Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Abstract

Background Rapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs. Methods Eighty‐six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg−1 hr−1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg−1 hr−1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery. Results Dexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days. Conclusions Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.

<p>Impact of Intraoperative Infusion and Postoperative PCIA of Dexmedetomidine on Early Breastfeeding After Elective Cesarean Section: A Randomized Double-Blind Controlled Trial</p>

“…DEX combined with sufentanil assisted analgesia after surgery, which could also reduce resting pain and exercise pain. Consistent with the study of DEX in other populations, 24 the perinatal experience, such as maternal recovery quality and comfort, in the DEX group was also improved compared to that in the standard care group. These benefits increase maternal motivation to breastfeed, increase the number of times the baby sucked on the nipple, and then increase the pituitary reflex secretion of prolactin and the release of oxytocin.…”

Retrospective Comparison of the Safety and Effectiveness of Dexmedetomidine Versus Standard of Care Before and During Cesarean Delivery in a Maternity Unit in Zhengzhou, China

“…Administration of dexmedetomidine before and during cesarean delivery resulted in less pain post-delivery in women during rest, uterine contractions, and while moving compared with post-delivery administration of normal saline combined with sufentanil. These outcomes parallel those reported in randomized trials [ 2 , 11 ]. Administration of dexmedetomidine before anesthesia has been shown to decrease post-delivery pain due to an opioid-sparing effect [ 7 ].…”

Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial

“…The cumulative PCA usage during three time period after the operation (0 to 24 h, 24 to 48 h, and 48 to 72 h) was the primary outcome, and was recorded by a blinded member of the acute pain service (APS) team. The secondary outcomes were postoperative pain intensity on the NRS and functional activity score (FAS) at rest and during coughing after 24, 48, and 72 h [ 10 ]. The FAS is a subjective pain intensity assessment tool that uses grades A, B, and C. Grade A indicates that functional activity is not limited by pain; grade B indicates that functional activity is moderately limited because of pain; and grade C indicates that functional activity is severely limited because of pain.…”