Intravenous dexmedetomidine as an ‘adjuvant’ to the infant spinal anesthetic

Monteleone, M; Teng, Howard

doi:10.1111/pan.13018

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…After discussion between the anesthesiologists and the surgical team, we concluded that rigid bronchoscopy (RBS) could wait and we developed three potential strategies to manage the patient (Table 1 ). In Discussed Option #3 (Table 1 ), the surgery could be performed under spinal anesthesia and sedation [ 2 , 3 ], and then RBS maintaining spontaneous respiration could be performed on another day. This would mean intubation would be unnecessary, and there would be no invasion to the subglottic area at all.…”

Section: Case Presentationmentioning

confidence: 99%

Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report

Doi,

Ekuni

2023

JA Clin Rep

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Background We report the anesthetic management of inguinal hernia repair for an infant with subglottic stenosis. A previously scheduled operation had been cancelled due to unexpected airway trouble during the induction. Case presentation A boy was born at 24 weeks of gestation and his trachea was intubated for 45 days. At 16 months old, surgery for inguinal hernia was planned, but cancelled due to unexpected narrow airway, and subglottic stenosis was first suspected. At 17 months old, he was transferred to us for inguinal hernia surgery. After careful discussion between the surgical team and the anesthesiologists, a strategy to manage this patient was developed. He underwent open hernia surgery under spinal anesthesia and diagnostic rigid bronchoscopy under tubeless general anesthesia separately, which revealed low-grade stenosis and some subglottic cysts. The postoperative course was uneventful. Conclusion Interdepartmental discussion weighing risks and benefits may deduce the safest and most appropriate anesthesia method.

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Section: Case Presentationmentioning

confidence: 99%

Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report

Doi,

Ekuni

2023

JA Clin Rep

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“…Sir –We thank Drs Monteleone and Teng for their interest in our pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair and for sharing their experience on the successful use of dexmedetomidine sedation with spinal anesthesia in an ex‐premature neonate and an infant .…”

mentioning

confidence: 99%

Reply to Monteleone, Matthew; Teng, Howard, regarding their comment ‘Dexmedetomidine as an adjuvant to the infant spinal anesthestic’

Bong

Tan

2017

Pediatric Anesthesia

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<p>Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review</p>

Jiang

Lin

et al. 2019

DDDT

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BackgroundPost-anesthetic shivering incurs discomfort to patients or even exacerbates their condition. However, no ideal drug has been well established for preventing post-anesthetic shivering. Currently, subarachnoid and epidural dexmedetomidine have demonstrated to have an anti-shivering effect.MethodsAn electronic search was conducted to identify randomized placebo-controlled trials reporting shivering and then compared subarachnoid and epidural dexmedetomidine with placebo in adults undergoing selective surgery. Data assessment and pooling were analyzed by Review Manager 5.3, STATA 15.0 and GRADE-pro 3.6 software.ResultsTwenty-two studies (1389 patients) were subjected to this meta-analysis. The incidence of post-anesthetic shivering decreased from 20.10% in the placebo group to 10.30% in the dexmedetomidine group (RR, 0.48; 95% CI, 0.39–0.59; Z=6.86, P<0.00001, I2=32%). Non-Indian, epidural-space route and cesarean subgroups indicated a better anti-shivering effect. In the subarachnoid-space route subgroup, a dosage of >5 μg showed significantly superior anti-shivering effects than that of ≤5 μg. Subarachnoid and epidural dexmedetomidine increased the incidence of bradycardia, had no impact on nausea and vomiting, shortened the onset of block and lengthened the duration of block and analgesia. However, its effect on hypotension and sedation remained uncertain. The overall risk of bias was relatively low. The level of evidence was high, and the recommendation of voting results was strong.ConclusionDexmedetomidine as a subarachnoid and epidural adjunct drug could decrease the incidence of post-anesthetic shivering in a dose-dependent manner. However, caution should be taken in patients with original bradycardia.

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Intravenous dexmedetomidine as an ‘adjuvant’ to the infant spinal anesthetic

Cited by 3 publications

References 4 publications

Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report

Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report

Reply to Monteleone, Matthew; Teng, Howard, regarding their comment ‘Dexmedetomidine as an adjuvant to the infant spinal anesthestic’

<p>Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review</p>

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