Effects of Dexmedetomidine Infusion on the Recovery Profiles of Patients Undergoing Transurethral Resection

Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Effect of milrinone on the inflammatory response and NF-kB activation in renal ischemia-reperfusion injury in mice / 대한마취과학회지

BACKGROUND: Milrinone increases intracellular adenosine 3',5'-cyclic monophosphate concentration and enhances vascular relaxation. Nuclear factor-kappa B (NF-kB) plays a key role in inflammatory responses during ischemia-reperfusion (I/R) injury. We aimed to investigate the effect of milrinone on the inflammatory responses and NF-kB activation in renal I/R injury in mice. METHODS: Thirty C57BL/6 mice were allocated into 3 groups. In group S (n = 10), only right nephrectomy was done. In group C (n = 10), the left kidney was subjected to 30 min of ischemia after right nephrectomy. In group M (n = 10), milrinone (5 microg/kg) was administered before ischemia. After 24 hours of reperfusion, the serum creatinine was measured, kidney samples were obtained for histology, and expressions of NF-kB and proinflammatory cytokines were analyzed. RESULTS: In group C, the serum creatinine concentration was markedly elevated, compared with group S. Creatinine concentration in group M was also elevated, but it was significantly lower than that in group C. Histologic evidence of renal damage was severe in group C, but it was improved in group M. In groups C and M, expression of NF-kB, tumor necrosis factor-alpha (TNF-alpha), intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2) mRNA increased significantly compared with group S (P < 0.05). But group M showed a lower expression of NF-kB, TNF-alpha, ICAM-1, MCP-1 and MIP-2 mRNA than group C (P < 0.05). CONCLUSIONS: Milrinone treatment attenuates the renal inflammatory response and activation of NF-kB, resulting in improvement of renal function and tissue injury.

The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patient-controlled sedation during breast biopsy surgery / 대한마취과학회지

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.

Comparison of an intraoperative infusion of dexmedetomidine or fentanyl for the perioperative hemodynamics, achieving hypnosis and sedation, and the postoperative pain control

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.

Comparison of an intraoperative infusion of dexmedetomidine or fentanyl for the perioperative hemodynamics, achieving hypnosis and sedation, and the postoperative pain control

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.

The Comparison of Sedation Quality, Side Effects, and Recovery Profiles of Propofol Alone, Propofol-Fentanyl and Porpofol-Ketamine PCS for MAC / 대한마취과학회지

BACKGROUND: Propofol has been the most widely used IV adjuvant during Monitored anesthesia care (MAC), even though it lacksanalgesic properties. This study was designed to compare sedation quality, side effects, and recovery profiles of propofol alone (group P), propofol-fentanyl (group PF) and propofol-ketamine (group PK) using PCS for breast biopsy procedures using local anesthesia. METHODS: Anxiety VAS, pain VAS and digit symbol substitution test (DSST) were measured in 60 excision breast biopsy patients with local anesthesia. Vital signs, respiratory (SpO2, RR, and ETCO2) variables, BIS, and OAA/S scores were recorded. Perioperative side effects (e. g., pain on injection, excessive sedation [OAA/S < 4], hypoventilation [ventilatory frequency 8 bpm], hypotension, dizziness, unpleasant feeling, Nausea) were also noted. RESULTS: There were no differences among the three PCS groups with respect to demographic data (Table 1). A/D ratio in PK group had a significant increase over P group. The incidence of excessive sedation and dizziness were significantly more frequent in the PK group patients (P < 0.05)(Table 1, 2). OAA/S scores were significantly decreased in the PK group during near the end of surgery, whereas BIS scores were only at the end of surgery (P < 0.05)(Fig. 1, 2). During 15 min after arrival at recovery room, significantly less patients in the PK group gave correct responses on the DSST than other groups (P < 0.05)(Fig. 2, 3). CONCLUSIONS: In contrast to past studies of ketamine as an alternative to opioid adjuncts during propofol PCS, it has no more advantage than supplemental fentanyl in terms of sedation level and side effects.

Dose-Related Prolongation of Ropivacaine Epidural Anesthesia by Epidural Ketamine / 대한통증학회지

BACKGROUND: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. METHODS: Sixty ASA physical status I-II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. RESULTS: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. CONCLUSIONS: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.