Comparison of an intraoperative infusion of dexmedetomidine or fentanyl for the perioperative hemodynamics, achieving hypnosis and sedation, and the postoperative pain control

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.

Comparison of an intraoperative infusion of dexmedetomidine or fentanyl for the perioperative hemodynamics, achieving hypnosis and sedation, and the postoperative pain control

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.

Pulmonary Embolism Detected in the Postanesthesia Care Unit Following Operation of Long Bone Fracture: A Case Report / 대한구급학회지

Clinical manifestations of pulmonary embolism are nonspecific during anesthesia. A 44 years old female received elective operation for right tibio-fibular fracture under spinal anesthesia. During operation, the patient received oxygen supply 5 L/min via mask with oxygen. On arrival of postanesthetic care unit, oxygen saturation of pulse oxymeter (SpO2) was 89% and with the 100% oxygen 10 L/min by mask, SpO2 went up rapidly to 100%. When the patient breathed under room air, SpO2 suddenly decreased to 80%. Chest x-ray at that time was non-contributory. Under the suspicion of pulmonary embolism, the patient was transferred to intensive care unit (ICU), and low molecular weight heparin (LMWH) treatment was started. LMWH was changed to regular heparin on the second day of ICU admission after conclusive diagnosis with spiral computed tomography and lung perfusion scan. The patient's oxygenation progressively improved and on the 10th day of ICU, the patient was transferred to general ward and she was discharged without any sequelae on the 23th day postoperatively.