Dexmedetomidine Improved Sleep Quality in the Intensive Care Unit After Laryngectomy.

Purpose: To examine whether nighttime dexmedetomidine infusion improved sleep quality in patients after laryngectomy. Patients and Methods: Thirty-five post-laryngectomy patients admitted to the intensive care unit (ICU) were randomly assigned to a 9-h (from 2100 h on surgery day to 0600 h the morning after laryngectomy) dexmedetomidine (0.3 µg/kg/h continuous infusion) or placebo group. Polysomnography results were monitored during the dexmedetomidine infusion period. The percentage of stage 2 non-rapid eye movement (stage N2) sleep was the primary outcome measure. Results: Thirty-five patients (18 placebo group; 17 dexmedetomidine group) had complete polysomnogram recordings. The percentage of stage N3 sleep was significantly increased in the dexmedetomidine infusion group (from median 0% (0 to 0) in placebo group to 0% (interquartile range, 0 to 4) in dexmedetomidine group (difference, -2.32%; 95% CI, -4.19 to -0.443; P = 0.0167)). Infusion had no effect on total sleep time, stage N1 or N2 sleep percentages, or sleep efficiency. It decreased muscle tensity and snore non-rapid eye movement. Subjective sleep quality improved. Hypotension incidence increased in the dexmedetomidine group, but significant intervention was not required. Conclusion: Dexmedetomidine infusion improved overall patient sleep quality in the ICU after laryngectomy.

Dexmedetomidine in combination with sufentanil for postoperative analgesia after partial laryngectomy.

BACKGROUND: Dexmedetomidine as an adjunct with opioids has been confirmed to spare opioids usage and improve analgesia for postoperative pain treatment. Furthermore, dexmedetomidine can attenuate the airway reflex. The aim of this study is to assess the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia after partial laryngectomy. METHODS: A total of 60 adult male patients were recruited and randomly allocated to receive sufentanil 1.0 µg ml-1 (Group S) or sufentanil 1.0 µg ml-1 plus dexmedetomidine 4 µg ml-1 (Group SD) for postoperative analgesia. The IV patient controlled analgesia (PCA) device was programmed to deliver 1.5 ml per demand with a 10 min lockout interval and 1.5 ml per hour background infusion. Cumulative consumption of sufentanil and pain intensity during 24 hour (h) after surgery were recorded. Coughing episodes per day, sleep quality, hemodynamic and respiratory profiles were measured. RESULTS: Compared with Group S, patients in Group SD required less sufentanil during the 0-24 h postoperative period (p < 0.0001) and reported significant lower pain intensity from the second postoperative hour to the end of the study (P < 0.0001). Daily coughing episodes, sleep disturbance was lower and patients' satisfaction was higher in Group SD (P < 0.05). Decrease in heart rate and mean blood pressure from baseline at 1 h, 2 h, 3 h, 12 h, and 24 h after operation were significantly greater in Group SD (P = 0.00). The incidence of PCA related adverse events were comparable between the two groups. CONCLUSION: Dexmedetomidine/sufentanil combination for postoperatjve analgesia in partial laryngectomized patients resulted in significant sufentanil sparing, better analgesia, reduced frequency coughing episodes, and better sleep quality. TRIAL REGISTRATION: Chinese Clinical Registry (ChiCTR): ChiCTR-TRC-14004618 , date of registration: 08 May 2014.

Effects of a Single Dose Dexmedetomidine on Surgical Field Visibility During Middle Ear Microsurgery: A Randomized Study.

OBJECTIVES: To investigate whether a single dose of dexmedetomidine (DEX) improves surgical field visibility. STUDY DESIGN: Randomized, prospective, double-blind study. SETTING: Tertiary teaching hospital. INTERVENTIONS: ASA I or II patients undergoing tympanoplasty with ossiculoplasty were randomly assigned to receive either 0.8 µg/kg DEX (Group D) or the same volume of saline (Group N) 10 min before anesthesia induction. MAIN OUTCOMES: The primary outcome was the visibility of the surgical field rated by surgeons by Boezaart score. The secondary outcomes were consumption of anesthesia, hemodynamic profiles, and subsequent recovery. RESULTS: Boezaart scores for surgical visibility were lower in Group D than in Group N (1.3 ±â€Š0.8 versus 1.8 ±â€Š0.9, P = 0.014). Minimum alveolar concentrations of sevoflurane (Group D 1 [0.9/1.1] versus Group N 1 [1/1.2], P = 0.018) and remifentanil consumption (Group D 370 [218/504] µg versus Group N 583 [300/1028] µg, P = 0.002) were less in Group D. Except for a transient increase in blood pressure and a decrease in heart rate during DEX infusion, hemodynamic profiles were more stable in Group D than in Group N. More patients needed morphine rescue and presented with postoperative nausea and vomiting in Group N than in Group D (Group D 1 versus Group N 8, P = 0.029). Recovery time was comparable between the two groups (Group D 19 min versus Group N 18 min, P = 0.569). CONCLUSION: Use of a single dose of DEX resulted in improved surgical visibility, less consumption of anesthesia, and more favorable hemodynamic profile while not delaying recovery time.