Comparative Evaluation of Hemodynamic Stability and Recovery during Conscious Sedation by Dexmedetomidine-Fentanyl Versus Ketamine- Fentanyl in procedures outside the operating room

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sarah A Abd-El Razek ◽  
Mohamed N El-shafei ◽  
Ashraf N Mostafa ◽  
Ibrahim M Ahmed
Keyword(s):  
Operating Room ◽  
Comparative Evaluation ◽  
Recovery Time ◽  
Conscious Sedation ◽  
Diagnostic Procedures ◽  
Loading Dose ◽  
Hemodynamic Stability ◽  
Analgesic Effects ◽  
Dilatation And Curettage ◽  
Sedative Drugs

Abstract Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, Email: predictable recovery with minimal post-operative sequels. Aim of the Work to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups. group DF received dexmedtomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery. And group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Our study showed that dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines, and propofol. Conclusion dexmedetomidine in combination with fentanyl is useful to provide conscious sedation for non operating room procedures in adults and it may be a valuable alternative to ketamine.

scholarly journals Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl dilatation and curettage

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G F Kamel ◽  
R M Ali ◽  
A E A Ismail ◽  
B E A Hanna
Keyword(s):  
Respiratory Depression ◽  
Recovery Time ◽  
Conscious Sedation ◽  
Diagnostic Procedures ◽  
Locus Ceruleus ◽  
Hemodynamic Stability ◽  
Analgesic Effects ◽  
Dilatation And Curettage ◽  
Recovery Profile ◽  
Sedative Drugs

Abstract Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis. Objective It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol. Conclusion This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.

scholarly journals Comparison of Dexmedetomidine with Fentanyl and Pentazocine – Promethazine in patients undergoing dilation and curettage in monitored anesthesia care

2021 ◽  
Vol 8 (3) ◽  
pp. 396-400
Author(s):  
Akanksha Aggarwal ◽  
Divya Mahajan
Keyword(s):  
Respiratory Depression ◽  
Recovery Time ◽  
Conscious Sedation ◽  
Monitored Anesthesia Care ◽  
Analgesic Effects ◽  
Dilatation And Curettage ◽  
Dilation And Curettage ◽  
Recovery Profile ◽  
Minor Surgery ◽  
Sedative Drugs

Dilatation and curettage (D and C) is an essential and common minor surgery in obstetrics and gynecology. Sedation, hypnosis and analgesia are used in combination for such short procedures. These days conscious sedation is provided to patients for day care surgeries which includes analgesia, sedation and anxiolysis while rapid recovery is ensured without side effects. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and conscious sedation without respiratory depression. It was to study the effect of dexemedetomidine with fentanyl versus Pentazocine with promethazine on hemodynamic stability and recovery during sedation in dilatation and curettage procedure. The comparison included the hemodynamic data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedetomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery and group PP received pentazocine 0.5 mg/kg (max 30mg) and Promethazine 12.5 mg slow intravenous Bolus. Dexmedetomidine is a safe drug which provides good hemodynamics and less recovery time. It also exerts sedative and analgesic effects without respiratory depression unlike most analgesic/sedative drugs, such as ketamine, pentazocine and benzodiazepines. This study demonstrates that dexmedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine administration showed better preservation of MAP and SpO2.

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 dexmeditomidine and propofol for hemodynamic and recovery characteristics in dilatation and curettage.

2020 ◽  
Vol 27 (06) ◽  
pp. 1244-1248
Author(s):  
Raza Farrukh ◽  
Waseem Sadiq Awan ◽  
Ahmed Hassan Khan ◽  
Asaad Rizwan Rana ◽  
Ahmed Aziz Jilani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Randomized Control Trial ◽  
Recovery Room ◽  
Recovery Time ◽  
Loading Dose ◽  
Dilatation And Curettage ◽  
Randomized Control ◽  
Group D ◽  
Trial Setting

Objectives: To evaluate the hemodynamic and recovery characteristics of dexmeditomidine and propofol in dilatation and curettage. Study Design: Randomized control trial. Setting: Department of Anaesthesia, DHQ Teaching Hospital Sargodha. Period: March 2016 to December 2017. Material & Methods: Patients undergoing dilatation & curettage were randomly divided into two groups, group P received IV propofol 1.5mg/kg slowly over 5 min and group D received dexmeditomidine at a loading dose of 1µg/kg followed by 0.5 µg/kg/h. During the procedure blood pressure and heart rate were compared in both groups. In the recovery room, recovery time was compared in both groups by using modified aldrete score. Results: In Group D, the decrease in heart rate was statistically significant when compared with group P. Both groups showed a decrease in MAP but results were not statistically significant when compared in both groups. Patients in group D were discharged earlier from recovery room than group P and results were statistically significant. Conclusion: Dexmeditomodine provides better recovery than propofol so it is a suitable drug for day care minor surgical procedures. Similarly dexmeditomidine is superior to propofol by providing less respiratory depression intraopertaively.

scholarly journals Sedative and analgesic effects of propofol–ketamine versus propofol–fentanyl for emergency department procedures

2020 ◽  
pp. 102490791989346
Author(s):  
Shahrad Tajoddini ◽  
Mojdeh Motaghi
Keyword(s):  
Recovery Time ◽  
Statistical Tests ◽  
Data Gathering ◽  
Chi Square ◽  
Double Blind ◽  
Analgesic Effects ◽  
Emergency Procedures ◽  
Chi Square Test ◽  
Group B ◽  
Sedative Drugs

Background: To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short-acting intravenous sedative drugs in the field of emergency medicine. Objectives: This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures. Methods: This study was a randomized, double-blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl–propofol or ketamine–propofol. For data gathering, pre-procedure, and procedure, modified Aldrete’s scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t-test, chi-square test, and analysis of variance. Results: Among the participants in this study, shoulder procedure was performed more than other procedures (56.6%). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). “Hypotension and bradycardia” were observed with fentofol and “tachycardia” was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures. Conclusion: Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension.

A comparative evaluation of newer sedatives in conscious sedation

2006 ◽  
Vol 30 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Dr. Bandana Koirala ◽  
Prof. R. Pandey ◽  
Prof. A. Saksen ◽  
Dr. Rakesh Kumar ◽  
Dr. Shivalal Sharma
Keyword(s):  
Comparative Evaluation ◽  
Recovery Time ◽  
Conscious Sedation ◽  
Blind Study ◽  
Double Blind Study ◽  
Onset Of Action ◽  
Double Blind ◽  
Safety And Efficacy ◽  
Effective Combination ◽  
Child Patients

This double blind study was undertaken to determine the safety and efficacy of orally administered newer sedatives and analgesics for conscious sedation in 120 child patients. Patients were randomly assigned into: Midazolam (I), Ketamine (II), Zolpidem (III), Midazolam plus Ketamine (IV), Midazolam plus Tramadol (V) and Zolpidem plus Tramadol (VI) groups of 20 each. Onset of action, level of sedation, ease of treatment completion, recovery time, and post-operative amnesia were assessed for all and compared. Midazolam plus ketamine was found the most effective combination providing a fast and adequate analgo-sedation in anxious and uncooperative child patients.

Efficacy of an Oxycodone-Propofol Combination versus a Fentanyl-Propofol Combination in Conscious Sedation during Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients

Gerontology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Peipei Guo ◽  
Huisheng Wu ◽  
Lan Liu ◽  
Qiu Zhao ◽  
Zhao Jin
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Adverse Reactions ◽  
Conscious Sedation ◽  
Endoscopic Retrograde ◽  
Patients Satisfaction ◽  
Low Incidence

<b><i>Background:</i></b> With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. <b><i>Objectives:</i></b> This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. <b><i>Methods:</i></b> A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, <i>n</i> = 97) and a “fentanyl combined with propofol” group (group FP, <i>n</i> = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. <b><i>Results:</i></b> There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO<sub>2</sub> &#x3c;90% for &#x3e;10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. <b><i>Conclusions:</i></b> Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

scholarly journals Clinical Effectiveness of an Anesthesiologist-Administered Intravenous Sedation Outside of the Main Operating Room for Pediatric Upper Gastrointestinal Endoscopy in Thailand

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Somchai Amornyotin ◽  
Prapun Aanpreung
Keyword(s):  
Operating Room ◽  
Gastrointestinal Endoscopy ◽  
Clinical Effectiveness ◽  
Upper Gastrointestinal Endoscopy ◽  
Intravenous Sedation ◽  
Main Operating Room ◽  
End Tidal ◽  
Sedative Drugs ◽  
Upper Gastrointestinal ◽  
Main Operating

Objectives. To review our sedation practice and to evaluate the clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy (UGIE) in Thailand.Subjects and Methods. We undertook a retrospective review of the sedation service records of pediatric patients who underwent UGIE. All endoscopies were performed by a pediatric gastroenterologist. All sedation was administered by staff anesthesiologist or anesthetic personnel.Results. A total of 168 patients (94 boys and 74 girls), with age from 4 months to 12 years, underwent 176 UGIE procedures. Of these, 142 UGIE procedures were performed with intravenous sedation (IVS). The mean sedation time was minutes. Propofol was the most common sedative drugs used. Mean dose of propofol, midazolam and fentanyl was  mg/kg/hr,  mg/kg/hr, and  mcg/kg/hr, respectively. Complications relatively occurred frequently. All sedations were successful. However, two patients became more deeply than intended and required unplanned endotracheal intubation.Conclusion. The study shows the clinical effectiveness of an anesthesiologist-administered IVS outside of the main operating room for pediatric UGIE in Thailand. All complications are relatively high. We recommend the use of more sensitive equipments such as end tidal and carefully select more appropriate patients.

In-office Endonasal Minor Revision Rhinoplasty

2021 ◽  
Author(s):  
Samuel R. Auger ◽  
Anil R. Shah
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Recovery Time ◽  
Plastic Surgeon ◽  
Endonasal Approach ◽  
Revision Rhinoplasty ◽  
Minor Revision ◽  
Facial Plastic ◽  
Level Of Experience ◽  
Technical Considerations

AbstractThe revision rhinoplasty presents many unique challenges to the facial plastic surgeon. While many cases will require a full revision in the operating room, there are several isolated deformities which may be repaired in the office via an endonasal approach. This provides many benefits to the patient and surgeon including decreased cost, shorter recovery time, avoidance of general anesthesia, and less discomfort. It is critical to identify defects appropriate for endonasal repair, establish clear expectations with the patient, and work within one's skill set and level of experience. The surgeon who can comfortably navigate both open and endonasal techniques can offer their patients a comprehensive set of solutions for revision rhinoplasty. In this article we outline the defects amenable to this type of repair as well as technical considerations for each defect addressed. We hope it serves as a useful framework for the range of deformities the rhinoplasty surgeon may take on for in-office repair.

Sign in / Sign up

Export Citation Format

Share Document