Dexmedetomidine in anaesthesia practice: A wonder drug?

Rastogi

et al. 2016

Korean J Anesthesiol

BackgroundModified radical mastectomy is associated with appreciable blood loss, while endotracheal intubation leads to elevated hemodynamic responses. The present study aimed to evaluate the clinical efficacy of dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia during modified radical mastectomy with I-Gel.MethodsSixty adult consenting female patients, of American Society of Anesthesiologists physical status 1 to 2 and aged 4,065 years, were blindly randomized into two groups of 30 patients each. The patients in Group I received intravenous dexmedetomidine at a loading dose of 1 µg/kg over 10 min, followed by maintenance infusion of 0.4 to 0.7 µg/kg/h, while patients in Group II were administered an identical amount of saline infusion until 15 min prior to the end of surgery. The primary end point was bleeding at the surgical field and hemodynamic changes; requirement of isoflurane, intraoperative fentanyl consumption and recovery time were assessed as secondary outcomes.ResultsThe patients receiving dexmedetomidine infusion showed significantly less bleeding at the surgical field (P < 0.05). A statistically significant reduction was also observed in the percentage of isoflurane required (0.82 ± 0.80%) to maintain the systolic blood pressure between 100 and 110 mmHg in patients receiving dexmedetomidine infusion compared with the Group II (1.50 ± 0.90%). The mean intraoperative fentanyl consumption in patients in the Group I was also significantly lower compared with that of the Group II (38.43 ± 5.40 µg vs. 75.12 ± 4.60 µg). The mean recovery time from anesthesia did not show any clinically significant difference between the groups.ConclusionsDexmedetomidine infusion can be used safely to decrease the bleeding at the surgical field with smooth recovery from anesthesia.

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gel®: a randomized control study

Rastogi

et al. 2016

Korean J Anesthesiol

Indian Journal of Critical Care Medicine

“…A meta-analysis by Tan and Ho (2010)[19] observed that incidence of bradycardia requiring intervention increased in studies that used both a loading dose and maintenance doses of dexmedetomidine in excess of 0.7 μg/kg/h. Transient hypertensive responses have also been observed with higher doses[20] due to initial stimulation of α2B receptors present in vascular smooth muscles.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients

Srivastava¹,

Sarkar²,

Kumar³

et al. 2014

Background and Objectives:Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation.Study Design:Prospective, randomized, controlled open-label study.Materials and Methods:A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups.Results:Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine.Conclusion:Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

“…10 Dexmedetomidine is another alpha-2 adrenoceptor agonist and has been introduced for clinical use in our country recently. 11 Numerous clinical studies have clearly established role of fentanyl as an adjuvant to bupivacaine and the effectiveness of fentanyl significantly prolongs postoperative pain free period. There for the discussion below, we compared our results with those studies in which dexmedetomidine were administered with bupivacaine or other local anaesthetic by epidural route.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Effect of Fentanyl and Dexmedetomidine on Post-Operative Analgesia and Haemodynamics When Added to Bupivacaine 0.5% in Epidural Block for Pelvic and Lower Limb Orthopaedic Surgeries

Chakole¹,

Pandey²,

Joshi³

2016

jemds