Uso de dexmedetomidina em anestesia geral para tratamento cirúrgico de aneurisma cerebral, em paciente gestante, portadora de doença hipertensiva específica da gestação: relato de caso

Background:Satisfactory analgesia is of great importance in the labor. The clinical efficacy and side effects of remifentanil in the management of labor pain had been evaluated. Dexmedetomidine (DMET) demonstrates an antinociceptive effect in visceral pain conditions. Aims of the study were to assess whether the combination of DMET with remifentanil would produce a synergistic effect that results in lower analgesic requirements. Furthermore, whether this combination would have less maternal and neonatal adverse effects.Patients and Methods:Sixty American Society of Anesthesiologists physical status I-II pregnant women had been enrolled into this study. All were full term (37-40 weeks’ gestation), singleton fetus with cephalic presentation in the first stage of spontaneous labor. They were divided into two groups group (I) Patient-controlled IV remifentanil analgesia (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a loading dose of DMET 1 μg/kg over 20 min, followed by infusion at 0.5 μg/kg/h group (II) Patient-controlled IV remifentanil analgesia (PCA) (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a the same volume of normal saline as a loading dose, followed by a continuous saline infusion. Visual analog scale score, maternal, and fetal complications and patients’ satisfaction were recorded.Results:Patients receiving a combination of PCA remifentanil and DMET had a lower pain score compared with remifentanil alone in the second stage of labor (P = 0.001). The Total consumption of remifentanil was reduced by 53.3% in group I. There was an increased incidence of maternal complications and a lower patient satisfaction score in group II.Conclusion:DMET has an opioid sparing effect; a combination of DMET and remifentanil produces a synergistic effect that results in lower analgesic requirements and less maternal and neonatal adverse events.

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“…Other authors described the use of DMET in pregnant women for nonobstetric surgery[ 16 ] and for C-section. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Combination of dexmedetomidine and remifentanil for labor analgesia: A double-blinded, randomized, controlled study

2015

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“…In addition, remifentanil is known to offer a neuron-protective effect in cases of opioid induced hyperalgesia or tolerance 23 . Dexmedetomidine was used in 2 of our patients and its use is recommended in pregnant patients 24 .…”

Section: Discussionmentioning

confidence: 99%

A case series discussing the anaesthetic management of pregnant patients with brain tumours

et al. 2013

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Pregnancy may aggravate the natural history of an intracranial tumour, and may even unmask a previously unknown diagnosis. Here we present a series of seven patients who had brain tumours during pregnancy. The aim of this case series is to characterize the current perioperative management and to suggest evidence based guidelines for the anaesthetic management of pregnant females with brain tumours. This is a retrospective study. Information on pregnant patients diagnosed with brain tumours that underwent caesarean section (CS) and/or brain tumour resection from May 2003 through June 2008 was obtained from the Department of General Anaesthesia and the Rose Ella Burkhardt Brain Tumour & Neuro-Oncology Centre (BBTC) at the Cleveland Clinic, OH, USA. The mean age was 34.5 years (range 29-40 years old). Six patients had glioma, two of whom had concomitant craniotomy and CS. Six cases had the tumour in the frontal lobe. Four cases were operated on under general anaesthesia and three underwent awake craniotomy. The neonatal outcomes of the six patients with elective or emergent delivery were six viable infants with normal Apgar scores. Pregnancy was terminated in the 7th patient. In conclusion, management of brain tumours in pregnant women is mainly reliant on case reports and the doctor's personal experience. Therefore, close communication between the neurosurgeon, neuroanaesthetist, obstetrician and the patient is crucial. General anaesthesia, propofol, dexmedetomidine and remifentanil were used in our study and were safe. Although this may not agree with previous studies, desflurane and isoflurane were used in our patients with no detectable complications.

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“…This is in contrast to maternal general anesthesia in preterm ewes where we observed progressive declines in both fetal heart rate and blood pressure. 38 As such, even though the current reported clinical use of dexmedetomidine in parturients is limited to case reports, 20–22 there would seem to be considerable clinical utility for an agent that is capable of producing profound maternal sedation with minimal fetal effects.…”

Section: Discussionmentioning

confidence: 99%

“…Collectively, this profile of activity continues to prompt evaluation of additional clinical applications, 14,15 ranging from facilitation of awake intubation, 16 to supplementation of sedation and pain control during craniotomy, 17 and sedation of pediatric patients. 18 As of now, these investigations have not included significant cohorts of pregnant patients outside of women who were terminating their pregnancies 19 or single case reports 20–22 and pregnancy is an exclusion criteria for most currently active dexmedetomidine clinical trials (http://www.clinicaltrials.gov-accessed 8 th April 2012). Nonetheless, a number of dexmedetomidine's actions could be of potential benefit to fetuses of parturients requiring heavy sedation, anesthesia, and/or analgesia during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Maternal and preterm fetal sheep responses to dexmedetomidine

Uemura

Shimazutsu

McClaine

et al. 2012

International Journal of Obstetric Anesthesia

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Background The α2 adrenergic receptor agonist dexmedetomidine has some unique pharmacologic properties that could benefit pregnant patients (and their fetuses) when they require sedation, analgesia, and/or anesthesia during pregnancy. The purpose of the present study was to delineate maternal and fetal responses to an intravenous infusion of dexmedetomidine. Methods This study was conducted on surgically-recovered preterm sheep instrumented for physiologic recording and blood sampling. Maternal and fetal cardiovascular and blood gas parameters and fetal cerebral oxygenation levels were recorded before, during, and after 3 h of dexmedetomidine infusion to the ewe at a rate of 1 μg/kg/h. Results Drug infusion produced overt sedation but no apparent respiratory depression as evidenced by stable maternal arterial blood gases; fetal blood gases were also stable. The one blood parameter to change was serum glucose, By the end of the 3 h infusion, glucose increased from 49 ± 10 to 104 ± 33 mg/dL in the ewe and from 22 ± 3 to 48 ± 16 mg/dL in the fetus; it declined post-drug exposure but remained elevated compared to the starting levels (maternal, 63 ± 12 mg/dL, P = 0.0497; and fetal, 24 ± 4 mg/dL, P = 0.012). With respect to cardiovascular status, dexmedetomidine produced a fall in maternal blood pressure and heart rate with fluctuations in uterine blood flow but had no discernable effect on fetal heart rate or mean arterial pressure. Likewise, maternal drug infusion had no effect on fetal cerebral oxygenation, as measured by in utero near-infrared spectroscopy. Conclusions Using a clinically-relevant dosing regimen, intravenous infusion of dexmedetomidine produced significant maternal sedation without altering fetal physiologic status. Results from this initial acute assessment support the conduct of further studies to determine if dexmedetomidine has clinical utility for sedation and pain control during pregnancy.

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Uso de dexmedetomidina em anestesia geral para tratamento cirúrgico de aneurisma cerebral, em paciente gestante, portadora de doença hipertensiva específica da gestação: relato de caso

Cited by 9 publications

References 3 publications

Combination of dexmedetomidine and remifentanil for labor analgesia: A double-blinded, randomized, controlled study

Combination of dexmedetomidine and remifentanil for labor analgesia: A double-blinded, randomized, controlled study

A case series discussing the anaesthetic management of pregnant patients with brain tumours

Maternal and preterm fetal sheep responses to dexmedetomidine

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