ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. MethodsThe randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). ConclusionDexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.
ObjectiveTo observe the effects and security of dexmedetomidine in combined spinal epidural anesthesia (CSEA) for laparoscopic total extraperitoneal hernia repair (TEP). MethodsFrom January 2010 to January 2013, we selected 90 patients who were going to receive TEP surgery as our study subjects. The patients were divided into three groups:M1, M2 and M3 with 30 patients in each. The patients had left lateral position, and anesthesia was done between 3-4 lumbar epidural line. Injection of 0.5% bupivacaine 2 mL was carried out, and epidural catheter was 3-5 cm. Anesthesia plane was adjusted from the chest 4 or 6 vertebra to the sacral vertebra. The three groups of patients were treated with micro pump using dexmedetomidine given at a pre-charge of 0.5 μg/kg, and then group M1 was maintained by 0.3 μg/(kg·h), M2 by 0.5 μg/(kg·h), and M3 by 0.7 μg/(kg·h). The changes of mean arterial pressure (MAP), heart rate, respiration and pulse oximetry (SpO2) were observed at each time point, and bispectral index (BIS) monitor and Ramsay sedation score test were also conducted. ResultsThe changes of MAP, heart rate and respiration in group M1 were not obvious; the Ramsay score for group M1 was 2 to 3, and BIS value after pre-charge was 65-84. For group M2, MAP, heart rate and respiration had a slight decline; Ramsay score was 3-5 points, and BIS value was 60-79. In group M3, patients had a milder decline in their MAP and respiration; the heart rate declined obviously after receiving dexmedetomidine and one patient with severe decline of the heart rate alleviated after active treatment; Ramsay score was 5 to 6 points, and BIS value was between 55 and 75. There was little change in SpO2 in all the three groups, and the difference was not statistically significant (P>0.05). ConclusionContinuous injection of dexmedetomidine at 0.3-0.5 μg/(kg·h) in CSEA is an alternative way for anesthesia, which can effectively promote sedation and reduce pain and discomfort.
Objective To study the sedative effects and safety of dexmedetomidine and midazolamfor acute exacerbate of chronic obstructive pulmonary disease ( AECOPD) underwentmechanical ventilation.Methods 68 AECOPD patients underwentmechanical ventilation were enrolled and randomly divided into adexmedetomidine group ( n =34) and a midazolam group ( n = 34) by acute physiology and chronic healthevaluation Ⅱ ( APACHEⅡ) score. The patients in the dexmedetomidine group were given a loading dose( 1 μg/kg) and then maintained with 0. 2-0. 8 mg·kg- 1 ·h- 1 . The patients in the midazolam group weregiven a loading dose ( 0. 05 mg/kg) and then maintained with 0. 06-0. 2 mg· kg- 1 · h- 1 . Sedation levelwas assessed by Ramsay score and maintained a Ramsay score of 3-4. The sedation onset time, disablesedatives wake time, duration of mechanical ventilation, extubation success rate, ICU length of stay, and 28days mortality after admission to the ICU were compared between two groups. And calmer respiratorydepression, circulatory and delirium adverse reactions incidence were also compared. Results Thedifferences in patients’age, gender, and APACHEⅡ score between two groups were not significant ( P gt;0. 05) . Compared with the midazolam group, the dexmedetomidine group had more rapid onset of sedation[ ( 49. 80 ±8. 20) s vs. ( 107. 55 ±19. 65) s, P lt;0. 01] , shorter wake-up time [ ( 18. 90 ±2. 30) min vs. ( 40. 82 ±19. 85) min, P lt;0. 01] , shorter duration of mechanical ventilation [ ( 4. 9 ±1. 6) d vs. ( 7. 8 ±2. 5) d,P lt;0. 01] , higher successful extubation rate ( 79. 41% vs. 58. 82% , P lt;0. 01) , and shorter ICUlength of stay[ ( 6. 5 ±2. 5) d vs. ( 9. 6 ±3. 4) d, P lt;0. 05] . Dexmedetomidine had lower respiratory depression rate, littleeffects on hemodynamics, lower occurrence and short duration of delirium. Conclusion It is highlyrecommended that dexmedetomidine be used for sedation in AECOPD patients with mechanical ventilation.
Objective To evaluate the effectiveness and safety of dexmedetomidine for postoperative sedation in cardiac patients. Methods Such databases as PubMed, EBSCO, Springer, Ovid, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched electronically from the date of their establishment to May 2012, and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies in accordance with the inclusion and exclusion criteria, extracted data and assessed methodology quality. Then the meta-analysis was performed using RevMan 5.1software. Results A total of 8 randomized controlled trials (RCTs) involving 1 157 patients were included. The Jadad scores of 7 RCTs were more than 3, and only 1 RCT scored 2. The results of meta-analysis showed that compared with the control group, dexmedetomidine significantly raised peripheral oxygen saturation (RR=0.90, 95%CI 0.31 to 0.49, P=0.003), decreased the incidence of average heart rate (RR=–5.86, 95%CI –7.31 to −4.40, Plt;0.000 01), ventricular tachycardia (RR=0.27, 95%CI 0.08 to 0.88, P=0.03), delirium (RR=0.28, 95%CI 0.16 to 0.48, Plt;0.000 01) and postoperative hyperglycemia (RR=0.57, 95%CI 0.38 to 0.85, P=0.006), and reduced the number of patients who needed vasoactive agents such as epinephrine (RR=0.53, 95%CI 0.29 to 0.96, P=0.04) and β-blocker (RR=0.60, 95%CI 0.38 to 0.94, P=0.03). However, it failed to shorten the time of both ICU stay (RR=−1.24, 95%CI −4.35 to 1.87, P=0.43) and mechanical ventilation (RR=−2.28, 95%CI −5.13 to 0.57, P=0.12), increase mean artery pressure (RR=−2.78, 95%CI −6.89 to 1.34, P=0.19), and well control postoperative nausea, vomiting and atrial-fibrillation. There were no significant differences between the two groups in myocardial infarction, acute cardiac failure, acute kidney failure, and mortality rate. Conclusion For postoperative sedation in cardiac patients, dexmedetomidine can effectively stabilize hemodynamic indexes, and reduce tachycardia, delirium, postoperative hyperglycemia and vasoactive agents. However, it has no marked influence on the prognosis. For the quantity and quality limitation of included studies, this conclusion needs to be proved by performing more high quality and large sample RCTs.
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.
Objective To evaluate the effectivity of dexmedetomidine on the early postoperative quality of recovery in patients undergoing ambulatory knee arthroscopy under general anesthesia. Methods Patients scheduled for knee arthroscopy at the Day Surgery Center of the First Affiliated Hospital of Anhui Medical University between June and September 2024 were selected. According to the computer-generated random allocation, patients were randomly divided into the dexmedetomidine group (Dex group) and the saline control group (NS group). The Dex group received a continuous infusion of dexmedetomidine at a rate of 0.04 µg/(kg·h) until discharge, whereas the NS group was administered a comparable volume of saline. The primary outcome measure was the EuroQol Five-Dimensional Five-Level (EQ-5D-5L) score for health-related quality of life measured at the postoperative 24 hours. Secondary outcome measures included the Athens Insomnia Scale score on the night of surgery and the incidence of adverse reactions such as nausea and vomiting within 24 hours postoperatively. Results A total of 60 patients were included, with 30 patients in each group. There were statistically significant differences in the EQ-5D-5L health scores at the postoperative 24 hours (0.857±0.081 vs. 0.721±0.098) and the Athens Insomnia Scale scores [2.00 (2.00, 3.00) vs. 4.00 (3.00, 5.25)] on the night of surgery between the Dex group and the NS group (P<0.05). The difference in the incidence of postoperative nausea and vomiting between the two groups was not statistically significant [1 case (3.3%) vs. 5 cases (16.7%); χ2=1.667, P=0.197]. No adverse reactions such as bradycardia, hypotension, urinary retention, respiratory depression, dizziness and lethargy occurred in both groups. Conclusion Dexmedetomidine can significantly improve the early postoperative quality of life and sleep in patients undergoing ambulatory knee arthroscopy, thereby facilitating early postoperative quality of recovery.
Objective To evaluate the influence of dexmedetomidine on the stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery. Methods From August 2014 to December 2015, 210 patients undergoing elective laparoscopic gastrointestinal operations were randomly divided into three groups, including the low concentration group (group D1), the high concentration group (group D2), and the control group (group C), with 70 cases in each group. The patients in group D1 and group D2 were injected with dexmedetomidine (0.4 and 0.8 μg/kg respectively) by infusion pump before anesthesia induction, and were continuously pumped with dexmedetomidine [0.4 and 0.8 μg/(kg·h) respectively] until the end of the surgery. Meanwhile, the patients in group C were injected with normal saline of the equal volumes. The heart rate and mean arterial pressure (MAP) was recorded before anesthesia, after endotracheal intubation and extubation. Myocardial ischemia and cardiovascular adverse events thatneeded to be handled were recorded. The concentrations of dopamine, adrenaline (AD) and noradrenaline (NE) were monitored at 15:00 one day before surgery (Ty), one hour after the beginning of surgery (T0), and at 15:00 of the 1st, 2nd, and 3rd day after surgery (T1, T2, T3). Results A total of 178 patients completed the study and were enrolled in this study, including 60 cases in group D1 and 59 cases in group D2 and C respectively. In group D1 and D2, the heart rates after intubation [(80.4±9.6), (68.2±10.5) times/minutes], extubation [(70.1±6.2), (69.7±7.8) times/minutes] and MAP after extubation [(100.2±12.0), (98.0±13.1) mm Hg (1 mm Hg=0.133 kPa)] were lower than those in group C [(98.4±10.5) and (95.2±7.3) times/minutes; (121.8±10.5) mm Hg], and the differences were significant (P<0.05). The bradycardia and hypotension in group D2 (27.12%, 22.03%) was significantly higher than those in group C (3.39%, 8.47%). Hypertension in group D1 and D2 (5.00%, 1.69%) was significantly lower than that in group C (37.29%), and the differences were significant (P<0.05). Compared with the base value at Ty in the three groups, the concentration of dopamine at T0-T3 in group C, at T0-T1 in group D1, and at T0 in group D2 increased significantly (P<0.05); the AD at T0-T3 in group C, at T0-T2 in group D1, and at T0-T1 in group D2 increased significantly (P<0.05); the NE at T0-T2 in group C, and at T1 in group D1 increased significantly (P<0.05). Compared with group C at the same time, the DA at T3 in group D1 and at T1-T3 in group D2, the AD at T2-T3 in group D1 and at T0-T3 in group D2, the NE at T0-T1 in group D1 and T0-T3 in group D2, decreased significantly (P<0.05). Conclusions Dexmedetomidine can effectively restrain the changes of hemodynamics and catecholamine induced by perioperative stress responses in a dose-dependent manner. During the surgery of elderly patients with cardiovascular risk, the concentration of dexmedetomidine should be controlled moderately to gain the optimal effect.
Objective To explore the influence of dexmedetomidine on wake-up test during spinal orthopaedic surgery. Methods All 80 patients taking spinal orthopaedic surgery were randomly divided into the trial group and the control group, with 40 cases in each group. The endotracheal intubation anesthesia was adopted in both groups with same anesthesia induction. Additionally, dexmedetomidine 0.8 μg/ (kg·h) was infused within 10 min in the trial group before anesthesia induction, and then another 0.5 μg/ (kg·h) was also infused from the intraoperation to suture of incision. For the control group, the same amount of normal saline was infused, and all the narcotics were stopped pumping 15 min before the wake-up test, but then were continued pumping after the wake-up test. Finally, the following indexes were analyzed: wake-up time, wake-up quality, hemodynamic changes at the time of 15 min before wake-up (T1), recovery of spontaneous breathing (T2), wake-up (T3) and 15 min after wake-up (T4), dosage of narcotics, and the incidence of adverse events. Results There was no significant difference in the operation time before wake-up between the two groups (P=0.07). For the trial group, the dosage of sevoflurane (P=0.03) and sufentanil (P=0.00) used before wake-up was significantly lower, the wake-up time (P=0.04) and bleeding amount during wake-up (P=0.00) were significantly less, the wake-up quality (P=0.03) was significantly higher, the blood pressure (P=0.00) and heart rate (P=0.00) when wake-up were significantly lower, and the incidence of adverse events (P=0.04) was significantly lower, compared with the control group. Conclusion Dexmedetomidine adopted in spinal orthopaedic surgery can significantly improve patient’s wake-up quality, shorten wake-up time, reduce bleeding amount when wake-up and adverse events after wake-up, and maintain the hemodynamic stability, so it has better protective effects.
Objective To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. Methods A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05). Conclusion For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
ObjectiveTo systematically review the efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery. MethodsThe PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on dexmedetomidine for controlled hypotension in orthognathic surgery from inception to May, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 RCTs involving 371 patients were included. The results of meta-analysis showed that the operation time of dexmedetomidine group was not significantly different from that of hypotensive drug group, but was shorter than that of saline group (MD=−23.20, 95%CI −44.05 to −2.35, P=0.03). There were no statistically significant differences in the mean arterial pressure and the intraoperative blood loss between dexmedetomidine group and the control group. Compared with those in the control group, the heart rate (MD=−18.78, 95%CI −30.80 to −6.77, P=0.002) and the incidence of postoperative adverse events (OR=0.25, 95%CI 0.08 to 0.76, P=0.01) in dexmedetomidine group were less than those in the control group significantly. ConclusionCurrent evidence shows that dexmedetomidine can be used effectively for controlled hypotension in orthognathic surgery. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.