an anesthetic choice in the management of PIH.

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Protective effect of dexmedetomidine on kidney injury of parturients with preeclampsia undergoing cesarean section: a randomized controlled study

Zhang

Wang

et al. 2019

Bioscience Reports

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The present study aimed to elucidate the effects of dexmedetomidine on kidney injury of parturients with preeclampsia (PE) undergoing cesarean section. Total 134 cesarean delivery women with PE were randomly divided into intervention group (IG) and control group (CG). Both groups underwent combined spinal and epidural anesthesia (CSEA), the IG was treated with 0.4 μg/(kg·min) dexmedetomidine for 10 min before surgery. The CG was treated with equivalent saline. Heart rate (HR), blood pressure, oxygen saturation (SpO2) of the two groups were measured at different time point after administration. Level of inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). Visual analogue score (VAS), Ramsay sedation score (RSS), and kidney injury related indexes were evaluated at different time points. The plasma-drug concentration of patients was determined by High Performance Liquid Chromatography (HPLC) method. Compared with CG, HR, PE, and diastolic blood pressure (DBP) showed lower level while SpO2 showed higher level in IG. Furthermore, expression of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and IL-10 in IG was decreased after drug administration, the contents of β2-MG, KIM-1 and urine protein were also decreased in contrast to the CG (all P<0.05). Besides, VAS score was decreased but Ramsay score was increased in the IG (both P<0.05). The results of HPLC showed that the half life of dexmedetomidine was about 20 min and it is speculated that the drug can be quickly metabolized within 24 h. Dexmedetomidine exerted protective effects on kidney injury of parturients with PE undergoing cesarean section.

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Postpartum hemorrhage and pregnancy induced hypertension during emergency lower segment cesarean section: dexmedetomidine to our rescue

Cited by 3 publications

References 9 publications

Dexmedetomidine as a rescue agent during intracranial neurosurgery in the setting of opioid tolerance

Dexmedetomidine as a rescue agent during intracranial neurosurgery in the setting of opioid tolerance

Combination of Dexmedetomidine and Tramadol in Patient-Controlled Intravenous Analgesia Strengthens Sedative Effect in Pregnancy-Induced Hypertension

Protective effect of dexmedetomidine on kidney injury of parturients with preeclampsia undergoing cesarean section: a randomized controlled study

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