Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients

Zhao, Jingping; Kong, Min; Qi, Bin; Ge, Dong-Jian

doi:10.1097/md.0000000000004576

Cited by 14 publications

(22 citation statements)

References 18 publications

(30 reference statements)

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“…Dexmedetomidine (DEX), with its potent and specific affinity of α 2 -adrenergic receptors, [10] has properties of sedation, antianxiety, and analgesic effects, [11–15] and can reduce the incidence of POED in pediatric patients undergoing inhalation anesthesia. [11,12,14,16–18] However, the impact of DEX on the incidence of POED in pediatric patients after intravenous anesthesia is unknown.…”

Section: Introductionmentioning

confidence: 99%

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

et al. 2016

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Postoperative emergence agitation/delirium (POED) is a common complication in pediatric surgery patients, which increases the risk of developing postoperative airway obstruction and respiratory depression. This study aims to investigate the safety and efficacy of intraoperative infusion of dexmedetomidine (DEX) and its effects on POED in pediatric patients undergoing tonsillectomy with or without adenoidectomy.Sixty patients scheduled for tonsillectomy with or without adenoidectomy, aged 2 to 8 years, were randomly allocated into 2 groups (n = 30). Pediatric patients in the group DEX received intravenous (IV) DEX 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h continuous infusion, and the same volume of 0.9% saline was administrated in the group control. Anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanyl. Intraoperative heart rate (HR), noninvasive blood pressure (NIBP), blood oxygen saturation (SPO2), recovery time, and extubation time were recorded. Pain level was evaluated using the objective pain score (OPS), pediatric anesthesia emergence delirium (PAED) scale and Cole 5-point scale (CPS) was used to evaluate POED when patients at 0, 5, 15 minutes, and then at intervals of 15 minutes for 60 minutes after parents arrival at postanesthesia care unit (PACU).The results showed that intraoperative HR was significantly lower in group DEX (P <0.05), mean diastolic and systolic NIBP was not statistically different between groups. Time to wake and time to extubation were lengthened in group DEX as compared with group control (P <0.05). OPS and CPS were lower in group DEX at 15, 30, and 45 minutes time points (P <0.05); however, there were no significantly differences in the PAED score at different time points in the PACU.The present data suggested that intraoperative infusion of dexmedetomidine combined with intravenous anesthetics can provide satisfactory intraoperative conditions for pediatric patients undergoing tonsillectomy with or without adenoidectomy, without adverse hemodynamic effects, though the lower incidence of POED was not observed.

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Section: Introductionmentioning

confidence: 99%

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

et al. 2016

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“…Our results also revealed another fascinating point that adding dexmedetomidine to morphine either IV or paravertebral without dexmedetomidine loading dose helped to avoid the annoying side effect of dexmedetomidine in form of accompanying hypotension and bradycardia [16,21], especially in trauma patients as in our study. This was obvious in our results when analyzed as we found comparable MAP and HR between the three groups throughout the study period with no significant differences.…”

Section: Discussionmentioning

confidence: 53%

“…Severe torturous pain caused by MRF is a clinical challenge that may result in serious respiratory complications with an increased risk of morbidity and mortality [5,16]. Management of these patients is mainly dependent on urgent and adequate pain control to help them breathe and cough effectively and cooperate for chest physiotherapy in order to maintain normal ventilation [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Management of these patients is mainly dependent on urgent and adequate pain control to help them breathe and cough effectively and cooperate for chest physiotherapy in order to maintain normal ventilation [16][17][18]. Dexmedetomidine has analgesic effect mediated through its action at the level of brain and brain stem, spinal cord and also at peripheral tissues [19] which is not dose-dependent; however, its hemodynamic associated effects are dependent on its dose [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine, a medetomidine's dextrogyrous enantiomer [10], possess an opioid-sparing effect due to its high selective α 2 adrenoceptor agonist effect [11]. It has been recently proved that perioperative dexmedetomidine administration reduces postoperative morphine requirements even without loading dose [12][13][14][15][16]. Dexmedetomidine has a synergistic action with opioids [17].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Mogahed¹,

Salama²,

Elkahwagy³

2017

J Anesth Clin Res

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Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Kaye

Chernobylsky

Thakur

et al. 2020

Curr Pain Headache Rep

138

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Purpose of Review Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). Recent Findings Dexmedetomidine, a selective alpha 2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Summary Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

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Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 18 publications

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

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