Haemodynamic responses to extubation after cardiac surgery with and without continued sedation

Conti, John A.; Smith, D.C.

doi:10.1093/bja/80.6.834

Cited by 39 publications

(15 citation statements)

References 5 publications

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“…During this period, significant reductions were seen in heart rate, and systolic and diastolic arterial pressures in the dexmedetomidine group, resulting in a lower rate pressure product and, potentially, less ischaemic events due to reduced oxygen demand [9]. An obvious advantage of dexmedetomidine, in contrast to other sedation agents used to blunt cardiovascular responses in the peri-extubation period, is the reported lack of respiratory depression [10].…”

Section: ¹1mentioning

confidence: 99%

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

et al. 1999

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SummaryDexmedetomidine, a highly selective and potent a 2 -adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) mg.kg ¹1.h ¹1 vs. 23.7 (27.5) mg.kg ¹1.h ¹1 , p < 0.0001], and 50% less morphine [11.2 (13.4) mg.kg. Cardiovascular effects and adverse events could be predicted from the known properties of alpha-2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.

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Section: ¹1mentioning

confidence: 99%

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

et al. 1999

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“…These practices determine short-term consequences, such as oversedation,[1234567] hypotension, venous thrombosis, prolonged ventilation,[89] increased incidence of bacteremia and ventilator-associated pneumonia,[1011] increased length of intensive care unit stay (LOS)[1213] and intermediate- to long-term effects such as critical illness myoneuropathy and post-traumatic stress disorder.…”

Section: Introductionmentioning

confidence: 99%

Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

Chawla

Myatra

Ramakrishnan

et al. 2014

Indian Journal of Critical Care Medicine

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Background and Aim:Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs). Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS) to help in standardizing best practices in these areas in the ICU.Materials and Methods:A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Society of Anesthesiologists (ISA) was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods.Results:Most ICUs function in a semi-closed model. Midazolam (94.99%) and Fentanyl (47.04%) were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay's Sedation Scale (56.1%) and Visual Analogue Scale (48.07%) were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method)-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation.Conclusion:The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.

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“…However, this variable was not a primary outcome variable for the present study, and may represent a type 1 error, although post hoc analysis reveals that the data have 80% power to detect a significant difference (α value 0.05). Further studies are obviously required.Sedation continued over the extubation period, has been shown to reduce haemodynamic disturbances and myocardial ischaemia [13]. We have previously shown [1] that dexmedetomidine provides cardiovascular stability, with a reduction in rate-pressure product over the extubation period.…”

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confidence: 99%

Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care

2000

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The respiratory effects of dexmedetomidine were retrospectively examined in 33 postsurgical patients involved in a randomised, placebo-controlled trial after extubation in the intensive care unit (ICU). Morphine requirements were reduced by over 50% in patients receiving dexmedetomidine. There were no differences in respiratory rates, oxygen saturations, arterial pH and arterial partial carbon dioxide tension (PaCO 2 ) between the groups. Interestingly the arterial partial oxygen tension (PaO 2 ) : fractional inspired oxygen (FIO 2 ) ratios were statistically significantly higher in the dexmedetomidine group. Dexmedetomidine provides important postsurgical analgesia and appears to have no clinically important adverse effects on respiration in the surgical patient who requires intensive care. Introduction:The α 2 -agonist dexmedetomidine is a new class of sedative drug that is being investigated for use in ICU settings. It is an effective agent for the management of sedation and analgesia after cardiac, general, orthopaedic, head and neck, oncological and vascular surgery in the ICU [1]. Cardiovascular stability was demonstrated, with significant reductions in rate-pressure product during sedation and over the extubation period. Dexmedetomidine possesses several properties that may additionally benefit those critically ill patients who require sedation. In spontaneously breathing volunteers, intravenous dexmedetomidine caused marked sedation with only mild reductions in resting ventilation at higher doses [2]. Dexmedetomidine reduces the haemodynamic response to intubation and extubation [3][4][5] and attenuates the stress response to surgery [6], as a result of the α 2 -mediated reduction in sympathetic tone. Therefore, it should be possible to continue sedation with dexmedetomidine over the stressful extubation period without concerns over respiratory depression, while ensuring that haemodynamic stability is preserved. The present study is a retrospective analysis of the respiratory response to dexmedetomidine in 33 postsurgical patients (who were involved in a randomized, double-blind, placebocontrolled trial [1]) after extubation in the ICU. Methods: Patients who participated in the present study were admitted after surgery to our general or cardiothoracic ICUs, and were expected to receive at least 6 h of postsurgical sedation and artificial ventilation. On arrival in the ICU after surgery, patients were randomized to receive either dexmedetomidine or placebo (normal saline) with rescue sedation and analgesia being provided, only if clinically needed, with midazolam and morphine boluses, respectively. Sedation was titrated to maintain a Ramsay Sedation Score [7] of 3 or greater while the patients were intubated, and infusions of http://ccforum.com/content/4/5/302 http://ccforum.com/content/4/5/302 study drug were continued for a maximum of 6 h after extubation to achieve a Ramsay Sedation Score of 2 or greater. The patients were intubated and ventilated with oxygenenriched air to attain acceptable arterial ...

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Haemodynamic responses to extubation after cardiac surgery with and without continued sedation

Cited by 39 publications

References 5 publications

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care

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