Efficacy and safety of dexmedetomidine as an intrathecal agent: a dose finding clinical study

Background and Objectives: Dexmedetomidine is increasingly being used in regional anesthesia as an adjuvant but there is no consensus on exact minimal and safe dose when used intrathecally. The present study was conducted to evaluate the efficacy of three different doses of dexmedetomidine when given intrathecally as an adjuvant to bupivacaine in patients undergoing lower abdominal surgery

Methodology: After taking ethical committee approval, and obtaining patients consent, 60 American Society of Anesthesiologist [ASA] physical status I and II patients in the age group of 25-60 years undergoing lower abdominal surgeries were divided randomly into three groups in this randomized double blind study. An intrathecal dose of 2.5 ml of 0.5% hyperbaric bupivacaine was administered to all patients supplemented with dexmedetomidine. In Group A 5 microg, Group B 7.5 microg and in Group C 10 microg of dexmedetomidine was administered with a volume of 3ml of study drug in each group. The onset time, time to peak sensory level, motor blockade, sedation, duration of motor block, analgesia and any adverse effects were noted. At the end of the study, data were compiled and analyzed with appropriate statistical tests

Results: Demographic profile was comparable in all the three groups. The time to onset of sensory block in Group C [1.55 +/- 0.510 mm] was significantly lower than Group A [2.15 +/- 0.745 min] and Group B [2.20 +/- 0.410 min]. Sensory regression by two segments was significantly higher in Group C [220.65 +/- 25.86 min] as compared to Group A [104.7 +/- 25.5min] and Group B [145.10 +/- 24.54 min]. [p < 0.05] The duration of motor block was shortest in Group A [243.8 +/- 22.0 min] as compared to Group B [305.4 +/- 35.8 min] and Group C [387.0 +/- 39.4 min]. The visual analogue scale score for pain was lesser in Group C as compared to the other two groups

Conclusion: Optimal dose of dexmedetomidine is difficult to define especially with prolonged duration of sensory and motor blockade in a dose dependent manner with minimal increase in side effects with higher doses. However, we conclude that 7.5 ug seems to be just optimal intrathecal dose of dexmedetomidine and can be used safely and effectively in lower abdominal surgeries

New and old oral anticoagulants in anesthesia practice: a balancing approach

For decades, vitamin K antagonist warfarin has been used for thromboprophylaxis or stroke prevention in atrial fibrillation. Recently, direct thrombin inhibitor - dabigatran and factor Xa inhibitors - rivaroxaban and apixaban, have emerged as alternatives to warfarin. The perioperative management of antithrombotic therapy involves establishing a balance between hemorrhagic risk and thrombotic risk. Routine coagulation assays like prothrombin time and activated partial thromboplastin time provide a crude estimation of their activity. Further, no specific antidotes are available to reverse their effect. These drugs are discontinued before elective surgery and timing is based on the patient's renal status also. For emergency surgery or bleeding, the management includes the principles of bleeding control; hemodialysis may be effective for dabigatran. Prothrombin complex concentrates are found to be more effective than frozen plasma but more studies are warranted

Changing anesthesia trends in cardiothoracic surgeries: a fast changing perspective

Off late, many complicated procedures are being performed throughout the globe in cardiothoracic surgery departments. Many of these advancements can be attributed to advancements in anesthesia techniques, availability of newer and safer anesthetic drugs. However, such role has never been stressed upon whereby advancements became possible in cardiothoracic surgeries. However the journey of advancements and refining of surgical and anesthetic techniques is never ending. The current narrative review throws light on the facts due to which cardiothoracic surgery has become highly safe