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 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.
ObjectiveTo observe the effect of dexmedetomidine combined with etomidate on the clinical safety and the tracheal extubation response after general anesthesⅠa in elderly patient undergoing thyroidectomy. MethodsFifty patients (aged between 65 and 75 years, ASAⅠor Ⅱ) scheduled for thyroid surgery between July 2012 and January 2013 were randomly divided into two groups:dexmedetomidine group (group D) and control group (group C) with 25 patients in each group. Group D received dexmedetomidine of 0.5 μg/(kg·h) through intravenous infusion after anesthesia induction, and the intravenous infusion was stopped five minutes before the end of surgery. Normal saline was infused at the same volume in group C at the same time. Patients were induced with etomidate at 0.2 mg/kg for anesthesia, and etomidate and remifentanil were used for the anesthesia maintenance during the operation. Heart rate (HR), systolic blood pressure SBP), diastolic blood pressure (DBP) and bispectral index (BIS) were recorded 5 (T1), 15 (T2) and 30 (T3) minutes after the beginning of the operation, and 15 (T4) and 5 (T5) minutes before the end of the operation. Moreover, the time of eye opening, time of extubation, the number of patients with restlessness and etomidate requirement were recorded. ResultsCompared with group C, HR and MAP at the time points of T2 and T5 in group D did not obviously change, but the number of restlessness patients in group D was significantly less than in group C (P<0.05). There was no statistically significant difference in time of eye opening and time of extubation between the two groups (P>0.05). Etomidate requirement in group D was[(8.6±2.1) μg/(kg·min)], which was significantly lower than that in group C[(14.4±3.4) μg/(kg·min)] (P<0.05). ConclusionDexmedetomidine combined with etomidate is efficient and safe for elderly patients undergoing thyroidectomy, and this method can effectively reduce cardiovascular responses to tracheal extubation, decrease the incidence of postoperative restlessness, and reduce the requirement of etomidate during the operation.
Objective To carry out a meta-analysis to evaluate the efficacy and safety of dexmedetomidine in comparison with midazolam as preoperative drug. Methods All randomized controlled trials (RCTs) about dexmedetomidine as preoperative drug compared with midazolam were identified. Meta analysis was performed by using the statistical software RevMan 4.2.10 on the basis of strict quality evaluation. Results Thirteen RCTs involving 806 patients were included. The results of meta analyses showed that dexmedetomidine was better than midazolam in decreasing perioperative blood pressure and heart rate, decreasing dosage of anesthetics, shortening of emergence time, and decreasing the occurrence of agitation, while the occurrence of perioperative hypotention and bradycardia of dexmedetomidine was much more than midazolam. The statistical outcomes showed that there were no differences between the two drugs in the satisfactory score, postoperative sedation score, the number of people needing analgesia, and occurrence of nausea and vomitting. Conclusion Significant advantages in favour of dexmedetomidine as preoperative drug are observed. Dexmedetomidine is safe except for more incidences of hypotension and bradycardia.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.
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.
Objective To assess the efficacy and safety of dexmedetomidine used for intravertebral anesthesia. Methods A search in PubMed Central, EBSCO, Springer, Ovid, CNKI and WanFang Data was conducted from the date of their establishment to February 2011, so as to collect the randomized controlled trails (RCTs) on dexmedetomidine used for intravertebral anesthesia. The reference lists of identified papers were examined for further trials. After the data were extracted and the quality was assessed in accordance with the inclusion and exclusion criteria, the Meta-analysis was conducted with RevMan5.0 software. Results A total of 13 RCTs involving 672 patients were included. The results of meta-analyses showed that compared with saline solution, dexmedetomidine tended to speed up the mean time of sensory block to reach T10 dermatome (MD= –2.39, 95%CI –4.40 to –0.39) and motor block to reach Bromage 3 (MD= –5.30, 95%CI –7.18 to –3.43). It also prolonged the time for two dermatomes regression of sensory blockade (MD=51.14, 95%CI 44.96 to 57.32) and complete resolution of motor blockade (MD=68.46, 95%CI 38.56 to 98.35). Peri-operative bradycardia significantly increased (RR=3.03, 95%CI 1.64 to 5.59) but shivering decreased (RR=0.47, 95%CI 0.28 to 0.80). In comparison with the control group, dexmedetomidine showed no difference in low blood pressure and occurrence of postoperative nausea and vomiting. Conclusion The current evidence shows that dexmedetomidine shortens the time for taking effect, prolongs the duration of intravertebral anesthesia, decreases the occurrence of shivering, and increases the occurrence of bradycardia.
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.
ObjectiveTo systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries. MethodsWe searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01). ConclusionCurrent evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
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.