ABSTRACT
Background: Premedication in children is more acceptable with the intranasal route. In this study, we evaluated the efficacy of intranasal dexmedetomidine as premedication in paediatric surgeries as compared to intranasal midazolam. Methods: This study was conducted in 60 patients of 6 to 12 years posted for tonsillectomy surgeries. Patients were randomly allocated into Group 1 and 2. Patient in group 1 (30) received 0.2mg/kg of intranasal midazolam as nasal drop using 1ml insulin syringe and similarly group 2 (30) received 1µg/kg of intranasal dexmedetomidine as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, pre oxygenation mask holding response score, post-operative agitation scores were evaluated. Results: In our study, we observed that 76.7% of children in dexmedetomidine group attained better sedation compared to 46.7% in midazolam group. Anxiolytic effect in Group 1 (83.3%) was slightly better than in Group 2 (80%). 90% of the patients in dexmedetomidine group allowed easy pre oxygenation compared to 80% in midazolam group. Venipuncture response was better with dexmedetomidine group (86.7%) compared to midazolam group (73.3%). Postoperative agitation response in both the groups was same. The fall in HR, SBP was more with dexmedetomidine and there was no significant change in DBP in both the groups. Conclusions: From our study, we concluded that premedication with intranasal dexmedetomidine is more effective than intra nasal midazolam in providing sedation. Both the drugs are effective in providing anxiolysis and better inducing condition. Therefore, intranasal dexmedetomidine is more efficacious than intranasal midazolam as premedication in children.
ABSTRACT
Resumen: El liposarcoma pleomórfico es una neoformación de tejidos blandos, que afecta principalmente las extremidades. Los pacientes que los presentan son candidatos a resección amplia o incluso amputación del miembro afectado. Como parte de una técnica anestésica integral y multimodal, destaca la utilización de bloqueos ecoguiados que disminuirán los requerimientos de opioides, teniendo un impacto importante en la preservación de la inmunidad del paciente oncológico, lo que le permitirá aumentar la tasa de supervivencia y su período libre de enfermedad; adicionando además un alfa 2 agonista, el cual nos brinda una adecuada analgesia postoperatoria, y realizando los bloqueos previos a la amputación, tenemos mayor tasa de éxito en la prevención del dolor y síndrome de miembro fantasma.
Abstract: Pleomorphic liposarcoma is a neoformation, which mainly affects the extremities. Being the patient candidate to perform a wide resection or even amputation of the affected limb. As part of a multimodal anesthetic technique, the use of ultrasound-guided blocks are useful, reducing opioid requirements, having an important impact on the preservation of the cancer patient's immunity, also adding an alpha 2 agonist, which provides adequate postoperative analgesia, and performing the blocks prior to amputation, we have a higher success rate in the prevention of pain and phantom limb syndrome.
ABSTRACT
Objective To explore the safety and feasibility of intravenous dexmedetomidine(Dex)combined with targeted infusion of remifentanil in endoscopic retrograde cholangiopancreatography(ERCP)anesthesia in older adult patients.Methods From January to August 2021,98 older adult patients(≥65 years old)undergoing ERCP were randomly divided into TRP and TRD groups.The TRP group was anesthetized with target-controlled infusion of propofol and remifentanil and the TRD group was treated with Dex combined with target-controlled infusion of remifentanil.mean arterial pressure(MAP),heart rate(HR),electrocardiogram(ECG),respiratory rate(RR),pulse oxygen saturation(SpO2),bispectral index(BIS)before anesthesia induction(T0),immediately after induction of anesthesia(T1),endoscopic introduction(T2),duodenal papilla intubation(T3),endoscopy withdrawal(T4)and postoperative awakening(T5)were observed.Arterial blood gas analysis at different time points(T0,every 15 min after anesthesia induction and T5),PaO2,and PaCO2,were recorded at the above mentioned time points;and the remifentanil concentration in target-controlled infusion,operation time,recovery time(from infusion of remifentanil to consciousness recovery),anesthesia recovery time(from consciousness recovery to leaving the operating room),intraoperative body movement,Aldrete scores out of the room,Visual Analogue Scale(VAS)at 60 min after surgery,occurrence of post-operative adverse reactions,as well as the satisfaction of anesthesiologists,endoscopists,and patients were recorded.Results Compared with the TRP group,MAP at T1 and T3,SpO2 and RR at T1,T2,T3,and T4,and BIS at T2,T3,T4,and T5 increased,whereas HR at T1,T2,T3,and T4 decreased;the number of mandibular rests,incidence of hypoxemia,Aldrete score,and satisfaction increased,whereas the VAS score at 60 min after surgery decreased in the TRD group(P<0.05).There were no statistically significant differences in postoperative adverse reactions,PaO2 and PaCO2,target-controlled infusion remifentanil concentration,operation time,recovery time,and anesthesia recovery time between the two groups.Conclusion Compared with the target-controlled infusion of propofol-remifentanil,intravenous infusion of Dex combined with target-controlled infusion of remifentanil can reduce the incidence of hypoxemia in older adult patients during ERCP surgery,and the anesthesia regimen can meet the anesthesia needs of ERCP surgery,which is safe and feasible.
ABSTRACT
Objective To investigate the effects of continuous infusion of extremely low-dose dexmedetomidine on the hemodynamic sta-bility and recovery of postoperative cognition of older adult patients undergoing carotid artery stenting(CAS).Methods 106 older adult patients undergoing CAS were randomly divided into the dexmedetomidine(group D,n= 52)and control groups(group C,n= 54).Hemo-dynamic and cerebral perfusion changes were recorded 15 min before anesthesia induction(T0),5 min after anesthesia induction(T1),5 min before stent placement(T2),5 min after stent placement(T3),and 5 min after tracheal extubation(T4).The standard deviations(SD)of mean arterial pressure(MAP),heart rate(HR),and regional cerebral oxygen saturation(rSO2)were calculated as SDMAP,SDHR,and SDrSO2,respectively.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate and compare changes in pre-and post-operative cognitive function and examine the incidence of postoperative cognitive dysfunction(POCD)in the two groups.Results SDMAP,SDHR,and SDrSO2 in group D were significantly lower than those in group C(P＜0.05).The applied dosages of anesthetics and vasoactive drugs were significantly lower in group D than C(P＜0.05).Extubation time in group D was significantly shorter than that in group C(P＜0.05).MoCA scores in group D were significantly higher one day after CAS than that in group C and POCD incidence was significantly lower in group D one month after CAS(P＜0.05).Conclusion Continuous infusion of low-dose dexmedetomidine has the potential to maintain hemodynamic stability and cerebral perfusion,reduce the dosage of anesthetic drugs,and improve postoperative cognitive performance in older adult patients.
ABSTRACT
Objective:To explore the effect of ultrasound-guided femoral nerve block with dexmedetomidine combined with ropivacaine on the pain of patients after knee arthroscopy combined with high tibial osteotomy(HTO).Methods:A total of 97 patients who underwent the treatment of HTO combined with knee arthroscopy in the Ankang central hospital from 2021 to 2022 were selected,and they were divided into the observation group(46 cases)and the control group(51 cases)based on the random number table method.All patients received anesthesiology with ultrasound-guided femoral nerve block.For anesthesia,the observation group used ropivacaine combined with dexmedetomidine,and the control group only used ropivacaine.The visual analogue scale(VAS)scores of them were assessed respectively at rests before surgery,and 3h,6h and 12h after surgery,and the times that patients pressed the button of patient controlled analgesia(PCA)within 4 time intervals included the postoperative 0-6h(T1),6-12h(T2),12-18h(T3)and 18-24 h(T4)were recorded.In addition,the doses of oral opioid drug within postoperative 24 h,48 h and 72 h also were recorded,and the relevant adverse reactions of anesthesiology after surgery were recorded.Results:The pain levels at postoperative 3h,6h and 12h in the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=2.181,3.113,3.073,P<0.05),respectively.The oral dosage of opioids within 24h,48h and 72h after surgery in observation group were significantly less than those in the control group,and the differences were statistically significant(t=6.356,9.778,11.284,P<0.05),respectively.The times of pressing PCA button within T1 and T2 intervals after surgery in observation group were also significantly lower than those in control group,and the differences were statistically significant(t=5.033,2.184,P<0.05),respectively.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,and the difference was statistically significant(x2=4.562,P<0.05).Conclusion:In the surgical anesthesia of knee arthroscopy combined with(HTO),the early analgesic effect of femoral nerve block with dexmedetomidine combined with ropivacaine is significant,and the oral dosage of opioids of patient decreases after surgery,and the risk of occurring adverse reaction that is relative to anesthesia after surgery is less.
ABSTRACT
@#Objective To evaluate the efficacy and safety of midazolam combined with dexmedetomidine for sedation during magnetic resonance imaging(MRI)examination in children.Methods The medical records of children who underwent sedated MRI examinations at the Sedation Center of Children's Hospital Affiliated to Shandong University from August 2021 to July 2022 were collected.The patients were divided into three groups based on age:Infant group(age≤1 year old,922 cases),toddler group(1 year old<age≤3 years old,1153 cases),and child group(3 years old<age≤8 years old,1698 cases).The sedation regimen was oral midazolam solution 0.5mg/kg combined with intranasal dexmedetomidine 2μg/kg.Medication taken 30 minutes prior to MRI examination.The sedation depth was evaluated using the Ramsay sedation scale.A score of≥5 points was considered to achieve deep sedation.The general data,sedation success rate,sleep time,wake time and the occurrence of adverse reactions were analyzed.Results The total number of children included in the analysis amounted to 3773,with 3480 cases successfully sedated,with a total success rate of 92.2%.The success rate of 15min and 30min sedation in child group was significantly lower than that in infant group and toddler group(P<0.05).The success rate of 45min and 60min sedation in toddler group was significantly lower than that in infant group and child group(P<0.05).The sleep time in child group was significantly longer than that in infant group and toddler group(P<0.001).The recovery time of infant group was longer than that of toddler group and child group(P<0.001).The overall incidence of adverse reactions was 4.9%.The incidence of total adverse reactions in child group was significantly lower than that in infant group and toddlers group(P<0.001).Conclusion Oral midazolam combined with intranasal dexmedetomidine is safe and effective for sedation during MRI examinations in children.The younger the age,the higher the sedation success rate,the longer the recovery time,but the overall incidence of adverse reactions is low.This combination of drugs is a safe and effective sedation option for pediatric MRI examinations.
ABSTRACT
Abstract Objective Uncooperative behavior in pediatric dentistry is one of the most common manifestations of dental anxiety. Managing anxious patients can be attained by moderate sedation. This study aimed to compare the effect of sedation by dexmedetomidine-ketamine combination (DEX-KET) versus dexmedetomidine (DEX) on behavior of uncooperative pediatric dental patients. Methodology In total, 56 uncooperative healthy children (3-5 years old) requiring dental treatment were divided randomly into two groups: Group I (study group), which received buccal dexmedetomidine (2 μg/kg) and ketamine (2 mg/kg), and Group II (control group), which received only buccal dexmedetomidine (4 μg/kg). Drugs effects were assessed in terms of hemodynamic parameters, patient's drug acceptance, child behavior, postoperative effect of sedation, amnesic effect, incidence of adverse events, as well as procedural induced stress measured by salivary secretory immunoglobulin A (s-IgA). Results Hemodynamic results did not reveal a statistically significant difference between the two study groups (P>0.05). There was a significant difference in patient's acceptance to sedative drug between both groups, favoring DEX (p=0.005). Children who received DEX-KET showed significantly better behavior than those who received DEX for local anesthesia (p=0.017) and during operative procedure (p=0.037). Adverse events, post-operative and amnesic effects of drugs were comparable in both groups (p>0.05). Moreover, the mean difference in the salivary s-IgA levels between initial and final value was not statistically significant between both groups (p=0.556). Conclusion Both DEX-KET combination and DEX alone are effective in providing hemodynamic stability. DEX-KET combination significantly improved the behavior of sedated children compared to DEX alone but the drug acceptance was decreased in the DEX-KET group. Both regimens did not have a negative effect on postoperative behavior of children and had comparable amnesic effect with no significant adverse events. Salivary s-IgA is not considered a potential stress biomarker in sedated children.
ABSTRACT
Objective:To compare esketamine versus dexmedetomidine in improving the adverse mood after cesarean section.Methods:One hundred and fourteen pregnant women undergoing elective cesarean section, aged 20-45 yr, with body mass index≤33 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, were divided into 3 groups ( n=38 each) by the random number table method: esketamine group (group S), dexmedetomidine group (group D) and control group (group C). After delivery, esketamine was intravenously injected as a bolus of 0.3 mg/kg, followed by an infusion of 0.3 mg·kg -1·h -1 throughout the surgery in group S, dexmedetomidine was intravenously injected as a bolus of 0.6 μg/kg, followed by an infusion of 0.6 μg·kg -1·h -1 throughout the surgery in group D, while the equal volume of normal saline was given instead, followed by an infusion of 14 ml/h throughout the surgery in group C. Patient-controlled intravenous analgesia was performed after the end of surgery. Esketamine 50 mg, sufentanil 50 μg and ondansetron 8 mg were given in group S, dexmedetomidine 200 μg, sufentanil 50 μg and ondansetron 8 mg were given in group D, while sufentanil 50 μg and ondansetron 8 mg were given in group C. When the visual analog scale score ≥4 within 48 h after operation, flurbiprofen axidate was intravenously injected as a rescue analgesic. Self-rating Anxiety Scale (SAS) scores and Edinburgh Postnatal Depression Scale (EPDS) scores were assessed at 1 day before surgery and 2 and 7 days after surgery. Serum levels of brain-derived neurotrophic factor (BDNF) were measured by enzyme-linked immunosorbent assay at 1 day before surgery and 2 days after surgery. The effective pressing times of patient-controlled analgesia (PCA) and requirement for rescue analgesia after operation were recorded. The occurrence of adverse reactions during operation and within 48 h after operation was also recorded. Results:Compared with group C, SAS scores and EPDS scores were significantly decreased at 2 and 7 days after surgery, serum BDNF concentrations were increased at 2 days after surgery, the effective pressing times of PCA were reduced, the requirement for rescue analgesia was decreased, and the incidence of intraoperative nausea and vomiting was reduced in S and D groups ( P<0.05). Compared with group D, SAS scores and EPDS scores were significantly decreased at 7 days after surgery, the effective pressing times of PCA were reduced ( P<0.05), and no significant change was found in serum BDNF concentrations at 2 days after surgery and requirement for rescue analgesia in group S ( P>0.05). The incidence of dreaminess was significantly higher in group S than in group C and group D ( P<0.05). Conclusions:Esketamine is better than dexmedetomidine in improving the adverse mood after cesarean section.
ABSTRACT
Objective:To evaluate the role of aquaporin 4 (AQP4) in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice and the relationship with protein kinase C (PKC).Methods:One hundred and fifty clean-grade healthy male C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were divided into 5 groups ( n=30 each) using a random number table method: control group (group C), mechanical ventilation group (group V), LY317615 group (group L), dexmedetomidine group (group D), and dexmedetomidine+ PMA group (group DP). Group C spontaneously breathed air for 6 h. The animals were mechanically ventilated for 6 h in group V. PKC inhibitor LY3176 15 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in group L. Dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in D and DP groups. PKC activator PMA 15 μg/kg was intraperitoneally injected at 60 min before mechanical ventilation in group DP. Mice were anesthetized at 1 day after mechanical ventilation, then sacrificed and hippocampal tissues were taken for microscopic examination of pathological changes in the hippocampal CA1 and CA3 areas (with a light microscope). Brain tissues were also taken to measure the water content and content of Evans blue (EB) and to detect the expression of PKC and AQP4 (by Western blot). The cognitive function was evaluated using a novel object recognition task at 3 days after mechanical ventilation. Results:Compared with group C, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group V and group DP. Compared with group V, the water content and EB content of brain tissues were significantly decreased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was down-regulated, the percentage of novel object exploration and discrimination index were increased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was significantly attenuated in group D and group L. Compared with group D, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group DP. Conclusions:AQP4 is involved in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice, and the mechanism is related to inhibiting activation of PKC.
ABSTRACT
Objective:To investigate the effect of dexmedetomidine (DEX) on intestinal barrier function impairment in gynecologic neoplasms patients undergoing laparoscopic surgery and the possible role of silent information regulator 1 (SIRT1) in this process.Methods:A prospective randomized controlled study was conducted. Forty patients who were to undergo laparoscopic surgery of gynecologic neoplasms under general anesthesia in the Second Hospital of Shanxi Medical University from May 2022 to May 2023 were prospectively selected. All patients were divided into the experimental group and the control group using the method of randomized numerical table, with 20 cases in each group. The experimental group was given a loading dose of DEX 0.5 μg/kg (intravenously pumped in 10 min) before induction of general anesthesia, and then maintained with DEX 0.2 μg·kg -1·h -1 until 30 min before the end of surgery. In the control group, the same dose of 0.9% sodium chloride injection was pumped intravenously. Taking 5 ml of peripheral venous blood from the upper extremities 10 min before induction of anesthesia (T 1), 1 h after the release of pneumoperitoneum (T 2) and 24 h after the release of pneumoperitoneum (T 3), respectively, the serum levels of SIRT1 and Claudin-1 proteins were measured by enzyme-linked immunosorbent assay. Then the concentrations of SIRT1 and Claudin-1 proteins and the time of first postoperative exhaust in the two groups of patients were compared. Results:The differences in age, body mass index, pneumoperitoneum time, operation time and anesthesia time between the two groups were not statistically significant (all P >0.05). At T 1, there was no statistically significant difference in concentrations of SIRT1 [(10.2±1.5) ng/ml vs. (10.0±1.3) ng/ml, t = 0.46, P = 0.468] and Claudin-1 [(405±45) pg/ml vs. (404±40) pg/ml, t = 0.13, P = 0.901] proteins between the control group and the experimental group. At T 2, the concentrations of SIRT1 [(8.4±1.3) ng/ml vs. (6.1±1.3) ng/ml, t=-5.55, P<0.001] and Claudin-1 [(383±39) pg/ml vs. (331±44) pg/ml, t=-4.02, P<0.001] proteins in the experimental group were higher than those in the control group, the differences were statistically significant. At T 3, the concentrations of SIRT1 [(8.4±1.2) ng/ml vs. (6.7±1.1) ng/ml, t=-4.56, P<0.001] and Claudin-1 [(388±40) pg/ml vs. (341±43) pg/ml, t=-3.63, P<0.001] proteins in the experimental group were higher than those in the control group, the differences were statistically significant. The time of first postoperative exhaust in the experimental group was shorter than that in the control group [(21.7±2.2) h vs. (27.9±3.4) h], and the difference was statistically significant ( t =6.78, P < 0.001). Conclusions:Dexmedetomidine may reduce the intestinal epithelial cell injury induced by laparoscopic surgery in patients with gynecologic neoplasms via activating SIRT1, and exert a protective effect on intestinal barrier function.
ABSTRACT
@#Objective To evaluate the incidence of postoperative atrial fibrillation (POAF) after dexmedetomidine and diazepam in patients undergoing coronary artery bypass grafting (CABG). Methods A retrospective cohort study was conducted in the patients who underwent CABG in the General Hospital of Northern Theater Command from October 2020 to June 2021. By propensity score-matching method, the incidence of POAF after dexmedetomidine and diazepam application in patients undergoing CABG was evaluated. Results Finally 207 patients were collected, including 150 males and 57 females, with an average age of 62.02±8.38 years. Among the 207 patients, 53 were treated with dexmedetomidine and 154 with diazepam before operation. There was a statistical difference in the proportion of hypertension patients and smoking patients between the two groups before matching (P<0.05). According to the 1∶1 propensity score-matching method, there were 53 patients in each of the two groups, with no statistical difference between the two groups after matching. After matching, the incidence of POAF in the dexmedetomidine group was lower than that in the diazepam group [9.43% (5/53) vs. 30.19% (16/53), P=0.007]. There was no death in the two groups during hospitalization, and there was no statistical difference in the main adverse events after operation. The ICU stay (21.28±2.69 h vs. 22.80±2.56 h, P=0.004) and mechanical ventilation time (18.53±2.25 h vs. 19.85±2.01 h, P=0.002) in the dexmedetomidine group were shorter. Regression analysis showed that age, smoking and diabetes were related to the increased incidence of POAF (P<0.05), and preoperative use of dexmedetomidine was associated with a reduced incidence of POAF (P=0.002). Conclusion For patients undergoing CABG, the incidence of POAF with dexmedetomidine before operation is lower than that with diazepam. Preoperative application of dexmedetomidine is the protective factor for POAF, and old age, smoking and diabetes are the risk factors for POAF.
ABSTRACT
Objective @# To investigate the impact of dexmedetomidine on the oncological behavior of hepatocellular carcinoma and explore the role of NF-E2-related factor 2 (Nrf2) at both in vitro and in vivo levels．@*Methods @# In vivo experiment，Male C57BL/6J mice were randomly divided into a control group ( Ctrl group) ，a hepatocellular carcinoma group ( HCC group) ，and a hepatocellular carcinoma + dexmedetomidine group ( HCC + Dex group) . Hepatocellular carcinoma was induced in mice by combining N-Nitrosodiethylamine ( DEN) / carbon tetrachloride ( CCl4 ) ，followed by daily intraperitoneal injection of 10% dexmedetomidine for two weeks．After feeding the mice for one month，the mice were assessed for the quantity and size of liver tumors．The proliferation ability of liver cancer was evaluated using Ki67 immunohistochemistry．Additionally，the expression level of Nrf2 protein in tumor tissue was measured through immunofluorescence．In vitro experiment，Hepa1-6 cells were incubated with different concentrations of dexmedetomidine (0. 1，1，5 nmol /L) for 48 hours to examine their effects．The proliferation， migration and invasion abilities of Hepa1-6 cells were evaluated using the MTT and Transwell methods．The expres- sion level of Nrf2 protein in the Hepa1-6 cells was measured using Western blot and immunofluorescence．Addition- ally，the proliferation ，migration and invasion abilities of cells were assessed after Nrf2 knockdown via si-RNA transfection，in combination with incubation with 1 nmol /L dexmedetomidine for 48 hours. @*Results @#ompared to the HCC group，the anatomical examination results revealed an increase in the number of liver tumors and the lon- gest diameter in the HCC + Dex group (P ＜0. 05) ． Ki67 immunohistochemistry results indicated the number of Ki67 positive cells in liver cancer tissue increased in the HCC + Dex group (P＜0. 01) ．The immunofluorescence assay demonstrated an upregulation of Nrf2 expression level in the HCC + Dex group (P ＜0. 05 ) ． MTT results showed that 1 nmol /L of dexmedetomidine increased the cell viability of Hepa1-6 cells (P＜0. 05) ．Transwell re- sults indicated that 0. 1 ，1 ，and 5 nmol /L of dexmedetomidine enhanced the invasive ability of Hepa1-6 cells， while 0. 1 and 1 nmol /L of dexmedetomidine enhanced the migration ability (P＜0. 05) ．Western blot and immu- nofluorescence results showed an upregulation of Nrf2 expression level in cells after treatment with 1 nmol /L dexme- detomidine (P＜0. 01) ．The Nrf2 expression level of cells was reduced using si-RNA，followed by treatment with 1 nmol /L dexmedetomidine．The results from MTT and Transwell assays revealed a decrease in the viability，invasion and migration ability of Hepa1-6 cells (P＜0. 01) ．@*Conclusion @# Dexmedetomidine may enhance the proliferation， invasion and migration capacity of hepatocellular carcinoma by upregulating the expression of Nrf2 .
ABSTRACT
@#Objective To investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. Methods Clinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. Results A total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ2=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.
ABSTRACT
OBJECTIVE To systematically evaluate the efficacy and safety of midazolam and dexmedetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， Embase， Web of Science， Cochrane Library， Clinical trials. gov， China Journal Full Text Database， Chinese Science and Technology Journal Database， Wanfang database and China Biomedical Literature Database， the data on the efficacy and safety of midazolam and dexmetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation were collected from the establishment of the database to March 31， 2023. After extracting data from clinical studies that met the inclusion criteria， the meta-analysis was conducted by using the RevMan 5.3 statistical software. RESULTS A total of 31 literature were included， with a total of 2 765 patients. Results of meta-analysis showed that the mechanical ventilation time [MD＝14.13， 95%CI （13.75， 14.52）， P＜0.000 01] and the length of hospitalization in the intensive care unit [MD＝0.92， 95%CI （0.54， 1.30）， P＜0.000 01] of patients in the midazolam group was longer than dexmedetomidine/ propofol group. The incidence of bradycardia in midazolam group was lower dexmedetomidine/propofol group [OR＝0.60， 95%CI （0.41， 0.90）， P＝0.01]， but there was no statistically significant difference in the incidence of hypotension between the two groups [OR＝0.69， 95%CI （0.47， 1.01）， P＝0.06]. The incidence of delirium [OR＝3.88， 95%CI （2.74， 5.49）， P＜0.000 01]， ventilator- associated pneumonia [OR＝2.32， 95%CI （1.19， 4.51）， P＝0.01]， and respiratory depression [OR＝5.70， 95%CI （3.09， 10.52）， P＜0.000 01] in midazolam group were higher than dexmedetomidine/propofol group. CONCLUSIONS Compared with dexmedetomidine/propofol， midazolam increases patients’ mechanical ventilation time and the length of hospitalization in the intensive care unit in terms of efficacy， and increases the risk of delirium and pulmonary complications in terms of safety， but has a smaller cardiovascular impact.
ABSTRACT
OBJECTIVE To investigate the effects of dexmedetomidine （DEX）-assisted general anesthesia on hemodynamics and cognitive function in elderly patients undergoing painless enteroscopy. METHODS From July 2020 to February 2022， 180 elderly patients undergoing painless enteroscopy in the outpatient operating room of the Second People’s Hospital of Jiaozuo were selected and divided into a control group （n＝90） and an observation group （n＝90） according to the random number table method. The control group was given routine general anesthesia （induced with sufentanil and propofol anesthesia， maintained with propofol anesthesia）， while the observation group was given DEX-assisted general anesthesia after preoperative preparation. The hemodynamic indexes [mean arterial pressure （MAP）， heart rate （HR）]， dosage of general anesthesia， awakening time， cognitive function [minimized mental status examination （MMSE）]， and the incidence of adverse drug reactions were compared between the two groups. RESULTS There was no significant difference in various indicators before anesthesia （T0） between 2 groups （P＞ 0.05）. Compared with T0， MAP and HR of the two groups were reduced significantly 10 minutes after anesthesia （T1）， at the time of enteroscope reaching the ileum and cecum （T2）， enteroscope withdrawal after the examination （T3）， and 10 minutes after surgery （T4）； but MAP and HR of the observation group at T1， T2， T3， and T4 were all higher than those of the control group （P＜0.05）. Compared with the control group， the dosage of general anesthesia and the recovery time in the observation group were significantly reduced or shortened， the MMSE scores at 1， 2 and 3 days after the operation were significantly increased， while the incidence of cognitive dysfunction and adverse reactions were significantly reduced （P＜0.05）. CONCLUSIONS DEX can effectively improve the hemodynamics and cognitive function of elderly patients undergoing painless enteroscopy， which is beneficial to reduce the dosage of general anesthesia， shorten recovery time， and has better safety.
ABSTRACT
Objective To explore the effect of dexmedetomidine on the neurological function and mast cells activation in the mouse with intracerebral hemorrhage(ICH).Methods The mouse was intraperitoneal-ly injected with dexmedetomidine at 30 min before intracerebral hemorrhage.After the preparation of intrace-rebral hemorrhage model,the neurological function,brain water content,number of mast cells around hemato-ma and expression levels of tryptase,IL-1β,TNF-α were detected.Results Compared with the control group,the neurological function score in the intracerebral hemorrhage group was significantly elevated(P＜0.05),the brain water content was significantly increased(P＜0.05),the mast cells number was significantly in-creased(P＜0.05),and the tryptase,IL-1β and TNF-α expression levels were sinificantly increased(P＜0.05);while the neurological function score in the dexmedetomidine group was significantly decreased(P＜0.05),the brain water content was significantly decreased(P＜0.05),the number of mast cells was signifi-cantly reduced and the tryptase,IL-1β and TNF-α expression levels were significantly decreased(P＜0.05).Conclusion Dexmedetomidine could inhibit the activation of mast cells around hematoma and reduce the dam-age of neurological function after mouse intracerebral hemorrhage.
ABSTRACT
Objective To study the effect of dexmedetomidine(DEX)on TNF-α-induced injury of human neuro-blastoma cell line SH-SY5Y and its mechanism.Methods CCK8 assay was used to detect cell activity and deter-mine the optimal dose of DEX and TNF-α.The cells were divided into control group,model group,DEX interven-tion model group,and the intervention group of DEX plus compound C.Western blot was used to detect the expres-sion of p-AMPK,SNHP,KIF5B,Drp1 and OPA1,and ELISA was used to detect the level of IL-1β and IL-6.Mitochondrial membrane potential(Δψm),respiratory chain complex enzyme activity(complex Ⅰ-Ⅳ),ATP,MDA,SOD,GSH,ROS were determined with commercially available kits.Results Compared with control group,level of p-AMPK,OPA1 and SNPH l in model group significantly decreased,while the level of Drp1 and KIF5B significantly increased(P＜0.01).The level of complexⅠ～Ⅳ,Δψm,ATP,GSH and SOD in DEX group signifi-cantly increased as compared with model group.The level of MDA,IL-1β and IL-6 significantly decreased(P＜0.01).Compared with DEX group,the level of Complex Ⅰ-Ⅳ,Δψm,ATP,GSH and SOD in DEX+CC group significantly decreased,while the level of MDA,IL-1β and IL-6 significantly increased(P＜0.01).Conclusions DEX improves mitochondrial function,alleviates oxidative stress and inflammatory response as well as TNF-α-induced cell damage with an AMPK dependent mechanism.
ABSTRACT
Objective To investigate the effect of dexmedetom idine(DEX)on lung tissue and Ras homolog gene family member A(RhoA)/Rho kinase 1(ROCK1)signaling pathway in lung tissue of rats with ventilator-induced lung injury(VILI).Methods A VILI rat model was established and separated into control group,model group(VILI group),dexmedetomidine low and high dose groups(DEX-L,DEX-H group),and high dose dexmedetomi-dine+lysophosphatidic acid(LPA)group(DEX-H+LPA group).Determination of wet/dry mass ratio of rat lung tissue(W/D);HE staining microscopy was applied to observe morphology of lung tissue;ELISA kit was applied to detect the level of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-6(IL-6)in bronchoalveolar lavage fluid(BALF);TUNEL staining method was applied to detect lung epithelial cell death;Immunoblotting was applied to detect the expression levels of apoptosis-related proteins,and RhoA,ROCK1 pro-teins.Results DEX could reduce lung injury,lung injury score,W/D,apoptosis rate,levels of TNF-α,IL-1β,IL-6,and expression of Bax,cleaved caspase-3,RhoA,ROCK,α-SMA in VILI rats(P＜0.05),while increased the expression of Bcl-2(P＜0.05);LPA could aggravate lung injury and increase lung injury score,W/D,apopto-sis rate,level of TNF-α,IL-1β,IL-6 and expressions of Bax,cleaved caspase-3,RhoA,ROCK and α-SMA(P＜0.05);Bcl-2 expression level was decreased(P＜0.05).Conclusions Dexmedetomidine may protect rats with ventilator-induced lung injury by the inhibition of RhoA/ROCK1 signaling pathway.
ABSTRACT
Objective To explore the effect of ultra-low dose dexmedetomidine on cough during an-esthesia recovery period in elderly patients undergoing carotid artery stenting(CAS).Methods A total of 111 elderly patients,75 males and 36 females,aged≥65 years,BMI 18-32 kg/m2,ASA physical statusⅡ or Ⅲ,diagnosed with asymptomatic unilateral severe carotid artery stenosis and scheduled for CAS,were randomly assigned to two groups using a random number table:the dexmedetomidine group(group D,n = 55)and the control group(group C,n = 56).Group D was given dexmedetomidine 0.2-0.5 μg/kg before anesthesia induction,and dexmedetomidine was intravenously infused at a ultra-low dose(0.1-0.2 μg·kg-1·h-1)after anesthesia induction to 30 minutes before the end of the operation,while group C did not receive any dexmedetomidine.The anesthesia regimen and intraoperative medication were the same for both groups.The MAP and HR were recorded 15 minutes before anesthesia induction(T0),5 minutes after anesthesia induction(T1),5 minutes before stent implantation(T2),5 minutes after stent implantation(T3),and 5 minutes after tracheal extubation(T4).The dosage of intraoperative propofol and remifentanil,cough and agitation during anesthesia recovery period,respiratory depression(SpO2＜90%),extubation time,postoperative puncture infection,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting were recorded.Results Compared with group C,MAP was significantly decreased at T1 and T2,increased at T3 and T4,and HR was significantly decreased at T1,T3,and T4 in group D(P＜0.05).Compared with group C,the intraoperative use of propofol and remifentanil was significantly decreased,and the incidence of cough and agitation during anesthesia recovery period was significantly decreased in group D(P＜0.05).There was no statistically significant difference in the incidence of respiratory depression,ex-tubation time,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting between the two groups.None of the recruited patients experienced infection at the puncture site.Conclusion Ultra-low dose dexmedetomidine can effectively maintain intraoperative hemodynamic stability,reduce the incidence of cough and agitation during anesthesia recovery period,and does not increase other postoperative adverse re-actions,enhancing anesthesia recovery quality in elderly patients undergoing CAS.
ABSTRACT
Objective:To explore the effects of dexmedetomidine (DEX) on postoperative pain, oxidative stress and adverse reactions in patients undergoing radical mastectomy.Methods:A total of 90 patients with breast cancer who received radical surgical treatment in our hospital from Jun. 2022 to Jun. 2023 were prospectively included as research objects and randomly divided into 3 groups with 30 patients in each group. DEX group was applied before, during and after surgery, respectively. The levels of pain visual analogue scale (VAS), Richmonation sedation score (RASS), superoxide dismu-tase (SOD) and malondialdehyde (MDA) were recorded.Results:The recovery time and extubation time in preoperative and intraoperative DEX group were significantly lower than those in postoperative DEX group, and the awakening time and extubation time in preoperative DEX group were significantly lower than those in intraoperative DEX group ( F value was 48.62 and 53.98, respectively, P<0.001). At 1 h, 6 h and 12 h after surgery, the VAS and RASS scores of patients in the preoperative and intraoperative DEX group were significantly lower than those in the postoperative DEX group, compared with those in the intraoperative DEX group. The VAS and RASS scores in the DEX group were significantly decreased ( F value: 62.34, 55.24, 69.26, 36.82, 24.20, 39.97, P<0.001). At 24h after surgery, there was no significant difference in VAS and RASS scores among the three groups ( F value was 0.45 and 0.81, respectively, P value was 0.613 and 0.418). Immediately after surgery, 24 h after surgery, 72 h after surgery, the SOD level of DEX group was significantly higher than that of DEX group before and during surgery ( F value was 29.37, 33.24, 10.35, P<0.001). MDA levels were significantly lower than those in postoperative DEX group ( F value was 30.52, 41.27, 8.26, P<0.001). There was no significant difference in the incidence of postoperative adverse reactions among all groups ( P>0.05) . Conclusion:Preoperative and intraoperative application of DEX can reduce postoperative pain and oxidative stress in breast cancer patients, help patients recover quickly after surgery, and preoperative application is superior to intraoperative application.