scholarly journals Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery

2019 ◽  
Vol 10 (04) ◽  
pp. 599-605
Author(s):  
Renu Bala ◽  
Arvind Chaturvedi ◽  
Mihir Prakash Pandia ◽  
Parmod K Bithal
Keyword(s):  
Pituitary Surgery ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Emergence Time ◽  
Hemodynamic Stability ◽  
Suprasellar Region ◽  
Extubation Time ◽  
Transsphenoidal Pituitary Surgery ◽  
Group D

Abstract BackgroundTranssphenoidal resection of pituitary tumors is the neurosurgical procedure of choice to excise most of the tumors of the sellar/suprasellar region. The main goals of anesthesia are maintenance of hemodynamic stability, provision of conditions that facilitate good surgical exposure, and a prompt and smooth emergence to allow neurological and visual assessment. Dexmedetomidine (Dex), a selective α-2 agonist, is known to maintain cardiovascular stability and anxiolysis and provide pain relief. Therefore, we hypothesized that intraoperative Dex will attenuate hemodynamic response to nasal speculum (NS) insertion, decrease analgesic requirement, and hasten postoperative recovery. Materials and MethodsThis prospective, randomized, double-blind, placebo-controlled study was conducted in 60 adult patients of either sex, American Society of Anesthesiologists status I or II undergoing elective pituitary surgery for excision of pituitary adenoma. Randomization was done into two groups; Group D (n = 30) received Dex bolus 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h, and group control Group C (n = 30) received normal saline (0.9%) in a similar manner. A standard anesthesia technique comprising fentanyl, propofol, rocuronium, sevoflurane, nitrous oxide, and oxygen was used. Intraoperative monitoring was uniform and standardized in all the patients; cardiovascular perturbations, if any, were noted and managed appropriately. After completion of surgery, tracheal extubation was performed, and emergence time, extubation time, modified Aldrete score, sedation, pain, time for first analgesic, nausea, vomiting, and shivering were recorded. ResultsIn both the groups, an increase in heart rate and blood pressure occurred at the time of laryngoscopy and intubation, NS insertion, and extubation, but it was more in Group C (p < 0.05). In Group D, intraoperative requirement of analgesic, neuromuscular relaxant, and inhalational anesthetic was lesser compared with Group C. Emergence time as well as visual analog scale at emergence was less in Group D. ConclusionsIntraoperative Dex infusion is a reasonable choice in patients undergoing transsphenoidal pituitary surgery.

scholarly journals Efficacy of Dexmedetomidine Infusion Without Loading Dose on Hemodynamic Variables and Recovery Time During Craniotomy: A Randomized Double-Blinded Controlled Study

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Ismail Mohammed Ibrahim ◽  
Rania Hassan ◽  
Raham Hasan Mostafa ◽  
Mayada Ahmed Ibrahim
Keyword(s):  
Recovery Time ◽  
Controlled Study ◽  
Control Group ◽  
Loading Dose ◽  
Hemodynamic Stability ◽  
Arterial Blood ◽  
Postoperative Intensive Care ◽  
Double Blinded ◽  
Group D ◽  
Dexmedetomidine Infusion

Background: Maintaining hemodynamic stability during intracranial surgery is one of the most important tasks. There is no general agreement regarding which anesthetics are optimal for craniotomy. Propofol and short-acting opioids are usually used, but their use is not without side effects. Recently, dexmedetomidine has been considered a safe alternative in different surgeries. Objectives: We aimed to assess the efficacy of 0.5 µg/kg/h dexmedetomidine infusion without loading dose as an adjunct to general anesthesia for craniotomy. Methods: A prospective, randomized, double-blinded, parallel-group, placebo-controlled trial was conducted. Setting: Single university teaching hospital’s operating rooms and postoperative intensive care unit. Patients: A total of 50 patients scheduled for elective supratentorial craniotomy participated in this study. Interventions: Patients were randomly divided into either control group (Group C) and Dexmedetomidine group (Group D). Main outcome measure: Intraoperative hemodynamics measurements at specific timings. Results: We found that dexmedetomidine had significantly maintained mean arterial blood pressure and heart rate (P-value < 0.001); with lower intraoperative fentanyl and propofol consumption in group D (132 ± 35 µg and 14 ± 30 mg, respectively) when compared to group C (260 ± 38 µg and 534 ± 66 mg, respectively). Finally, a lesser sedation level was noticed in the dexmedetomidine group, together with a significantly lesser recovery time of 10.3 ± 4 min. Conclusions: Dexmedetomidine infusion without loading dose could be an efficacious and safe agent in achieving hemodynamic stability with intraoperative opioid-sparing effect and lesser recovery time.

scholarly journals Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

2020 ◽  
Vol 7 (01) ◽  
pp. 19-26
Author(s):  
Devika Bharadwaj ◽  
Charu Mahajan ◽  
Richa Aggarwal ◽  
Hemanshu Prabhakar ◽  
Arvind Chaturvedi
Keyword(s):  
Bispectral Index ◽  
Intraoperative Complications ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Postoperative Recovery ◽  
P Value ◽  
Continuous Variables ◽  
Extubation Time ◽  
Group D ◽  
Transsphenoidal Resection

Abstract Background Use of short-acting anesthetic agents such as propofol and desflurane allows rapid awakening and prompt neurological assessment of patients undergoing endoscopic transnasal transsphenoidal resection of pituitary tumors. However, there are no studies comparing the effect of these two agents in these patients. We performed this study to compare the intraoperative hemodynamics and postoperative recovery characteristics of patients undergoing endoscopic transnasal transsphenoidal (TNTS) pituitary tumor surgery using bispectral index (BIS)-guided administration of desflurane and propofol. Materials and Methods In this prospective, randomized trial, 60 patients undergoing endoscopic TNTS pituitary surgery were randomized to receive BIS-guided administration of either propofol (Group P) or desflurane (Group D) for the maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), intraoperative complications, time to emergence, extubation, cognition, and modified Aldrete score were evaluated. Statistical analysis was performed using STATA 12.0. Categorical and continuous variables were compared between the groups using Fisher’s exact test and t-test, respectively. Emergence from anesthesia and hemodynamics at various stages of surgery was compared between the groups using Wilcoxon rank sum test. The p-value < 0.05 was considered statistically significant. Results The HR was significantly higher at all stages of surgery in group P (p = 0.01). MAP was comparable between the groups at various time points (p > 0.05). Both emergence time (8.5 vs. 15 minutes; p < 0.00) and extubation time (10 vs. 17.5 minutes; p < 0.00) were significantly shorter in Group D compared with Group P. Modified Aldrete score at 5 and 10 minutes after extubation was higher with desflurane than propofol, but early cognition was comparable between the two groups. Conclusion The hemodynamics and early cognition score were comparable in patients receiving propofol or desflurane. Desflurane provides rapid emergence and recovery when compared with propofol.

scholarly journals Dexmedetomidine decreased the post‐thyroidectomy bleeding by reducing cough and emergence agitation – a randomized, double‐blind, controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Hun Kim ◽  
Yoo Seok Kim ◽  
Seongcheol Kim ◽  
Ki Tae Jung
Keyword(s):  
Postoperative Bleeding ◽  
Postoperative Hemorrhage ◽  
Controlled Study ◽  
Emergence Agitation ◽  
Double Blind ◽  
Extubation Time ◽  
Registration Number ◽  
Recovery From Anesthesia ◽  
Postanesthetic Care Unit ◽  
Group D

Abstract Background Bleeding after thyroidectomy occurs due to violent coughing during emergence. Dexmedetomidine is helpful for the smooth emergence and suppression of cough. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy. Methods Randomized, double-blind, controlled trials were conducted in female patients (ASA I–II, aged 20 to 60 years). The patients were randomly allocated into two groups. Approximately 15 min before the end of the surgery, dexmedetomidine was administered (0.6 µg/kg/h) without a loading dose in group D (n = 69), and normal saline was administered in group S (n = 70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), and recovery time were assessed during the administration of the study drugs and recovery from anesthesia. The amount of postoperative hemorrhage was measured for 3 days. Results Data from a total of 139 patients were analyzed. The incidence of severe cough was significantly lower in group D than in group S (4.3 % vs. 11.5 %, P = 0.022). The emergence agitation in the postanesthetic care unit was significantly lower in group D than in group S (P = 0.01). Postoperative bleeding was significantly lower in group D than in group S until the second postoperative day (P = 0.015). Conclusions Dexmedetomidine can be helpful in decreasing bleeding after thyroidectomy by reducing coughing and emergence agitation. Trial registration This study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).

ERAS Improves Postoperative Recovery in Children

2021 ◽  
Author(s):  
Tingmei Wu ◽  
Haiwen Li ◽  
Huixia Zhou ◽  
Xuemei Hao ◽  
Xiaojun Wang ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Robot Assisted ◽  
Cytokine Levels ◽  
Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

A small dose of dexmedetomidine decreased the postoperative bleeding by reducing cough and emergence agitation after thyroidectomy – A randomized, double-blind, controlled study

2021 ◽  
Author(s):  
Sang Hun Kim ◽  
Yoo Seok Kim ◽  
Seongcheol Kim ◽  
Ki Tae Jung
Keyword(s):  
Controlled Trial ◽  
Postoperative Bleeding ◽  
Postoperative Hemorrhage ◽  
Controlled Study ◽  
Emergence Agitation ◽  
Double Blind ◽  
Extubation Time ◽  
Registration Number ◽  
Postanesthetic Care Unit ◽  
Group D

Abstract Background: Bleeding after a thyroidectomy occurs due to violent cough during the emergence. Dexmedetomidine is helpful for smooth emergence and suppressing the cough. The purpose of the present study was to compare the effect of dexmedetomidine on postoperative bleeding after thyroidectomy. Methods: Randomized, double-blind, controlled trial in female patients (ASA I–II, aged 20 to 60 years) were conducted. Patients were randomly allocated into two groups. About fifteen minutes before the end of the surgery, dexmedetomidine was administered (0.6 μg/kg/hr) without a loading dose in group D (n=69), and normal saline was administered in group S (n=70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), recovery time were assessed during the administration of study drugs and recovery from anesthesia. Amounts of postoperative hemorrhage were measured for 3 days. Results: A total of 139 patients were analyzed. The incidence of severe cough was significantly decreased in group D compared to group S (4.3% vs. 11.5%, P = 0.022). Emergence agitation in the postanesthetic care unit was significantly decreased in group D compared to group S (P = 0.01). Postoperative bleeding showed a significant decrease in group D compared to group S until the second postoperative day (P = 0.015). Conclusions: Dexmedetomidine can decrease postoperative bleeding by reducing coughing and emergence agitation after thyroidectomy. Trial registration: This study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).

Rhinomanometry for Preoperative and Postoperative Assessment of Nasal Obstruction

1989 ◽  
Vol 101 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Andrew S.D. Gordon ◽  
Thomas V. McCaffrey ◽  
Eugene B. Kern ◽  
John F. Pallanch
Keyword(s):  
Nasal Obstruction ◽  
Pituitary Surgery ◽  
Control Group ◽  
Study Group ◽  
Nasal Resistance ◽  
Airway Narrowing ◽  
Asymptomatic Patients ◽  
Before And After ◽  
Transsphenoidal Pituitary Surgery ◽  
Clinically Significant

In this retrospective study we used active, anterior mask rhinomanometric methods to measure nasal resistance before and after surgery for nasal obstruction. The study group comprised 60 patients with nasal obstruction who had 63 preoperative and postoperative rhinomanograms and the control group contained 14 asymptomatic patients who underwent rhinomanometric studies before transnasal, transsphenoidal pituitary surgery. Before surgery the study group had significantly higher total and combined unilateral nasal resistances than either the control group before surgery ( p < 0.05 and p < 0.01, respectively) or the study group after surgery ( p < 0.0001 for both comparisons). Surgery normalized the nasal resistances of the study group in relation to the control group. A total nasal resistance greater than 1 cm H2O/L/sec or a unilateral resistance greater than 3.5 cm H2O/L/sec suggests clinically significant nasal obstruction. Airway narrowing and obstructive symptoms correlated with airway resistance in the preoperative patient, but symptoms did not correlate well with postoperative resistance.

scholarly journals Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

2018 ◽  
Vol 27 (4) ◽  
pp. 343-349
Author(s):  
Elif Doğan Bakı ◽  
Şahin Ulu ◽  
Ahmet Yüksek ◽  
Hüseyin Arıcan ◽  
Remziye Sıvacı
Keyword(s):  
Rating Scale ◽  
Postoperative Recovery ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Depth Of Anesthesia ◽  
Extubation Time ◽  
Duration Of Surgery ◽  
Eye Opening ◽  
The Difference ◽  
Pain Rating Scale

Objective: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. Materials and Methods: Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant. Results: Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C. Conclusion: In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

Side-Effects of Antihypertensive Treatment: A Placebo-Controlled Study

1978 ◽  
Vol 55 (s4) ◽  
pp. 341s-344s ◽  
Author(s):  
G. E. Bauer ◽  
J. Baker ◽  
S. N. Hunyor ◽  
P. Marshall
Keyword(s):  
Drug Therapy ◽  
Mild Hypertension ◽  
Treated Group ◽  
Controlled Study ◽  
Control Group ◽  
Age Related ◽  
Blood Pressure Study ◽  
Modern Drug ◽  
Mild Hypertensive ◽  
Group D

1. A questionnaire, modified from Bulpitt & Dollery (1973), inquired about 20 symptoms commonly associated with hypertension or its drug therapy in 1017 subjects (age 30–69 years). Groups consisted of (a) active therapy, (b) placebo, (c) no tablets, and (d) a non-study control group. The response rate was 96% in the first three groups and 92% in group (d). 2. The subjects in groups (a), (b) and (c) constituted part of a placebo-controlled, patient-blind intervention study in the treatment of mild hypertension (The Australian National Blood Pressure Study). 3. After age/sex adjustment of the data, only sleepiness and self-assessed depression were found to be more common in the actively treated group. Impotence, failure of ejaculation and nocturia were age-related symptoms. Generally, complaint rate was higher in females. 4. The knowledge of a mild hypertensive condition or its modern drug therapy lead to very few symptoms in a non-hospital population who already have a fairly high ‘complaint level’.

scholarly journals Is Infusion of Subhypnotic Propofol as Effective as Dexamethasone in Prevention of Postoperative Nausea and Vomiting Related to Laparoscopic Cholecystectomy? A Randomized Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mine Celik ◽  
Aysenur Dostbil ◽  
Mehmet Aksoy ◽  
Ilker Ince ◽  
Ali Ahiskalioglu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Double Blind ◽  
Significant Difference ◽  
Group D

Background. Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC.Methods. A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively.Results. In the 0–24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P.Conclusion. We concluded that infusion of propofol 1 mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.

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