Appropriate dose of dexmedetomidine for the prevention of emergence agitation after general anesthesia for tonsillectomy in preschool children / 中国医师杂志

Objective To evaluate the effective dose of dexmedetomidine (DEX) for prevention of emergence agitation (EA) after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy.Methods 80 preschool children undergoing a selective tonsillectomy were randomly divided into 2 groups:intravenous group (total intravenous anesthesia,n =40) and inhalation group (sevoflurane inhaled anesthesias,n =40).According to the spot-slope method,intravenous group and inhalation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction.The EA,adverse effects,the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded.Results The ED50s for prevention of EA were 0.28 μg/(kg · h) in intravenous group and 0.34 μg/(kg · h) in inhalation group.The duration of children's staying post-anesthesia care unit (PACU) and the incidence of pain were significantly greater in those with EA than those without (P ＜ 0.05),and the incidence of the postoperative behavioral outcomes were not statically different (P ＞ 0.05).No severe adverse reactions were observed in 95％ confidence limits.Conclusions 0.28 (0.22-0.35) μg/(kg · h) and 0.34 (0.27-0.43) μg/(kg · h) of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy.

Clinical study on the sedation and analgesia effect of dexmedetomidine combined with sufentanil in severe acute pancreatitis patients with mechanical ventilation / 中国医师杂志

Objective To investigate the sedation and analgesia clinical effects of dexmedetomidine and midazolam sufentanil in severe acute pancreatitis patients with mechanical ventilation.Methods Sixty four patients with mechanical ventilation in severe acute pancreatitis were randomly divided into dexmedetomidine and midazolam groups,and 32 cases in each group.All patients were routinely given sufentanil continuous intravenous analgesia.The patients in dexmedetomidine group received dexmedetomidine 1.0 μg/kg loading dose by intravenous injection and followed with 0.2 ～ 0.7 μg/(kg · h) continuous intravenous infusion.The patients in midazolam group received midazolam:0.05 mg/kg loading dose by intravenous injection and followed with 0.02 ～0.08 mg/(kg · h) continuous intravenous infusion.The sedation and analgesia effects and inflammation index changes in two groups were observed.Results The analgesia and sedation onset time,awake time and time of live in intensive care unit (ICU) in dexmedetomidine group were significantly superior to the midazolam group (P ＜ 0.05).Before weaning from mechanical ventilation the white blood cell count,C-reaction protein (CRP),heart rate,and respiratory frequency index in dexmedetomidine group were significantly better than those in midazolam group (P ＜ 0.05).The adverse event's incidence rate in dexmedetomidine group (9.38％) was ignificantly lower s than that in midazolam group (31.25％) (P ＜0.05).Conclusions The application of dexmedetomidine combined with sufentanil in severe acute pancreatitis patients with mechanical ventilation may play a good role of sedative and analgesic effects,and alleviating the inflammatory reaction of patients,as well as fewer adverse events.

The comparison of sedative effect and analysis of influencing factors of recovery for different doses of dexmedetomidine in children undergoing echocardiography / 中国医师杂志

Objective To investigate the effectiveness and safety of intranasal different dose of dexmedetomidine for pediatric echocardiography sedation and to discuss the factors concerning recovery.Methods In a single-blinded randomized clinical trial,183 children were studied with a range of 2months and 33 months of age,and American Society of Anesthesiologists(ASA) physical status Ⅰ to Ⅱ.Those children were divided randomly into one of three groups.Groups D1,D2,and D3,which were received intranasal dexmedetomidine 1.0,1.5,and 2.0 μg/kg,respectively.The induction time,recovery time,examination time,and total sedation time were compared.The success rate of sedation and the occurrence of any side-effects with the drug were compared.Sex,age,weight,dose,induction time,and examination time were used as independent valuations,the recovery time was used as dependent valuation,and then the multiple linear regression analysis was performed to filtrate and formulate the valuable factors influencing recovery time.Results The induction time had no significantly difference among groups (P ＞ 0.05).The recovery time of group D3 was longer than group D1 and group D2 (P ＜ 0.05).The total sedation time of group D3 was longer than group D1 (P ＜ 0.05).The success rate of sedation and the incidence of sideeffects had no significantly difference among groups (P ＞0.05).Children's weight and medicine dose were found to affect recovery time.Conclusions Intranasal dexmedetomidine 1 ～ 2 μg/kg could be used effectively and safely in children undergoing echocardiography examination.Weight and dose were considered as key indexes to predict recovery time.

The clinical observation of dexmedetomidine combined with oxycodone or fentanyl during brachial plexus blockade in the thyroid surgery / 中国医师杂志

Objective To investigate the effect of small dose of dexmedetornidine on venous continuous infusion combined with oxycodone or fentanyl during brachial plexus blockade.Methods Sixty thyroid patients (ASA Ⅰ or Ⅱ) undergone brachial plexus anesthesia for cutting or cutting thyroid tumor patients were randomly and double-blindly into three groups (n =20 in each group).Group A:single brachial plexus anesthesia;group B:dexmedetornidine combined with fentanyl;group C:dexmedetornidine combined with oxycodone.Blood pressure (Bp),heart rate (HR),the determination of plasma norepinephrine (NE),cortisol (Cor),the concentration of blood glucose (Glu),VAS,Ramsay calm score,local anesthetics dosage and side effect formation rate at the beginning operation (To),skin incision (T1),separation of the glands (T2),gland excision (T3),and the end of the surgery (T4) were recorded.Results Compared to group A,the mean arterial pressure (MAP),HR,NE,Cor,and Glu were much lower at each time point (P ＜ 0.05) in groups B and C;Ramsay calm score and VAS score were significantly better at each time point (P ＜ 0.05);the incidence of chills and lidocaine additional quantity were significantly lower (P ＜0.01).However,compared to groups A and C,choking cough response rates were much higher in group B (P ＜ 0.01).Conclusions Small dose of dexmedetornidine on venous continuous infusion combined with oxycodone during brachial plexus blockade for thyroid patients both can eliminate the preoperative patients nervous anxiety,and effectively restrain perioperative stress response,maintain hemodynamics stable,implementation of intraoperative awaken to reduce complications.It is the new choice of anesthetic adjuvant.

Study on the dose-effect relationship of sufentanil with dexmedetomidine after hip arthroplasty in PCIA / 中国医师杂志

Objective To investigate the dose-effect relationship of sufentanil combined with dexmedetomidine which used in clinical effectiveness and safety of intravenous analgesia after hip arthroplasty.Methods Sixty patients (after hip arthroplasty) were randomly divided into three groups:group A (sufentanil 0.5 μg/kg),group B (sufentanil 0.75 μg/kg),and group C (sufentanil 1 μg/kg).Each group was combined with dexmedetomidine 1.5 μg/kg in patient controlled analgesia (PCA) pump.Mean arterial pressure (MAP),heart rate (HR),SpO2,numerical rating scale (NRS) scores,and Ramsay sedation scores were recorded at T1 (4 h after operation),T2 (8 h after operation),T3 (24 h after operation),and T4(48 h after operation).Harris hip scores were recorded at T0(preoperative),T3,and T4.The total number of pushing patient controlled intravenous analgesia (PCIA),dezocine dosage,and the occurrence of adverse events in each group situation were recorded.Results There were no significant differences in MAP,HR,and SpO2 among groups.Compared to group A,NRS scores of groups B and C were lower during the analgesia (P ＜0.01).Compared to group A,Ramsay sedation scores of groups B and C were higher at T1,and T2 (P ＜ 0.01).Compared to group A,Harris hip scores of groups B and C were higher at T3,and T4 (P ＜ 0.01).Compared to group C,adverse reactions of groups A and B were less during the analgesia (P ＜ 0.01).Compared to group A,the total number of press PCIA and dezocine amount were decreased in groups B and C (P ＜ 0.01).Conclusions The 0.75 μg/kg sufentanil combined with 1.5 μg/kg right beauty holds the minimum for intravenous analgesia effect after hip arthroplasty and calm exactly satisfied,less adverse reaction,for PCIA ideal drug formula.

Effect of dexmedetomidine combined with video laryngoscopy during orotracheal intubation for pa-tients with spontaneous breathing / 中国医师杂志

Objective To investigate the effectiveness of different dose dexmedetomidine ( DEX) combined with video laryngoscopy during orotracheal Intubation for patients with spontaneous breathing. Methods A total of 87 emergency or intensive care unit ( ICU) patients with spontaneous breathing was in-cluded (age range:18 to 75 years).The patients were randomly divided into three groups with 29 cases each:midazolam combined with fentanyl group ( A) , low dose DEX group ( B) , and high dose DEX group (C).Mean arterial pressure (MAP),heart rate (HR), and SpO2 were detected before injecting different dosage drugs (T0), during intubation (T1),after intubation immediately (T2), at 3 min after intubation ( T3 ) .The amount of intubation time and side effects in each group were assessed.Results Compared to A group, the changes of hemodynamics in group B and C were more stable after injecting drugs.The doctors spend less time for intubation in group B and C.The rate of significant bradycardia in group C was higher than other groups.Conclusions If you can assess indications, doses and timings strictly, it was safety and availability to control intubation response in the patients with spontaneous breathing by injected of DEX.