scholarly journals Comparison of remifentanil concentrations with and without dexmedetomidine for the prevention of emergence cough after nasal surgery: a randomized double-blinded trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ha Yeon Kim ◽  
Hyun Jeong Kwak ◽  
Dongchul Lee ◽  
Ji Hyea Lee ◽  
Sang Kee Min ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
Saline Group ◽  
Nasal Surgery ◽  
Remifentanil Infusion ◽  
Effect Site Concentration ◽  
Double Blinded ◽  
Group D ◽  
Blinded Trial

Abstract Background Preventing emergence cough after nasal surgery is critical. Emergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction. In the present study, we compared the effect-site concentration (Ce) of remifentanil to prevent emergence cough after propofol anesthesia for nasal surgery when remifentanil was or was not combined with dexmedetomidine. Methods Forty-seven patients with propofol-remifentanil anesthesia for nasal surgery were randomly assigned to a dexmedetomidine group (Group D, n = 23) or a saline group (Group S, n = 24). Group D and Group S were infused with dexmedetomidine (0.5 μg/kg) and saline, respectively, for 10 min before the completion of surgery. A predetermined Ce of remifentanil was infused until extubation. Remifentanil Ce to prevent cough in 50 and 95% of patients (EC50 and EC95) was estimated using modified Dixon’s up-and-down method and isotonic regression. Hemodynamic and recovery parameters were recorded. Results The EC50 of remifentanil Ce was significantly lower in Group D than in Group S (2.15 ± 0.40 ng/mL vs. 2.66 ± 0.36 ng/mL, p = 0.023). The EC95 (95% CI) of remifentanil Ce was also significantly lower in Group D [2.75 (2.67–2.78) ng/mL] than in Group S [3.16 (3.06–3.18) ng/mL]. Emergence and recovery variables did not differ between the two groups. Conclusion The remifentanil EC50 to prevent cough after propofol-remifentanil anesthesia was significantly lower (approximately 19%) when a combination of remifentanil and 0.5 μg/kg dexmedetomidine was used than when remifentanil infusion alone was used in patients undergoing nasal surgery. Therefore, the Ce of remifentanil may be adjusted to prevent emergence cough when used in combination with dexmedetomidine. Trial registration ClinicalTrials.gov (NCT03622502, August 9, 2018).

scholarly journals Comparison of Remifentanil Concentrations with and without Dexmedetomidine for the Prevention of Emergence Cough after Nasal Surgery: A Randomized Double Blinded Trial

2020 ◽  
Author(s):  
Ha Yeon Kim ◽  
Hyun Jeong Kwak ◽  
Dongchul Lee ◽  
Ji Hyea Lee ◽  
Sang Kee Min ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
Saline Group ◽  
Nasal Surgery ◽  
Remifentanil Infusion ◽  
Effect Site Concentration ◽  
Double Blinded ◽  
Group D ◽  
Blinded Trial

Abstract Background: After nasal surgery, preventing emergence cough is critical. Emergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction. In the present study, we compared the effect-site concentration (Ce) of remifentanil for preventing emergence cough after propofol anesthesia when remifentanil was or was not combined with dexmedetomidine after nasal surgery.Methods: Forty-seven patients who underwent nasal surgery with propofol-remifentanil anesthesia were randomly divided into a dexmedetomidine group (Group D, n=23) or a saline group (Group S, n=24). Group D and Group S were infused dexmedetomidine (0.5 μg/kg) or saline for 10 min before the completion of surgery. Remifentanil was infused a predetermined Ce until extubation. Remifentanil Ce for the prevention of cough in 50% of patients (EC50) and 95% of patients (EC95) was estimated using modified Dixon's up-and-down method and isotonic regression. Hemodynamic and recovery parameters were observed.Results: The EC50 of remifentanil Ce in Group D was significantly lower than that in Group S (2.15 ± 0.40 ng/mL vs. 2.66 ± 0.36 ng/mL, p = 0.023). The EC95 (95% CI) of remifentanil Ce was also significantly lower in Group D [2.75 (2.67-2.78) ng/mL] than in Group S [3.16 (3.06-3.18) ng/mL]. Emergence and recovery parameters were comparable between the two groups. Conclusion: The remifentanil EC50 for the prevention of cough after propofol-remifentanil anesthesia was significantly lower (approximately 19%) when a combination of remifentanil and 0.5 μg/kg dexmedetomidine was used than when remifentanil infusion alone was used in patients undergoing nasal surgery. Therefore, the Ce of remifentanil may be adjusted for the prevention of emergence cough when used in combination with dexmedetomidine.Trial registration: ClinicalTrials.gov, NCT03622502, Registered August 9, 2018, https://clinicaltrials.gov

scholarly journals Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Macario Camacho ◽  
Justin M. Wei ◽  
Lauren K. Reckley ◽  
Sungjin A. Song
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Nasal Surgery ◽  
Upper Airways ◽  
Obstructive Sleep

Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods. The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions. The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

scholarly journals Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate in prevention of post spinal shivering in uroscopic surgery. (RCT)

2019 ◽  
Author(s):  
Heba Omar ◽  
Wessam adel ◽  
Mohamed Mahmoud Hassan ◽  
Amany Hassan ◽  
Passaint Hassan ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Magnesium Sulphate ◽  
Intrathecal Injection ◽  
Saline Group ◽  
Sedation Score ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Operating Theatres ◽  
Double Blinded ◽  
Group D

Abstract Background: Hypothermia and shivering are associated common complications after spinal anesthesia especially in uroscopic procedures when large amounts of cold intraluminal irrigating fluids are used. Magnesium sulphate and dexmedetomidine are the most effective adjuvants with least side effects. Our aim of the study is to compare the effect of intrathecal dexmedetomidine versus intrathecal magnesium sulfate in prevention of post spinal shivering. Methods: This prospective randomized, double-blinded controlled study was conducted at Kasr El-Aini Hospital on 105 patients scheduled for uroscopic surgeries. patients were randomly allocated into three groups using computerized generated random tables, Group C (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5 mg) +0.5 ml normal saline, Group M (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5 mg) +25 mg magnesium sulfate in 0.5 ml saline and Group D (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5mg) + 5 μg dexmedetomidine in 0.5 ml saline. Primary outcomes were the incidence and intensity of shivering. Secondary outcomes were incidence of hypothermia (Temp < 36° C), sedation, the use of meperidine to control shivering and complications, bradycardia, nausea and vomiting. Results: C group showed statistically significant higher number of total patients who developed shivering (21), patients who developed grade IV shivering (20) and patients who needed meperidine (21) to treat shivering than M group (8,5,5) and D group (5,3,6) which were comparable to each other. Time needed to give meperidine after giving the block was similar in the three groups. Hypothermia didn’t occur in any patient in the three groups. The three groups were comparable regarding occurrence of nausea, vomiting, bradycardia & hypotension. All patients of C group, 32 patients in M group and 33 patients in D group had sedation score of 2. 3 patients in M group and 2 patients in D group had a sedation score of 3. Conclusions: intrathecal injection of dexmedetomidine and magnesium sulfate were both effective in reducing the incidence of post spinal shivering. So, we encourage the use of magnesium sulphate being more physiological, readily available in most operating theatres and much cheaper than dexmedetomidine.

scholarly journals Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery. (RCT)

2019 ◽  
Author(s):  
Heba Omar ◽  
Wessam adel ◽  
Mohamed Mahmoud Hassan ◽  
Amany Hassan ◽  
Passaint Hassan ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Spinal Anaesthesia ◽  
Saline Group ◽  
Sedation Score ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Operating Theatres ◽  
C 32 ◽  
Double Blinded ◽  
Group D

Abstract Background: Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. Methods: This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. Results: Group C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6) , which were comparable to each other. The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. Conclusions: Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post -spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.

scholarly journals Newborn Glial Heterotopia with Upper Airway Obstruction Who Underwent Endoscopic Nasal Surgery

2021 ◽  
Vol 60 (1) ◽  
pp. 21-27
Author(s):  
Tomotaka Hemmi ◽  
Jun Suzuki ◽  
Satoko Sato ◽  
Hiroyuki Ikushima ◽  
Takenori Ogawa ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Nasal Surgery ◽  
Endoscopic Nasal Surgery ◽  
Glial Heterotopia

scholarly journals Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery. (RCT)

2019 ◽  
Author(s):  
Heba Omar ◽  
Wessam adel ◽  
Mohamed Mahmoud Hassan ◽  
Amany Hassan ◽  
Passaint Hassan ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Spinal Anaesthesia ◽  
Saline Group ◽  
Sedation Score ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Operating Theatres ◽  
C 32 ◽  
Double Blinded ◽  
Group D

Abstract Background: Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. Methods: This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. Results: Group C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6) , which were comparable to each other. The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. Conclusions: Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post -spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.

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