Dexmedetomidine versus sufentanil as adjuvants to bupivacaine for brachial plexus block during upper extremity surgery: a randomized clinical trial

Abstract Background: Brachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB. Methods: In this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to two equal study groups (n = 20), receiving 1 mL of 5 μg.mL-1 sufentanil (group S) or 1 mL of 100 μg.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40). Results: The duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0~130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0~130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0~7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0~-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting. Conclusion: Our study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.

Ultrasound Guided Fascia Iliaca Compartment Block Using Either Bupivacaine Or Bupivacaine With Dexmedetomidine For Postoperative Analgesia In Patients With Femur Fractures.

Background: Femur fractures are extremely painful due to the lowest pain threshold of the periosteum among the deep somatic structures. Perioperative Fascia Iliaca Compartment Block (FICB), when administered using a local anesthetic agent, bupivacaine, can reduce morbidity by providing satisfactory pain relief. Dexmedetomidine, an alpha-2 agonist, is known to prolong the local anesthetic effects without causing any significant side effects. We compared analgesic duration of ultrasound guided FICB with bupivacaine alone and bupivacaine with dexmedetomidine for postoperative analgesia. A prospective, randomized, double blinded study was conducted on 50 patientsMaterials And Method: aged 18 to 65 years undergoing femur fracture surgeries. Patients were divided into 2 groups of 25 each. Both groups received USG guided FICB. Group A received 28 ml 0.25% bupivacaine and 2 ml normal saline (NS). Group B received 28 ml 0.25% bupivacaine and 30 mcg dexmedetomidine in NS. Pain scores were assessed every 5 minutes until 15 minutes post FICB, during positioning for subarachnoid block and every 2 hours until 24 hours post-operatively. Total duration of analgesia, cumulative analgesia requested in 24 hours, Ramsay sedation and patient satisfaction scores were recorded. Results: The mean duration of analgesia in Group A was 419.4 ± 115.35 minutes (95%CI: 374.2 – 464.6) and in Group B was 656.6 ± 137.99 minutes (95%CI: 602.5 –710.7), p <0.001. Mean VAS score during positioning for SAB in Group A was 1.60 ± 0.50 and in Group B was 0.96 ± 0.68. USG guided FICB with dexmedetomidine is superior inConclusion: providing prolonged post-operative analgesia in comparison to bupivacaine alone

Single-bolus dexmedetomidine in prevention of emergence delirium in pediatric ophthalmic surgeries: A randomized controlled trial

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.

The antioxidant effect of preischemic dexmedetomidine in a rat model: increased expression of Nrf2/HO-1 via the PKC pathway

Abstract Background The precise underlying mechanism of antioxidant effects of dexmedetomidine-induced neuroprotection against cerebral ischemia has not yet been fully elucidated. Activation of Nuclear factor erythroid 2-related factor (Nrf2) and Heme Oxygenase-1 (HO-1) represents a major antioxidant-defense mechanism. Therefore, we determined whether dexmedetomidine increases Nrf2/HO-1 expression after global transient cerebral ischemia and assessed the involvement of Protein Kinase C (PKC) in the dexmedetomidine-related antioxidant mechanism. Methods Thirty-eight rats were randomly assigned to five groups: sham (n = 6), ischemic (n = 8), chelerythrine (a PKC inhibitor; 5 mg.kg-1 IV administered 30 min before cerebral ischemia) (n = 8), dexmedetomidine (100 µg.kg-1 IP administered 30 min before cerebral ischemia (n = 8), and dexmedetomidine + chelerythrine (n = 8). Global transient cerebral ischemia (10 min) was applied in all groups, except the sham group; histopathologic changes and levels of nuclear Nrf2 and cytoplasmic HO-1 were examined 24 hours after ischemia insult. Results We found fewer necrotic and apoptotic cells in the dexmedetomidine group relative to the ischemic group (p< 0.01) and significantly higher Nrf2 and HO-1 levels in the dexmedetomidine group than in the ischemic group (p< 0.01). Additionally, chelerythrine co-administration with dexmedetomidine attenuated the dexmedetomidine-induced increases in Nrf2 and HO-1 levels (p< 0.05 and p< 0.01, respectively) and diminished its beneficial neuroprotective effects. Conclusion Preischemic dexmedetomidine administration elicited neuroprotection against global transient cerebral ischemia in rats by increasing Nrf2/HO-1 expression partly via PKC signaling, suggesting that this is the antioxidant mechanism underlying dexmedetomidine-mediated neuroprotection.

The impact of emergence delirium on hospital length of stay for children who underwent tonsillectomy/adenotonsillectomy: an observational retrospective study

Abstract Background Emergence Delirium (ED) is a combination of disturbance of perception and psychomotor agitation that is common in pediatric patients after general anesthesia, especially at preschool age. Since the effect of ED on the length of stay has been studied in adults but infrequently in children, the aim of this study was to investigate the relationship between ED and length of stay in this population. Methods A single center, retrospective, observational study was carried out in children who underwent tonsillectomy or adenotonsillectomy. The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED. In addition to the time to hospital discharge (time frame 24 hours), drugs used, comorbidities, early postoperative complications, and pain were investigated if potentially associated with the complication. Results Four hundred sixteen children aged from 1.5 to 10 years (183 female, 233 male) were included. ED occurred in 25.5% of patients (n = 106). Patients were divided into the ED group and the No-ED group. The discharge time was similar in both groups. No significant differences were observed in the frequency of postoperative complications. The use of fentanyl or dexmedetomidine did not affect ED occurrence. The frequency of pain was greater in the ED group, both in the recovery room and in the ward (p= 0.01). Conclusions The occurrence of ED in children after tonsillectomy/adenotonsillectomy did not extend the length of stay.

The effect of dexmedetomidine on expression of neuronal nitric oxide synthase in spinal dorsal cord in a rat model with chronic neuropathic pain / O efeito da dexmedetomidina na expressão do óxido nítrico sintase neuronal na medula espinhal dorsal em um modelo rato com dor neuropática crônica

Abstract Background Neuropathic pain typically refers to the pain caused by somatosensory system injury or diseases, which is usually characterized by ambulatory pain, allodynia, and hyperalgesia. Nitric oxide produced by neuronal nitric oxide synthase (nNOS) in the spinal dorsal cord might serve a predominant role in regulating the algesia of neuropathic pain. The high efficacy and safety, as well as the plausible ability in providing comfort, entitle dexmedetomidine (DEX) to an effective anesthetic adjuvant. The aim of this study was to investigate the effect of DEX on the expression of nNOS in spinal dorsal cord in a rat model with chronic neuropathic pain. Methods Male Sprague Dawley (SD) rats were randomly assigned into three groups: sham operation group (sham), (of the sciatic nerve) operation (CCI) group, and dexmedetomidine (DEX) group. Chronic neuropathic pain models in the CCI and DEX groups were established by sciatic nerve ligation. The thermal withdrawal latency (TWL) was measured on day 1 before operation and on day 1, 3, 7 and 14 after operation. Six animals were sacrificed after TWL measurement on day 7, and 14 days after operation, in each group, the L4-6 segment of the spinal cords was extracted for determination of nNOS expression by immunohistochemistry. Results Compared with the sham group, the TWL threshold was significantly decreased and the expression of nNOS was up-regulated after operation in the CCI and DEX groups. Compared with the CCI grou[, the TWL threshold was significantly increased and the expression of nNOS was significantly down-regulated on day 7 and 14 days after operation in the DEX group. Conclusion Down-regulated nNOS in the spinal dorsal cord is involved in the attenuation of neuropathic pain by DEX.

Resumo Antecedentes A dor neuropática refere-se tipicamente à dor causada por lesões ou doenças do sistema somatossensorial. De modo geral, é caracterizada por dor à ambulação, alodinia e hiperalgesia. O óxido nítrico produzido pela enzima óxido nítrico sintase neuronal (nNOS) na medula espinhal dorsal pode ter um papel predominante na regulação da dor neuropática. A alta eficácia e segurança, bem como a plausível capacidade de proporcionar conforto, faz com que a dexmedetomidina (DEX) seja um adjuvante anestésico eficaz. O objetivo deste estudo foi investigar o efeito da DEX na expressão de nNOS na medula espinhal dorsal em um modelo de ratos com dor neuropática crônica. Métodos Ratos Sprague Dawley (SD) machos foram distribuídos aleatoriamente em três grupos: grupo de cirurgia simulada (sham), grupo de cirurgia (do nervo ciático; CCI) e grupo dexmedetomidina (DEX). Os modelos de dor neuropática crônica nos grupos CCI e DEX foram estabelecidos por ligadura do nervo ciático. A latência de retirada térmica (TWL) foi medida no dia 1 antes da cirurgia e nos dias 1, 3, 7 e 14 após o procedimento. Seis animais de cada grupo foram eutanasiados após a medida de TWL nos dias 7 e 14 após a cirurgia e o segmento L4-6 da medula espinhal foi extraído para determinação da expressão de nNOS por imuno-histoquímica. Resultados Em comparação ao grupo sham, o limiar de TWL diminuiu significativamente e a expressão de nNOS foi regulada de maneira positiva após a cirurgia nos grupos CCI e DEX. Comparado ao grupo CCI, o limiar de TWL aumentou de forma significativa e a expressão de nNOS caiu significativamente diminuída nos dia 7 e 14 após a cirurgia no grupo DEX. Conclusão A regulação negativa de nNOS na medula espinhal dorsal está envolvida na atenuação da dor neuropática pela DEX.

A randomized comparative study of preoperative fentanyl and dexmedetomidine nebulization on the hemodynamic response to endotracheal intubation

Background: Intense sympathetic activity is linked to laryngoscopy and endotracheal intubation, which could lead to intraoperative problems. We undertook this study to compare the effects of preoperative nebulized Fentanyl and Dexmedetomidine on hemodynamic response to laryngoscopy and endotracheal intubation, taking advantage of their high bioavailability and better absorption through nasal mucosa. Aim and Objectives: The objectives of the study were (i) to compare the effect of preoperative nebulization on the hemodynamic response to laryngoscopy and intubation; and (ii) to assess intraoperative requirement of anesthetic agents. Materials and Methods: This prospective, randomized, and comparative study was conducted among 100 American Society of Anesthesiologists (ASA) I, II patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized in two groups. Group A was given Fentanyl Nebulization (2 ?g/kg in 4 ml of 0.9% saline) and Group B was given Dexmedetomidine nebulization (1 ?g/kg in 4 ml of 0.9% saline) 10 min before anesthesia induction. Hemodynamic parameters were noted before and immediately after induction, 1 min, 5 min and 10 min after intubation. The main goal was to assess how Fentanyl and dexmedetomidine nebulization affect the laryngoscopy and intubation-induced stress response. The secondary outcome was to assess the intraoperative requirement of anesthetic agents, observe adverse effects of study drug and sedation score. Results: Dexmedetomidine nebulization was found to be more effective in blunting rise in heart rate post laryngoscopy compared to Fentanyl Nebulization (P < 0.0001) as well as in MAP after 10 min of intubation (P < 0.0001). Requirement of propofol was seen to be significantly reduced in Group B compared to Group A (P < 0.05). Sedation scores were significantly higher in Group B (P < 0.05). No evidence of side effects was observed in any group. Conclusion: Nebulisation of dexmedetomidine was found to be more effective in attenuation of stress response of laryngoscopy and intubation compared to nebulisation of fentanyl, with stable intraoperative hemodynamic and no significant side effects.

Dexmedetomidina vía nasal en colecistectomía laparoscópica / Dexmedetomidine intranasally in laparoscopic cholecystectomy

Resumen: Introducción: la dexmedetomidina es un adyuvante en el manejo anestésico perioperatorio y si se administra por vía nasal las dosis requeridas tienen mínimos efectos secundarios. Material y métodos: ensayo clínico aleatorizado doble ciego en pacientes sometidos a colecistectomía laparoscópica con anestesia general, comparando la dexmedetomidina intranasal (1 μg/kg de peso ideal) contra placebo, se comparó el efecto analgésico postoperatorio por medio de la escala visual análoga del dolor (EVA) y el consumo de opioides transanestésico. El análisis estadístico se realizó con t de Student y exacta de Fisher. Resultados: se incluyeron 54 pacientes aleatorizados en dos grupos: dexmedetomidina y control. El 81.5% de los sujetos fueron mujeres, no se encontró diferencia entre los grupos en las variables demográficas. La media de la calificación EVA a los 60 minutos para el grupo dexmedetomidina fue (2.89 ± 1.9), estadísticamente inferior comparada contra el grupo control (5.78 ± 2.3) (p ˂ 0.0001). El consumo de opioides para dexmedetomidina fue (0.424 ± 0.074 μg/h) estadísticamente menor al control (0.697 ± 0.136 μg/h) (p ˂ 0.0001) con un tamaño del efecto de Cohen de 250%. Conclusiones: disminución significativa en EVA y en el consumo de opioides con el uso de dexmedetomidina intranasal en colecistectomía laparoscópica.

Abstract: Introduction: dexmedetomidine is and useful adjuvant agent in the perioperative anesthetic management associated to nasal administration with minimum adverse effects. Material and methods: a randomized, controlled, double blind, clinical trial was carried out in elective patients undergoing laparoscopic cholecystectomy with general anesthesia. Aim of this study was to compare the postoperative analgesic effect through visual analogue scale (VAS) and the perioperative opioid consumption. Dexmedetomidine was administrated intranasally (1 μg/kg dose) versus placebo. Statistical analysis was realized through student t and Fisher Test. Results: 54 patients were randomized in two groups: dexmedetomidine vs control. Not significant differences were found between both groups in demographic variables but 81.5% were women. Mean of VAS score at 60 minutes was significantly inferior (2.89 ± 1.9) versus control group (5.78 ± 2.3) (p ˂ 0.0001). Mean of opioids consumption in dexmedetomidine group (0.424 ± 0.074 μg/h) was significant minor of control group (0.697 ± 0.136 μg/h) (p ˂ 0.0001). Size effect through Cohen test was 250%. Conclusion: statistically decrease in VAS and in opioid consumption was observed using dexmedetomidine nasally in laparoscopic cholecystectomy.

Effect of dexmedetomidine on tourniquet-induced skeletal muscle injury

SUMMARY OBJECTIVE: The aim of this study was to investigate whether dexmedetomidine could reduce tourniquet-induced skeletal muscle injury. METHODS: C57BL6 male mice were randomly assigned to sham, ischemia/reperfusion, and dexmedetomidine groups. Mice in the ischemia/reperfusion and dexmedetomidine groups received normal saline solution and dexmedetomidine intraperitoneally, respectively. The sham group underwent the same procedure as the ischemia/reperfusion group, with the exception of tourniquet application. Subsequently, the ultrastructure of the gastrocnemius muscle was observed, and its contractile force was examined. In addition, Toll-like receptor 4 and nuclear factor-κB expression within muscles was detected by Western blot. RESULTS: Dexmedetomidine alleviated myocyte damage and increased the contractility of skeletal muscles. Moreover, dexmedetomidine significantly inhibited the expression of Toll-like receptor 4/nuclear factor-κB in the gastrocnemius muscle. CONCLUSION: Taken together, these results demonstrate that dexmedetomidine administration attenuated tourniquet-induced structural and functional impairment of the skeletal muscle, partly through inactivation of the Toll-like receptor 4/nuclear factor-κB pathway.

Efficacy of dexmedetomidine as adjuvant to ropivacaine in paravertebral block for post-operative analgesia in breast cancer surgery

Background: Paravertebral block can be given for pain management after modified radical mastectomy (MRM). Although many additives to ropivacaine in PVB have been tried for post-operative analgesia, none has been found ideal. Aims and Objectives: We have compared the duration of analgesia in PVB using adjuvant like dexmedetomidine with ropivacaine after MRM. Materials and Methods: Sixty female patients posted for MRM and axillary dissection were split into two groups. Group R administered ultrasound-guided PVB with 20 ml ropivacaine 0.5% and Group RD administered 20 ml of 0.5% ropivacaine with dexmedetomidine 1 mcg/kg. After confirming PVB, surgery was done under general anesthesia in all patients. Time for 1st analgesia requirement was the main objective of our trial. Other objectives were to record visual analog scale scores and total analgesic need. Results: Post-operative analgesia duration was increased in the group RD (7.11 ± 1.42 h) in contrary to Group R (3.68 ± 1.85 h). Total paracetamol consumption post-operative 24 h was decreased in Group RD (1.63 ±0.89 g) in contrary to Group R (2.74 ± 0.76 g). Conclusion: Dexmedetomidine in PVB provides prolonged pain relief after MRM.

Comparison of intranasal midazolam-fentanyl with dexmedetomidine–fentanyl as pre-medication in the paediatric age group

Background & objectives: Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Methods: Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 ?g/kg) and group B received intranasal dexmedetomidine (1 ?g/kg)-fentanyl (2 ?g/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher’s Facial Pain Scale. Results: Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher’s Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine- fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Interpretation & conclusions: Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Effect of combined sedation using multiple drugs on inflammatory cytokines in patients with acute respiratory distress syndrome

Abstract he innate immune response plays an important role in the pathophysiology of acute respiratory distress syndrome (ARDS); however, no drug has been proven to be beneficial in the management of ARDS. Therefore, the aim of this study was to investigate the effects of using combined sedatives on systemic inflammatory responses in patients with ARDS. A total of 90 patients with ARDS and an intubation time of > 120 h were randomly divided into the propofol group (group P), midazolam group (group M), and combined sedation group (group U). Patients in groups P and M were sedated with propofol and midazolam, respectively, whereas patients in group U were sedated with a combination of propofol, midazolam, and dexmedetomidine. The dosage of sedatives and vasoactive drugs, duration of mechanical ventilation, and incidence of sedative adverse reactions were documented. The dosage of sedatives and vasoactive drugs, as well as the incidence of sedative adverse reactions in group U, was significantly lower than those in groups P and M. Similarly, the duration of mechanical ventilation in group U was significantly shorter than that in groups P and M. Hence, inducing sedation through a combination of multiple drugs can significantly reduce their adverse effects, improve their sedative effect, inhibit systemic inflammatory responses, and improve oxygenation in patients with ARDS

DEX, Delirium and Dilemma

ABSTRACT Dexmedetomidine has been subjected to an extensive evaluation for its' role in the prevention of postoperative delirium following cardiac surgery. In striking contrast to the preexisting meta-analysis supporting postoperative delirium-reduction with dexmedetomidine, few recently concluded multicentric large scale randomized controlled trials suggest otherwise. This article aims to present a nuanced perspective of the evolving controversy by attempting to decode the apparent incongruences in the literature accumulating off-late, which is particularly pertinent amidst an ever-escalating heterogeneity in the current research ecosystem.

Effects of dexmedetomidine on vital signs during postoperative anesthesia recovery period in gynecological patients undergoing general anesthesia surgery and analysis on risk factors for complications / 中国基层医药

Objective:To investigate the effects of dexmedetomidine on vital signs during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery and analysis of risk factors for complications.Methods:A total of 80 gynecological patients undergoing general anesthesia surgery who received treatment in Lishui People's Hospital from March 2021 to March 2022 were included in this study. They were randomly divided into an observation group and a control group ( n = 40/group). All patients were subjected to general anesthesia. The observation group was infused with 0.5 μg/kg dexmedetomidine intravenously 15 minutes before induction of anesthesia and then infused with dexmedetomidine at a rate of 0.2 μg/kg per hour until 20-30 minutes before the end of the operation. The control group was identically given 0.9% normal saline. The recovery quality, vital signs before surgery and during recovery from general anesthesia (systolic blood pressure, diastolic blood pressure, heart rate, body temperature), and complications during recovery from general anesthesia were compared between the two groups. These patients were divided into a complication group and a non-complication group according to whether there were complications during recovery from general anesthesia. Univariate and multivariate Logistic regression analyses were performed to analyze the high-risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery. Results:The time to awaken, time to recover spontaneous respiration, and time to extubation in the observation group were significantly shorter than those in the control group ( t = 3.74, 2.97, 2.56, all P < 0.05). Systolic blood pressure, diastolic blood pressure, and heart rate measured during recovery from general anesthesia were significantly lower in the observation group compared with the control group ( t = 5.71, 4.53, 4.53, all P < 0.001). Body temperature ( t = 4.40, P < 0.001) and the incidence of complications ( χ2 = 5.69, P < 0.05) were significantly lower in the observation group compared with the control group. These patients were divided into complication ( n = 22) and non-complication ( n = 58) groups according to whether they had complications during recovery from general anesthesia. Univariate and multivariate logistic regression analyses showed that American Association of Anesthesiologists grade II, presence of underlying diseases, abnormal leukocyte count, and no use of dexmedetomidine were the risk factors for postoperative complications in gynecological patients undergoing general anesthesia surgery ( OR = 2.38, 2.86, 2.17, 3.60, all P < 0.05). Conclusion:Dexmedetomidine can improve awakening quality and vital signs and reduce complications during recovery from general anesthesia. American Association of Anesthesiologists grade, underlying disease, abnormal white blood cell count, and no use of dexmedetomidine are the risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery.

Effect of dexmedetomidine on cough reactions during recovery from general anesthesia in thyroid tumor surgery / 中华地方病学杂志

Objective:To explore the effect of dexmedetomidine on cough reactions and related indexes during recovery from general anesthesia in thyroid tumor surgery.Methods:A total of 90 patients with thyroid tumor who underwent general anesthesia for thyroid tumor surgery from July 2019 to July 2021 in the First People's Hospital of Shangqiu City, Henan Province were selected and divided into the observation group (45 cases) and the control group (45 cases) according to the random number table method. The observation group was given dexmedetomidine 0.5 μg/kg intravenously at the beginning of the surgery, and the intravenous drip time should not be less than 10 min; the control group was given the same dose of normal saline intravenously. The recovery time and extubation time of the two groups were compared, and the incidence of cough reactions during the recovery from general anesthesia was compared. Changes of visual analogue scale (VAS) of pain at 6 h, 24 h and 48 h after surgery, and the changes of stress response indexes [cortisol (Cor), epinephrine (E) and norepinephrine (NE)] and pain factors [prostaglandin E2 (PGE2), neuropeptide Y (NPY) and β-endorphin (β-EP)] before and 48 h after surgery were compared.Results:The recovery time and extubation time in the observation group [(15.62 ± 3.64), (18.27 ± 4.25) min] were faster than those in the control group [(23.12 ± 4.53), (25.65 ± 3.89) min, P < 0.001]. The incidence of cough reactions during recovery from general anesthesia in the observation group [8.89% (4/45)] was lower than that in the control group [28.89% (13/45), P = 0.015]. The VAS score in the observation group was lower than that in the control group at 6 h, 24 h and 48 h after surgery ( P < 0.001). The levels of serum Cor, E and NE at 48 h after surgery in both groups were higher than those before surgery ( P < 0.001); and the serum Cor, E, and NE levels in the observation group were lower than those in the control group at 48 h after surgery ( P < 0.001). The serum PGE2 and NPY levels of the two groups at 48 h after surgery were higher than those before surgery, while β-EP level was lower than that before surgery ( P < 0.001); the serum PGE2 and NPY levels in the observation group were lower than those in the control group at 48 h after surgery, while β-EP level was higher than that in the control group ( P < 0.001). Conclusion:Dexmedetomidine can reduce the cough reactions during recovery from general anesthesia in thyroid tumor surgery, significantly reduce pain, and has little effect on stress response and pain factors.

Observation on the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone in anesthesia intensive care unit for elderly patients undergoing thoracoscopic radical resection of lung cancer / 中国医师进修杂志

Objective:To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit (AICU) in elderly patients after thoracoscopic radical surgery for lung cancer.Methods:Using the method of prospective study, 80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected. The patients were divided into dexmedetomidine combined with sufentanil group (S group) and dexmedetomidine combined with oxycodone group (Q group) by random digits table method with 40 cases each group. On the basis of routine monitoring and treatment after operation, the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump, the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump. The wake-up time, extubation time, awakening quality (Aldrete score and bucking score) and comfort level (Bruggrmann comfort scale score, BCS score) after entering the AICU were record; the sedation score (Ramsay score) and pain relief score (numerical rating scale score, NRS score) and hemodynamic changes (mean arterial pressure and heart rate) 3, 5, 7, 10 and 14 h after entering the AICU were record; the level of serum inflammatory factors, including tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) immediately, 5 h and 14 h after entering the AICU; press times of analgesia pump, adverse events, bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results:The bucking score in Q group was significantly lower than that in S group: (1.02 ± 0.77) scores vs. (1.88 ± 0.34) scores, the Aldrete score and BCS score were significantly higher than those in S group: (8.93 ± 0.25) scores vs. (5.97 ± 0.32) scores and (3.03 ± 0.32) scores vs. (0.93 ± 0.52) scores, and there were statistical differences ( P<0.01); there were no statistical difference in wake-up time and extubation time between two groups ( P>0.05). There were no statistical difference Ramassy score, NRS score 3 and 5 h after entering the AICU, mean arterial pressure and heart rate between two groups ( P>0.05); the Ramassy score 7, 10 and 14 h after entering the AICU in Q group was significantly lower than that in S group, the NRS score, mean arterial pressure and heart rate were significantly lower than those in S group, and there were statistical differences ( P<0.01). There were no statistical differences in TNF-α, IL-6 and CRP immediately after entering the AICU between two groups ( P>0.05); the TNF-α, IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group, and there were statistical difference ( P<0.01). The press times of analgesia pump, bleeding volume of drainage tube and the incidences of nausea vomiting, respiratory depression, lethargy, restlessness, fever and lung infection in Q group were significantly lower than those in S group: (4.63 ± 1.10) times vs. (18.80 ± 1.54) times, (129.67 ± 4.14) ml vs. (164.00 ± 8.14) ml, 10.0% (4/40) vs. 52.5% (21/40), 2.5% (1/40) vs. 25.0% (10/40), 7.5% (3/40) vs. 47.5% (19/40), 0 vs. 20.0% (8/40), 2.5% (1/40) vs. 22.5% (9/40) and 2.5% (1/40) vs. 20.0% (8/40), and there were statistical differences ( P<0.01 or <0.05); there was no severe hypotension, severe bradycardia and delirium in both groups. The overall satisfaction score in Q group was significantly higher than that in S group: (3.53 ± 0.63) scores vs. (2.70 ± 0.65) scores, and there was statistical difference ( P<0.01). Conclusions:Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation, without affecting the extubation time, and can effectively reduce the degree of pain, stress and inflammatory reaction in the early recovery period, and reduce the incidence of adverse events after surgery.

Effects of Epidural Labor Analgesia plus Dexmedetomidine on Postpartum Depression in Parturients： A Prospective Study / 中山大学学报(医学科学版)

ObjectiveTo investigate the effects of epidural analgesia plus dexmedetomidine infusion on postpartum depression in parturients with natural childbirth. MethodsWe selected 70 parturients aged between 22 and 36， with singleton， term， cephalic presentation， natural delivery and ASA class I or Ⅱ. The cases undergoing epidural analgesia with ropivacaine and sufentanil were randomly divided into two groups by using a random number table （n=35 for each group）. The control group （Group C） used intravenous infusion of normal saline， while the experimental group （Group D） used equivalent volumes of intravenous infusion of dexmedetomidine. Participants were followed up at 1， 6， 12 weeks after childbirth to assess the severity of postpartum depression. Blood samples were collected at 12 h and 48 h after childbirth to measure the serum prolactin levels. The hemodynamic （HR and MAP） changes， VAS scores， and Ramsay scores were recorded at five time points： before analgesia （T1）， 10 min after analgesia （T2）， 30 min after analgesia （T3）， 12 h （T4） and 24 h （T5） after delivery. The number of analgesia pump presses and adverse events were also documented. ResultsCompared with Group C， Group D showed significantly lower EPDS scores at 1 week after childbirth， significantly higher prolactin concentrations at 12 h and 48 h after childbirth， significantly lower VAS scores at T2， T3 and T4， significantly higher Ramsay score at T3 and significantly reduced number of analgesia pump presses （P < 0.05）. ConclusionEpidural analgesia plus intravenous infusion of dexmedetomidine can alleviate early postpartum depression in women undergoing natural delivery， promote early prolactin secretion and provide a safe and effective adjunctive analgesic and sedative effect.

Effects of dexmedetomidine on intestinal stress response and cellular immune function in patients with gynecologic malignancies undergoing laparoscopic surgery / 肿瘤研究与临床

Objective:To explore the effects of dexmedetomidine (DEX) on intestinal stress response and cellular immune function in patients with gynecologic malignancies undergoing laparoscopic surgery.Methods:A total of 60 patients with gynecologic malignancies who scheduled to undergo laparoscopic surgery under general anesthesia in the Second Hospital of Shanxi Medical University from March 2021 to March 2022 were selected. All patients were divided into the DEX group and the control group according to the random number table method, with 30 cases in each group. The DEX group included 12 cases of cervical cancer, 10 cases of endometrial cancer and 8 cases of ovarian cancer; the control group included 14 cases of cervical cancer, 9 cases of endometrial cancer and 7 cases of ovarian cancer. The DEX group: intravenous anesthesia was induced with a dose of DEX 0.5 μg/kg (infusion was completed within 10 min), general anesthesia was maintained with DEX 0.2 μg·kg -1·h -1 pumped intravenously, and the drug was stopped 30 min before surgery. The control group: equal amount of 0.9% sodium chloride solution was pumped intravenously. The venous blood was drawn at the time points of 10 min before general anesthesia (T 0), at the end of operation (T 1) and 1 d after the operation (T 2) to detect the stress response indicators such as cortisol (COR), epinephrine (E), norepinephrine (NE) levels, and immune indicators such as CD4 +, CD8 + proportions and CD4 +/CD8 + at T 0, T 1,and T 2. In addition, the pneumoperitoneum time, general anesthesia time, operation time and intestinal function recovery time were recorded. Results:At T 0, there were no statistically significant differences in the levels of COR, E and NE between the DEX group and the control group (all P > 0.05). At T 1, the levels of COR, E and NE were (146±12) μg/L, (158±14) ng/L, (265±12) ng/L, respectively in the control group, and (136±18) μg/L, (149±15) ng/L, (158±12) ng/L, respectively in the DEX group; the levels of COR, E and NE in the DEX group were lower than those in the control group ( t values were -2.51, -2.37, -2.08, all P < 0.05). At T 2, the levels of COR, E and NE were (124±12) μg/L, (131±16) ng/L, (234±8) ng/L, respectively in the control group, and (116±15) μg/L, (123±12) ng/L, (228±10) ng/L, respectively in the DEX group; the levels of COR, E and NE in the DEX group were also lower than those in the control group ( t values were -2.35, -2.23, -2.17, all P < 0.05). At T 0, there were no statistically significant differences in the proportions of CD4 +, CD8 + and CD4 +/CD8 + between the DEX group and the control group (all P > 0.05). At T 1, the proportions of CD4 +, CD8 + and CD4 +/CD8 + were (23±3)%, (20±3)%, 1.12±0.16, respectively in the control group, and (27±4)%, (23±4)%,1.22±0.19, respectively in the DEX group; the proportions of CD4 +, CD8 + and CD4 +/CD8 + in the DEX group were higher than those in the control group ( t values were -3.43, -2.29, 2.13, all P < 0.05). At T 2, the proportions of CD4 +, CD8 + and CD4 +/CD8 + were (26±3)%, (23±4)%, 1.17±0.16, respectively in the control group, and (31±5)%, (25±4)%, 1.26±0.19, respectively in the DEX group; the proportions of CD4 +, CD8 + and CD4 +/CD8 + in the DEX group were higher than those in the control group ( t values were -4.32, -2.02, 2.02, all P < 0.05). In addition, the time of first exhaust in the DEX group was shorter than that in the control group ( P<0.05). Conclusions:DEX can reduce the intestinal stress response of gynecologic malignancies patients undergoing laparoscopic surgery, thereby improving the immunosuppression of patients. It is also of great significance to protect intestinal mucosal barrier and recover the intestinal function, and DEX has a high safety.

Effects of different doses of dexmedetomidine on inflammatory factors and immune function during laparoscopic surgery in patients with gynecological malignant tumors / 肿瘤研究与临床

Objective:To explore the effects of different doses of dexmedetomidine (DEX) on inflammatory factors and immune function in patients with gynecological malignant tumors who underwent laparoscopic surgery.Methods:A total of 60 patients with gynecological malignant tumors who underwent laparoscopic surgery from January 2021 to December 2021 in the Second Hospital of Shanxi Medical University were selected as the research objects. All patients were divided into the control group, low-dose DEX group (group D1) and high-dose DEX group (group D2) by using random number table method, 20 cases in each group. Patients in D1 and D2 groups were intravenously pumped DEX 0.5 μg/kg and 1.0 μg/kg 10 minutes before induction of anesthesia, and then maintained with DEX 0.5 μg·kg -1·h -1 and 1.0 μg·kg -1·h -1 until 30 minutes before the end of operation; and patients in the control group were given the same amount of Nacl solution. The 10 ml peripheral venous blood were collected at 10 minutes before induction of anesthesia (T 1), 1 h after pneumoperitoneum relief (T 2) and 24 h after pneumoperitoneum relief (T 3). The changes of interleukin-6 (IL-6), interleukin-10 (IL-10), the proportion of CD4 +, the proportion of CD8 + and CD4 +/CD8 + ratio of the three groups were compared, and the cases of bradycardia and hypotension in perioperative period and the time of first exhaust after operation were recorded. Results:At T 1,T 2 and T 3, the expression level of IL-6 in the control group was (7.95±0.26) pg/ml, (8.30±0.24) pg/ml and (8.35±0.28) pg/ml, respectively, and the difference was statistically significant ( F = 14.14, P < 0.001); the expression level of IL-10 in the control group was (38.9±2.6) pg/ml, (44.5±6.6) pg/ml and (46.3±4.6) pg/ml, respectively, and the difference was statistically significant ( F = 12.45, P < 0.001); the proportion of CD4 + in the control group was (38.5±2.1)%, (29.5±4.6)% and (29.6±3.5)%, respectively, and the difference was statistically significant ( F = 40.82, P < 0.001); the ratio of CD8 + in the control group was (30.1±3.7)%, (35.1±6.3)% and (40.3±8.2)%, respectively, and the difference was statistically significant ( F = 13.02, P < 0.001); the CD4 +/CD8 + ratio in the control group was 1.29±0.14, 0.84±0.09 and 0.75±0.14, respectively, and the difference was statistically significant ( F = 99.94, P < 0.001). The expression level of IL-6 in group D1 and group D2 was (8.10±0.32) pg/ml and (8.01±0.30) pg/ml at T 2, and (8.12±0.35) pg/ml and (8.05±0.34) pg/ml at T 3,which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The expression level of IL-10 in group D2 was (40.6±3.5) pg/ml at T 2, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the expression level of IL-10 in group D1 and group D2 was (43.7±3.5) pg/ml and (42.4±3.9) pg/ml, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD4 + in group D2 was (34.5±4.3)%, which was higher than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD4 + in group D1 and group D2 was (32.1±4.2)% and (33.7±2.8)%, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD8 + in group D2 was (30.7±5.5)%, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD8 + in group D1 and group D2 was (35.4±5.8)% and (32.5±5.1)%, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The CD4 +/CD8 + ratio in group D1 and D2 was 0.99±0.17 and 1.14±0.16 at T 2, 0.93±0.19 and 1.05±0.16 at T 3, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). Meanwhile, 1 case of hypotension occurred in the the control group and group D1, respectively; 3 cases of bradycardia and 2 cases of hypotension occurred in the group D2. The time of exhaust in the control group was later than that in group D1 and D2, and the difference was statistically significant ( P < 0.05). Conclusions:DEX can inhibit the inflammatory reaction during laparoscopic surgery in patients with gynecological malignant tumors, reduce immune damage. The anti-inflammatory action and immune protection of high-dose of DEX is more significant compared with low-dose of DEX, while high dose of DEX is more likely to cause hemodynamic fluctuations in perioperative period.

Role of activation of VGLUT2 neurons in vagal nodose ganglion in dexmedetomidine-caused bradycardia in mice / 中华麻醉学杂志

Objective:To evaluate the role of activation of vesicular glutamate transporter 2 (VGLUT2) neurons in vagal nodose ganglion in dexmedetomidine-caused bradycardia in mice.Methods:Ninety-six SPF healthy male VGLUT2-cre mice, aged 10 weeks, weighing 20-25 g, were divided into 6 groups ( n=16 each) by the random number table method: normal saline control group (NS group), dexmedetomidine group (Dex group), viral control + chemogenetic control + dexmedetomidine group (eGFP-NS+ Dex group), viral transfection + chemogenetic control + dexmedetomidine group (hM4Di-NS+ Dex group), viral control + chemogenetic inhibition + dexmedetomidine group (eGFP-CNO+ Dex group) and viral transfection + chemogenetic inhibition + dexmedetomidine group (hM4Di-CNO+ Dex group). Dexmedetomidine 100 μg/kg was intraperitoneally injected in Dex group. The equal volume of normal saline was intraperitoneally injected in NS group. AAV2/9-hSyn-DIO-hM4Di-eGFP was injected in the right nodose ganglion in hM4Di-NS+ Dex group and hM4Di-CNO+ Dex group, and AAV2/9-hSyn-DIO-eGFP was injected in the right nodose ganglion in eGFP-NS+ Dex group and eGFP-CNO+ Dex group, allowing the virus expression for 21 days. On the 22nd day after virus injection, clozapine-n-oxide (CNO) 5 mg/kg was intraperitoneally injected in hM4Di-CNO+ Dex group and eGFP-CNO+ Dex group, the equal volume of normal saline was intraperitoneally injected in hM4Di-NS+ Dex group and eGFP-NS+ Dex group, 1 h later the efficacy of CNO reached the peak, and then dexmedetomidine 100 μg/kg was intraperitoneally injected. The respiratory rate, heart rate, SpO 2 and discharge frequency of the right vagal nodose ganglion were synchronously measured by multi-channel electrophysiology in vivo. The expression of phosphorylated extracellular signal-regulated kinase (pERK) and VGLUT2 and co-expression of pERK and VGLUT2 in the right vagal nodose ganglion were detected by immunofluorescence assay. Results:Compared with NS group, the percentage of heart rate variation and neuron firing frequency after administration were significantly increased, and pERK expression was up-regulated in the other five groups ( P<0.05). Compared with Dex group, the percentage of heart rate variation and neuron firing frequency after administration were significantly decreased, and pERK expression was down-regulated in hM4Di-CNO+ Dex group, and no significant change was found in the parameters mentioned above in hM4Di-NS+ Dex group, eGFP-NS+ Dex group and eGFP-CNO+ Dex group ( P>0.05). Compared with hM4Di-CNO+ Dex group, the percentage of heart rate variation and neuron firing frequency after administration were significantly increased, and pERK expression was up-regulated in eGFP-CNO+ Dex group ( P<0.05). There was no significant difference in the percentage of respiratory variation and SpO 2 among the six groups ( P>0.05). The expression of VGLUT2-positive neurons was abundant in nodose ganglia, and the co-expression rate of pERK and VGLUT2 was nearly 90%. The co-expression rate of pERK and VGLUT2 decreased to about 30% after inhibition of VGLUT2 neurons in ganglion. Conclusions:The mechanism by which dexmedetomidine causes bradycardia is associated with activation of VGLUT2 neurons in vagal nodose ganglia in mice.