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Purpose: Emergency delirium (ED), a common postoperative neurologic complication, causes behavioral disturbances leading to self?traumas and also has long?term adverse effects in children. Our aim was to investigate the efficacy of a single?bolus dose of dexmedetomidine in reducing the incidence of ED. Additionally, pain relief, number of patients who needed rescue analgesia, hemodynamic parameters, and adverse events were assessed. Methods: One hundred and one patients were randomly allocated into two groups: 50 patients received 15 mL of dexmedetomidine 0.4 ?g/kg (group D) and 51 patients received volume?matched normal saline (group C). Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored regularly throughout the procedure. ED was assessed with Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and pain was measured using the modified Objective Pain Score (MOPS). Results: The incidences of ED and pain were higher in group C than group D (P < 0.0001 and P < 0.0001, respectively). Group D showed significant decrease in MOPS and PAEDS values at 5, 10, 15, and 20 min (P < 0.05), HR at 5 min (P < 0.0243), and SBP at 15 min (P < 0.0127). There was no significant difference in DBP between the two groups at any time point. The mean blood pressure (MBP) at 10 min was significantly less in group D than group C (P < 0.001). Conclusion: Dexmedetomidine 0.4 ?g/kg as a single bolus over 10 min immediately after intubation is effective for the prevention of ED and significantly reduces the need of rescue analgesia without compromising the hemodynamic parameters in children undergoing ophthalmic surgery.
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OBJECTIVES@#To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.@*METHODS@#A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (@*RESULTS@#Compared with the control group, the observation group had significantly decreased MAP at T@*CONCLUSIONS@#Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.
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Child , Humans , Bronchi , Bronchoscopy , Dexmedetomidine/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam , Prospective StudiesABSTRACT
OBJECTIVE@#To verify whether dexmedetomidine hydrochloride (Dex) alleviates renal ischemia-reperfusion (IR) injury in diabetic rats by increasing the expression of hypoxia inducible factor-1 (HIF-1).@*METHODS@#A rat model of type 2 diabetes mellitus was established by high-fat diet and streptozotocin injection. The rats were subjected to daily intragastric administration of 0.05 mg/kg digoxin for 7 consecutive days and intraperitoneal injection of Dex 2 h before renal IR injury induced by ligation of the bilateral renal arteries for 60 min followed by reperfusion for 120 min. After reperfusion, blood samples were taken for detection of serum creatinine (Scr) and urea nitrogen (BUN) levels. Western blotting was used to detect the expression of HIF-1, cleaved caspase-3, Bcl-2, and Bax in the renal tissues; the expression of the HIF-1, p-eNOS, and eNOS were detected using ELISA. The percentage of apoptotic glomerular cells was assessed using TUNEL assay.@*RESULTS@#The levels of Scr, BUN, HIF-1, p-eNOS, and eNOS and the percentage of apoptotic cells in both normal and diabetic rats increased significantly after renal IR injury ( < 0.05). The expressions of Scr, BUN, p-eNOS, and eNOS decreased while HIF-1 expression increased significantly in Dex-treated rats with renal IR injury ( < 0.05). Compared with the non-diabetic rats, the diabetic rats showed more obvious increase in the expressions of Scr, BUN, p-eNOS, and eNOS following renal IR injury. In the diabetic rats with renal IR injury, Dex treatment prior to the injury significantly lowered the expressions of Scr, BUN, p-eNOS, eNOS, cleaved caspase-3, and Bax, decreased the percentage of apoptotic cells, and increased the levels of HIF-1a and Bcl-2 ( < 0.05). Digoxin treatment significantly antagonized the effects of Dex in the diabetic rats with renal IR injury by increasing the expressions of cleaved caspase-3 and Bax, promoting glomerular cell apoptosis, and decreasing renal expressions of HIF-1 and Bcl-2 ( < 0.05).@*CONCLUSIONS@#Dex alleviates renal IR injury in diabetic rats probably by inhibiting renal expression of HIF-1 and glomerular cell apoptosis.
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Animals , Rats , Dexmedetomidine , Diabetes Mellitus, Experimental , Diabetes Mellitus, Type 2 , Hypoxia , Hypoxia-Inducible Factor 1, alpha Subunit , Kidney , Rats, Sprague-Dawley , Reperfusion InjuryABSTRACT
Objective To establish neuropathic pain models,explore the effects and mechanisms of dexmedetomidine on neuropathic pain.Methods Wistar rats were randomly divided into four groups (n =9):0.9％ sodium chloride solution CCI group (N),dexmedetomidine CCI group (D),ZD7288 CCI group (Z) and sham-operated group (Sham).Sciatic nerve ligation was performed in group N,D and Z.The sciatic nerve in group Sham was exposured without ligation.7 d after surgery,the rats in group D were intraperitoneal injected with dexmedetomidine (40 μg· kg-1),and the rats in group Z were intraperitoneal injected with ZD7288 (10 mg·kg-1)once a day for 3 d.The same volume of 0.9％ sodium chloride solution was given at the same time in group N.The behavioral test was performed before and 7 d after operation,as well as 3 d after injection treatment.Mechanical allodynia was assessed by paw withdrawal mechanical threshold (PWMT) to von Frey filaments.Thermal hyperalgesia was assessed by paw thermal withdrawal latency (TWL) to radiant heat.Dexmedetomidine block of HCN channels in dorsal root ganglion (DRG) neurons were confirmed by whole-cell recording.Results 7 d after surgery,the PWMT and TWL of rats in group N,D and Z were decreased significantly (P ＜ 0.05).The PWMT and TWL in group Sham were no significant difference before and after operation.Dexmedetomidine significantly increased the levers of PWMT and TWL in group D and Z after treatment for 3 d,and group Z was greater than group D (P ＜ 0.05).Dexmedetomidine (0.1,1,10 μmol· L-1) caused a concentration-dependent decrease in the amplitude of Ih in DRG neurons from (-844.43 ± 386.34) to (-215.99 ± 63.90) pA (P ＜ 0.05),and the inhibition rate of Ih was (11.87 ± 1.80) ％,(35.26 ± 3.65) ％ and (52.02 ± 5.56) ％,respectively(P ＜0.05).Dexmedetomidine produced a dose-related shift to the left of the Ih activation,and a negative shift in V1/2 (P ＜ 0.05).V1/2 shifted from (-86.21 ± 1.68) to (-103.54 ± 2.01) mV (P ＜ 0.05).The slope values were not altered by dexmedetomidine.Conclusion Dexmedetomidine produces a dose-dependently analgesic effect on neuropathic pain after peripheral never injury,which is likely due to the inhibition of Ih and reduction of ectopic spontaneous discharge in DRG neurons.
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AIM:To investigate the effect of dexmedetomidine hydrochloride on hemodynamics, sedation and analgesia effect during cataract surgery for senile patients with hypertension.METHODS: Totally 90 senile patients with hypertension receiving cataract surgery were randomly divided into two groups, 45 cases in study group during the surgery by intravenous infusion of dexmedetomidine hydrochloride, 45 cases in control group were given normal saline for intravenous infusion.Blood flow dynamics index level were detected in two groups at five time points of before surgery (T0), beginning of the surgery (T1), 10 min after beginning (T2), 20 min after beginning (T3), the end of surgery (T4).Analgesia and sedation scores were compared in two groups, the incidence of adverse reactions and complications were recorded in two groups.RESULTS: Heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP) increased significantly at the time points of T1, T2, T3, T4 compared with T0 time point in the control group (P0.05).Sedation scores in the study group were significantly higher than that of the control group at the same time (P<0.05).The incidence of adverse reactions and complications in the study group was significantly lower than that of the control group (P<0.05).CONCLUSION: Application of dexmedetomidine hydrochloride to monitoring anesthesia during senile cataract patients with hypertension surgery, can stabilize the hemodynamics and has obvious sedation and analgesia effect.
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Objective To investigate the effect of dexmedetomidine hydrochloride on hemodynamics,immune function and inflammatory factors in patients with gynecological laparoscopic operation.Methods According to the random comparison table,86 elderly patients with gynecological laparoscopic operation were divided into observation group(43cases) and control group(43cases).The observation group received conventional general anesthesia,and intravenously pumped with dexmedetomidine hydrochloride.The the control group received conventional general anesthesia,and intravenously pumped with normal saline.The changes of hemodynamics,immune function and inflammatory factors were observed and compared in different periods in the two groups.Results Compared with before induction,the level of HR increased significantly at intubation(t=-3.257,-5.019,all P0.05),the level of MAP increased significantly at intubation in control group(t=-2.122,P0.05);Compared with before induction,the levels of CRP and IL-6 increased significantly at after operation and 24 h after operation in the two groups(CRP:t=-9.974,-16.872;IL-6:t=-7.284,-11.449,all P0.05),the levels of CD+3,CD+4,CD+4/CD+8 and NK decreased significantly after operation in the control group(t=11.514,10.317,9.180,6.815,all P<0.05),there were statistically significant differences after operation in the two groups(t=10.232,10.298,7.728,4.900,all P<0.05),and the level of NK decreased significantly at 24h after operation in the control group(t=4.362,P<0.05).Conclusion Dexmedetomidine hydrochloride can keep hemodynamics stability,reduce immune function damage and inflammation.
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OBJECTIVE:To observe the effects of dexmedetomidine hydrochloride on extubation stress response in elderly pa-tients during general anesthesia recovery period. METHODS:80 patients underwent general anesthesia of abdominal surgery were randomly divided into observation group and control group,with 40 cases in each group. Both groups received routine anesthesia before surgery and during surgery. 10 min before the end of surgery,observation group was given intravenous pump of dexmedeto-midine hydrochloride diluted to 10 ml 0.5 μg/kg,and control group was given constant volume of 10 ml 0.9% Sodium chloride so-lution. HR,MAP and SaO2 levels of 2 groups were compared before the induction of anesthesia (T0),at the moment of intrave-nous injection of dexmedetomidine hydrochloride or 0.9%Sodium chloride solution(T1),at the moment immediately before extuba-tion(T2),at the moment of extubation(T3),1 min after extubation(T4),5 min after extubation(T5)and 10 min after extubation (T6). Ramsay sedation score of 2 groups were compared at T0,T2,T4,T5 and T6;cough score,restlessness score,awake time(t1) and extubation time(t2)were also compared between 2 groups. RESULTS:Compared with at T0,the fluctuation of HR and MAR in 2 groups decreased significantly and became stable gradually at T4,T5 and T6,and HR and MAP of observation group at T1-T6 were significartly lower than those of control group,with statistical significance(P0.05). There was statistical significance in Ramsay sedation score between 2 groups at T2,T4,T5 and T6 (P<0.05). The cough score and restlessness score of observation group were significantly lower than those of control group,and t1 and t2 were significantly shorter than those of control group,with statistical significance(P<0.05). CONCLUSIONS:Dexmedetomidine hydro-chloride can relieve extubation stress reaction in elderly patients during general anesthesia recovery period with good safety.
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OBJECTIVE:To compare the anesthetic effect and safety of dexmedetomidine hydrochloride and propofol in pain-less colonoscopy. METHODS:80 patients who underwent painless colonoscopy was retrospectively analyzed and divided into group A and group B. Group A was given loading dose of 1 mg/kg propofol within 30 s and maintained with 6 mg/(kg·h);group B was given loading dose of 0.3 μg/kg Dexmedetomidine hydrochloride injection by micropump for slow pumping 5 min and maintained with 0.2-0.3 μg/(kg·h). Mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2)and respiratory rate(RR)be-fore examination (T0),before microscopic examination (T1),1 min (T2) and 10 min(T3) after microscopic examination,1 min (T4)and 5 min(T5)after colonoscopy withdrawal,onset time of anesthesia,entry time,examination time and discharge time,pa-tients with adjunctive use of fentanyl and incidence of adverse reactions in 2 groups were observed. RESULTS:MAP in group A at T1 was significantly lower than T0,HR in 2 groups at T1-T3 was significantly lower than T0,the differences were statistically signifi-cant(P0.05). Onset time of an-esthesia,patients with adjunctive use of fentanyl and incidence of adverse reactions in group B were significantly lower than group B,the differences were statistically significant(P<0.05). CONCLUSIONS:Both dexmedetomidine hydrochloride and propofol has good anesthetic effect in painless colonoscopy,but dexmedetomidine has better safety.
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Objective To investigate the myocardial protection effect of dexmedetomidine hydrochloride during off-pump coronary artery bypass graft surgery. Methods Forty patients undergoing off-pump coronary artery bypass grafting were randomly divided into two groups:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine hydrochlo-ride was given at a loading dose of 0. 5 μg?kg-1 to patients in group D, and then infused continuously at a rate of 0.5 μg?kg-1?h-1.The same amount of saline was given to patients in group C. After loading dosing,general anesthesia was per-formed with TCI technique.Trans-esophagus Doppler monitoring was conducted to monitor the blood volume and heart function, and close monitoring of fluid infusion to maintain stable circulation.Invasive blood pressure and heart rate were recorded every 5 min. Blood samples were taken for detection of cTnI,CK-MB,TNF-αand IL-6 contents at the following time points:after induction ( t0 ) ,before operation ( t1 ) ,after operation ( t2 ) ,12 h postoperation ( t3 ) and 24 h postoperation ( t4 ) . Results The blood pressure and heart rate decreased significantly at t0 and t1 in group D compared with group C,and there were no significant differ-ences in the two indexes at other time points between the two groups.Blood CK-MB,cTnI and inflammation factors TNF-α,IL-6 were much higher at t2,t3,t4 than at t0 and t1 in both groups(P<0.05).They were significantly decreased at t2,t3,t4 in group D relative to group C (P<0.05).Vessel active medicines were less given after the operation in group D (P<0.05). Conclusion Dexmedetomidine hydrochloride can mitigate the inflammation responses caused by off-pump coronary artery bypass grafting,re-duce the myocardial injury and improve the cardiac function of the patients.
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Objective To observe the effects of dexmedetomidine hydrochloride on the cisatracurium-induced neuromuscular blockade in geriatric, young and middle-aged patients. Methods Forty elderly patients and forty young and middle-aged patients undergoing elective abdominal surgery under general anesthesia were randomly divided into 4 groups ( n=20 each):elderly dexmedetomidine hydrochloride group (group DE),elderly control group (group CE),young and middle-aged dexmedetomidine group (group DY) and young and middle-aged control group (group CY).In groups DE and DY,a loading dose of 0.5 μg?kg-1 dexmedetomidine was intravenously infused over 10 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.4μg?kg-1?h-1 until the end of surgery.Equal volume of 0.9% sodium chloride was given in groups CE and CY.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium 0.15 mg?kg-1.Four groups were maintained with infusion of propofol and remifentanil. Neuromuscular blockade was maintained with continuous cisatracurium infusion in the four groups and was monitored with TOF-Watch SX acceleromyography at the adductor pollicis.The onset time,TOF no reaction period,duration of action,the amount of cisatracurium consumption,and the spontaneous recovery index ( T1 25% to 75%) were recorded. Results The four groups were comparable in the demographic data.Intubation conditions,the onset time and recovery index were not significantly different among the four groups. The duration of blockade action in groups DE and DY was ( 61. 1 ± 8.9) min and (53.6±9.3) min,which was significantly longer than that in group CE [(49.9±5.8) min] and group CY [(44.8± 6.4) min] (P<0.01).The duration of blockade action was significantly longer in groups DE and CE than in groups DY and CY (P<0.05).The amount of cisatracurium consumption in groups CE and CY was significantly higher than that in groups DE and DY (P<0.05). Conclusion The neuromuscular blockade is longer and the requirement of cisatracurium is less in elderly patients than in young and middle-aged patients.Continuous infusion of dexmedetomidine hydrochloride can't accelerate the onset time of cisatracurium.But duration of action is prolonged and the amount of cisatracurium consumption is lower in patients with infusion of dexmedetomidine hydrochloride.
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Objective To determine the EC50 of dexmedetomidine hydrochloride ( DEX) which causes disappearance of explicit memory by process dissociation procedure (PDP). Methods Forty patients those who had senior middle school or higher educational background undergoing lower extremity surgery with grade ASA Ⅰ or Ⅱ, without hearing impairment, dysphasia,nervous system disorders,and having no drugs in the treatment of the central nervous system were included.PDP was applied to establish study table and record, and calculate performance of explicit memory and implicit memory. Memory performance was statistically compared with 0, 0 memory was considered to be statistically significant and disappearance, respectively.Sequential method was used for determination.According to explicit memory disappearance or not,target concentration of the next patient was adjusted (increase or decrease).DEX target concentration of the first patient was set to 4 ng?mL-1,and the ratio of target concentration between the adjacent patients was 1.2.If the explicit memory of the former patient disappeared,the target concentration of the next patient was decreased by 1 concentration gradient;if the explicit memory of the former patient did not disappear,the target concentration of the next patient was increased by 1 concentration gradient, and so forth. All the 40 patients were determined.The median effective dose (D1) and 95% confidence interval (CI) of DEX were calculated. Results The ED50 of DEX causing explicit memory disappearance was 5.23 ng?mL-1,and the 95% CI was 4.07-6.39 ng?mL-1. Conclusion In clinical,target concentration of dexmedetomidine hydrochloride 5.23 ng?mL-1 levels for sedation,can cause half of patients’ explicit memory disappear,so as to avoid intraoperative awareness.
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OBJECTIVE:To evaluate effects of dexmedetomidine hydrochloride on cardiovascular response of middle aged and elderly patients during tracheal extubation period. METHODS:110 general anesthesia patients with colorectal cancer were collected and randomly divided into observation group and control group,with 55 cases in each group. All patients received general anesthe-sia with same dose. Observation group was given intravenous pump of dexmedetomidine hydrochloride 0.5 μg/kg after surgery,and control group was given intravenous pump of propofol 0.5 μg/kg. HR and MAP of 2 groups were compared 10 min before tracheal extubation,at the moment of tracheal extubation,5 and 10 min after tracheal extubation. The oxygen saturation of blood,the time of respiration recovery,opening eyes and extubation were recorded in 2 groups. RESULTS:There was no statistical significance in HR and MAP between 2 groups 10 min before extubation and 10 min after extubation (P>0.05). HR and MAP of observation group were significantly lower than those of control group at the moment of extubation and 5 min after extubation,the levels of HR and MAP were significantly increased in the 2 groups with statistical significance (P0.05). The time of open-ing eyes in observation group was significantly shorter than in control group,with statistical significance (P<0.05). CONCLU-SIONS:Dexmedetomidine hydrochloride could significantly decrease cardiovascular stress response and shorten recovery time of middle age and elderly patients with colorectal cancer during tracheal extubation period.
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Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.
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Objective To analyze the effect of dexmedetomidine hydrochloride injection on patients with craniocerebral disease who has no artificial airway in the process of bronchoalveolar lavage treatment.Methods Forty-six patients (age 17-28,average age 56.6±9.2,26 men and 20 women) with craniocerebral disease who has no artificial airway were selected,and were treated by bronchoalveolar lavage for lung infection.The patients were randomly divided into two groups,control and test group.The control group (n=23) received midazolam for sedative and the test group (n=23) received dexmedetomidine hydrochloride for sedative while they were in the process of bronchoalveolar lavage treatment.Heart rate,mean arterial pressure and blood oxygen saturation of fingers collected from patients before and during the process of bronchoalveolar lavage were compared.Results In the process of bronchoalveolar lavage treatment,the minimum blood oxygen saturation of finger artery from the control group was lower than that from the test group,the fastest heart rate from the control group was greater than that from the test group,and the lowest mean arterial pressure from the control group was lower than that from the test group (P＜0.05).In two groups,heart rate in the process of bronchoalveolar lavage treatment was faster than that from before the treatment,while both mean arterial pressure and blood oxygen saturation of finger artery were decreased (P＜0.05).Conclusions Continuous intravenous pumping of dexmedetomidine hydrochloride on patients with craniocerebral disease who has no artificial airway during the process of bronchoalveolar lavage treatment is effective and safe,and it has less inhibitory effect on respiratory function and blood pressure.