Dexmedetomidine improves surgical field in cochlear implant surgery: a randomized, double-blind, placebo-controlled trial

Objectives: Sympatholytic properties of dexmedetomidine have many advantages to use in general anesthesia especially in pediatric age group undergoing cochlear implant surgeries. This study is designed to compare the effects of bolus dose of dexmedetomidine followed by infusion with placebo in cochlear implant surgeries for quality of hypotensive anesthesia with hemodynamic stability and incidence of complications in pediatric age group particularly emergence delirium with sevoflurane

Methodology: 60 pediatric patient of ASA grade I or II with congenital or acquired deafness of age ranging from 2 to 8 years scheduled for cochlear implant surgery were included in this study. Group D were administered dexmedetomidine 0.5 micro g/kg in 100 ml 0.9% NaCI over 10 min followed by infusion of dexmedetomidine at 0.5 micro g/kghr[-1] and Group P was given placebo only i.e. 0.9% NaCl 100 ml over 10 min followed by infusion at 2 ml.hr[-1]. Heart rate [HR] and mean arterial pressure [MAP] at different time interval, intraoperative fentanyl and propofol consumption, surgeons' satisfaction score and complications, particularly incidences of emergence delirium were recorded

Statistical analysis: Mean with standard deviation of various parameters of both groups was compared using student's t test were analyzed

Result: statistical significant lowering of MAP, HR, opioid consumption and rate of complications were lower in dexmedetomidine group compared to placebo group

Conclusion: Intraoperative administration of dexmedetomidine provides better surgical field and subsequently higher surgeon's satisfaction score leading to reduced surgery time with better recovery profile

comparative evaluation of the effect of intravenous dexmedetomidine and clonidine on intraocular pressure after suxamethonium and intubation

In patients with penetrating eye injury and a full stomach, suxamethonium is still used for rapid sequence induction of anesthesia. But its use is associated with the rise in intraocular pressure [IOP] and this can result in permanent vision loss in these patients. Dexmedetomidine and clonidine are two alpha-2 adrenergic agonist drugs which prevent the rise in IOP. The aim of this study is to compare the efficacy of intravenous [i.v.] dexmedetomidine and clonidine in preventing an increase in IOP after administration of suxamethonium and tracheal intubation. Sixty patients undergoing elective nonophthalmic surgery under general anesthesia were included in this clinical study. Patients were randomly assigned into three groups to receive 0.5 mcg/kg dexmedetomidine [Group D], 2 mcg/kg clonidine [Group C] or normal saline [Group S] as premedication i.v. over a period of 10 min before induction. IOP, heart rate, and mean arterial pressure were recorded before and after premedication, after suxamethonium, after intubation and then after 5 min. Following administration of dexmedetomidine and clonidine IOP decreased in both groups. After suxamethonium IOP increased in all three groups but it never crossed the baseline in Group D and C. After laryngoscopy and intubation IOP again increased in all three groups but in dexmedetomidine group it never crossed the baseline whereas in clonidine group it was significantly higher than the baseline. Single i.v. dose of dexmedetomidine premedication [0.5 mcg/kg] blunt the IOP and hemodynamic response to suxamethonium injection and tracheal intubation more effectively than single i.v. dose of clonidine premedication [2 mcg/kg]