Erratum: Addendum: Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial.

[This corrects the article on p. 357 in vol. 22, PMID: 36246035.].

Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial.

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 µg/kg for 4 min for induction, followed by maintenance of 0.4 µg/kg/h. Group F received an infusion of fentanyl 1 µg/kg over 4 min for induction, followed by maintenance at 1 µg/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P = 0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

Low-Dose Dexmedetomidine Reduces Median Effective Concentration (EC 50) of Propofol More than Fentanyl in Unparalysed Anaesthetised Patients for I-gel Insertion: a Randomised Controlled Trial.

BACKGROUND: Literature shows fentanyl reduces the median effective concentration (EC50) of propofol when used for various noxious stimuli. However, fentanyl combined with propofol has a depressive effect on haemodynamics. We hypothesise that low dose dexmedetomidine will reduce the propofol requirement for induction with better haemodynamic profile compared with fentanyl. MATERIAL AND METHODS: 120 ASA I/II adult patients, of age group 20 to 60 years, scheduled for elective day-care surgeries under general anaesthesia were randomised to three equally distributed groups as group D, group F and group S (control) of 40 patients each. They received infusions of dexmedetomidine 0.5 mcg/kg, fentanyl 1.5 mcg/kg and normal saline (control) respectively over 5 min prior to induction with propofol TCI (Marsh model). EC50 of propofol (primary objective) for I-gel insertion in each group was determined from the estimated effect site concentration (Ce), using Dixon's up-and-down method . Secondary objectives were propofol dose requirement and percentage change in haemodynamics during induction. RESULTS: Our study demonstrates that low-dose dexmedetomidine premedication achieves more reduction in the EC50 (2.4 µg/ml, IQR 2.4 - 2.6 µg/ml, 95% CI 2.40 - 2.55 µg/ml) and dose of propofol (1.14 ± 0.28 mg/kg, 95% CI 1.05 - 1.23 mg/kg), for I-gel insertion, than that can be achieved by the use of fentanyl with propofol (EC50 of 3.0 µg/ml IQR 3.0 - 3.05 µg/ml, 95% CI 2.94 - 3.11 µg/ml; propofol dose 1.89 ± 0.55 mg/kg, 95% CI 1.72 - 2.07 mg/kg ) without any significant change in the haemodynamics. CONCLUSION: Low-dose dexmedetomidine when compared with fentanyl significantly reduce the EC50 and dose of propofol required for I-gel insertion with propofol TCI, without much change in the haemodynamic profile. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2019/03/018003.

Pulmonary venous baffle obstruction following senning procedure - Role of transesophageal echocardiography.

We present a case of D-transposition of great arteries with atrial septal defect and patent ductus arteriosus electively posted for Senning's operation at 10 months of age. The patient developed signs of lung congestion immediately after termination of cardiopulmonary bypass. A stenosis in the pulmonary venous baffle was detected in transesophageal echocardiography showing a peak gradient of 10 mmHg and a mean gradient of 5 mmHg. Hence, revision of baffle was planned. The stenotic area was excised and augmented with homologous pericardium. Post-correction, lung compliance improved and the peak and mean gradient decreased to 3 and 1 mm Hg, respectively. The patient was extubated in the intensive care unit after 36 h and shifted to ward after 5 days with stable hemodynamics.

Iatrogenic aortic regurgitation following primary closure of ventricular septal defect: Role of transesophageal echocardiography.

Iatrogenic valvular regurgitation following cardiac surgery has been reported as a result of leaflet perforation or entrapment. Due to its central location, the aortic valve is one of the most vulnerable structures for iatrogenic injuries. Proper assessment of the aortic valve by transesophageal echocardiography (TEE) should be done after a cardiac surgery in the periaortic area. We hereby report a case of iatrogenic aortic regurgitation which was developed after primary closure of perimembranous ventricular septal defect. It was timely diagnosed by TEE after termination of cardiopulmonary bypass and helped in further management.