Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus

Abstract

Background: Total intravenous anesthesia (TIVA) versus inhalational anesthesia was selected as the anesthetic method, in order to avoid the use of muscle relaxants during repair of brachial plexus injury. We designed this study to determine effect and efficacy of TIVA versus sevoflurane during repair of brachial plexus injury. Methods: Sixty patients scheduled for repair of injured brachial plexus from January 2009 till December 2011 were enrolled in this prospective, single-blind, randomized study. They received either inhalation induction with sevoflurane and maintenance with sevoflurane and fentanyl (Group 1) or TIVA with, propofol and fentanyl (Group 2) or TIVA with dexmedetomidine and fentanyl (Group 3). Hemodynamics, intubation conditions, sedation score were assessed. Postoperative pain using visual analogue scale (VAS) was assessed. Discharge time, postoperative respiratory condition, any postoperative complications were recorded. Results: All groups provided a similar significant reduction in hemodynamics compared with baseline values. Respiratory rate values of dexmedetomidine-fentanyl group were significantly higher than those in other groups. Oxygen saturation values of dexmedetomidine-fentanyl group were significantly higher than those of propofol-fentanyl group. Time to reach an Aldrete score of 10 was similar in all groups. Patients in sevoflurane-fentanyl group have significantly higher visual analogue score than other groups. Sedation score was higher in the dexmedetomidine-fentanyl group. Conclusion: TIVA with propofol and with dexmedetomidine was more effective and favorable anesthesia than sevoflurane anesthesia during repair of brachial plexus injury.

Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials

“…Nevertheless, this meta-analysis has several limitations. First, only eight trials 3,[21][22][23]35,37,44,47 reported the source of their funding; and therefore, we did not know Fig. 6 Results of subgroup analysis of the incidence of postoperative shivering by routes of dexmedetomidine administration whether the other trials were supported by industry, which could make the design prone to show the drug in its best light.…”

“…3,9,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Other control agents included fentanyl, [33][34][35][36] remifentanyl, 37,38 meperidine, 15 midazolam, [39][40][41] propofol, 43,44 ketamine, 45,46 tramadol, 24,47 clonidine, 42 propacetamol, 48 and buprenorphine 49 ( 8 were reported in the 39 included trials, and all studies reported every endpoint mentioned in the Methods section (reporting bias). 8 however, some bias 8 may exist in of the two trials, 27,32 as the length of surgery was not clear.…”

Effects of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients: a double-blind randomized controlled trial

“…Dexmedetomidine is a highly effective and selective α 2-adrenergic receptor agonist, which manifests the effects of sedation, analgesia, anti-anxiety and sympathetic inhibition in a dose-dependent manner, with few side effects. At present, clinical research shows that dexmedetomidine can reduce the dose requirements for intravenous or inhalation anesthetics and opioids, and the hemodynamics is more stable during the operation 3 – 5 . However, there is no report on the effect of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients.…”

Effects of Etomidate Combined With Dexmedetomidine on Adrenocortical Function in Elderly Patients: A Double-Blind Randomized Controlled Trial

“…Dexmedetomidine is a highly effective and selective α 2-adrenergic receptor agonist, which manifests the effects of sedation, analgesia, anti anxiety and sympathetic inhibition in a dose-dependent manner, with few side effects. At present, clinical research shows that dexmedetomidine can reduce the dose requirements for intravenous or inhalation anesthetics and opioids, and the hemodynamics is more stable during the operation [3,4,5]. However, there is no report on the effect of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients.…”