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

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.

Download Full-text

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

QJM ◽

10.1093/qjmed/hcaa039.050 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Cited By ~ 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.

Download Full-text

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

QJM ◽

10.1093/qjmed/hcab086.102 ◽

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.

Download Full-text

Can liver cirrhosis patients benefit from target controlled infusion of propofol for conscious sedation during endoscopic variceal ligation?

International Surgery Journal ◽

10.18203/2349-2902.isj20173869 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2907

Author(s):

Jun-Xiang Li ◽

Jun-Chao Wu ◽

Wei-Wei Lin ◽

Xiao Wang

Keyword(s):

Liver Cirrhosis ◽

Respiratory Depression ◽

Recovery Time ◽

Conscious Sedation ◽

Demographic Data ◽

Endoscopic Variceal Ligation ◽

Target Controlled Infusion ◽

Scale Scores ◽

Degree Of Satisfaction ◽

Sedation Group

Background: The aim of the present study was to evaluate the feasibility of conscious sedation using target controlled infusion of propofol combined with a single dose of fentanyl during endoscopic variceal ligation in patients with liver cirrhosis.Methods: Forty-eight patients with liver cirrhosis scheduled for endoscopic variceal ligation were randomly assigned to deep sedation group (DS group) with intravenous bolus of propofol and conscious sedation group (CS group) with target controlled infusion of propofol, 1 μg/kg fentanyl was intravenously injected in each patient before administration of propofol. Cardiorespiratory parameters were monitored, and the side-effects were recorded. The depth of sedation was assessed by both of the sale of observer′s assessment of alertness/sedation (OAA/S) and the bispectral index (BIS). The quality of sedation/analgesia was evaluated by the endoscopist and patients using Visual Analog Scores (VAS). The recovery level was evaluated with the Aldrete scales.Results: No significant differences were found on demographic data and initial parameters in the two groups. Compared with the CS group, the changes of mean arterial pressure (MAP) and heart rate (HR) and the signs of respiratory depression were significant in the DS group (p<0.05). The recovery time in DS group (16.7±2.7 minutes) was much longer than that in the CS group (9.3±3.0 minutes, p<0.01). There was no difference in Visual Analogue Scale scores for endoscopist’s satisfaction between the two groups (9.2±0.6 versus 9.0±0.6, p>0.05), but a higher degree of satisfaction for patient was found in the DS group (9.3±0.6 versus 7.9±0.7, p<0.01).Conclusions: Conscious sedation with target controlled infusion of propofol combined with a single bolus of fentanyl for endoscopic variceal ligation in patients with liver cirrhosis had better hemodynamic stability, less respiratory depression and shorter recovery time.

Download Full-text

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

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919893466 ◽

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.

Download Full-text

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

Gerontology ◽

10.1159/000511173 ◽

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

Background: 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. Objectives: This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. Methods: 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, n = 97) and a “fentanyl combined with propofol” group (group FP, n = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. Results: There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO2 <90% for >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. Conclusions: Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

Download Full-text

Benefit and Risk Evaluation of Biased μ-Receptor Agonist Oliceridine versus Morphine

Anesthesiology ◽

10.1097/aln.0000000000003441 ◽

2020 ◽

Vol 133 (3) ◽

pp. 559-568 ◽

Cited By ~ 5

Author(s):

Albert Dahan ◽

C. Jan van Dam ◽

Marieke Niesters ◽

Monique van Velzen ◽

Michael J. Fossler ◽

...

Keyword(s):

Utility Function ◽

Respiratory Depression ◽

Receptor Agonist ◽

Ventilatory Response ◽

Cold Pressor Test ◽

Cold Pressor ◽

Population Pharmacokinetic ◽

Potency Ratio ◽

Analgesic Effects ◽

Hypercapnic Ventilatory Response

Background To improve understanding of the respiratory behavior of oliceridine, a μ-opioid receptor agonist that selectively engages the G-protein–coupled signaling pathway with reduced activation of the β-arrestin pathway, the authors compared its utility function with that of morphine. It was hypothesized that at equianalgesia, oliceridine will produce less respiratory depression than morphine and that this is reflected in a superior utility. Methods Data from a previous trial that compared the respiratory and analgesic effects of oliceridine and morphine in healthy male volunteers (n = 30) were reanalyzed. A population pharmacokinetic–pharmacodynamic analysis was performed and served as basis for construction of utility functions, which are objective functions of probability of analgesia, P(analgesia), and probability of respiratory depression, P(respiratory depression). The utility function = P(analgesia ≥ 0.5) – P(respiratory depression ≥ 0.25), where analgesia ≥ 0.5 is the increase in hand withdrawal latency in the cold pressor test by at least 50%, and respiratory depression ≥ 0.25 is the decrease of the hypercapnic ventilatory response by at least 25%. Values are median ± standard error of the estimate. Results The two drugs were equianalgesic with similar potency values (oliceridine: 27.9 ± 4.9 ng/ml; morphine 34.3 ± 9.7 ng/ml; potency ratio, 0.81; 95% CI, 0.39 to 1.56). A 50% reduction of the hypercapnic ventilatory response by morphine occurred at an effect-site concentration of 33.7 ± 4.8 ng/ml, while a 25% reduction by oliceridine occurred at 27.4 ± 3.5 ng/ml (potency ratio, 2.48; 95% CI, 1.65 to 3.72; P < 0.01). Over the clinically relevant concentration range of 0 to 35 ng/ml, the oliceridine utility function was positive, indicating that the probability of analgesia exceeds the probability of respiratory depression. In contrast, the morphine function was negative, indicative of a greater probability of respiratory depression than analgesia. Conclusions These data indicate a favorable oliceridine safety profile over morphine when considering analgesia and respiratory depression over the clinical concentration range. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Effectiveness of misoprostol for induction of first and early second trimester spontaneous miscarriages in parous women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184498 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4512

Author(s):

Tamima Al-Dughaishi ◽

Amjad Hamed Al-Haddabi ◽

Mussab Mussab Mubarak Hamed Al-Jabri ◽

Vaidyanathan Gowri

Keyword(s):

Success Rate ◽

First Trimester ◽

University Hospital ◽

Second Trimester ◽

Sultan Qaboos University ◽

Dilatation And Curettage ◽

Dilation And Curettage ◽

Medical Termination ◽

Surgical Evacuation ◽

Incomplete Miscarriage

Background: Medical termination of missed miscarriage and incomplete miscarriage with misoprostol, are an alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in highly parous woman for incomplete and missed miscarriage.Methods: This was a retrospective study was conducted in two different time lines (2010 and 2014). All patients admitted to the Sultan Qaboos University hospital, Muscat, Oman, for the management of first-trimester miscarriages (missed and incomplete types) during the study period were included. Some women were moved to dilation and curettage even after misoprostol. The effect of gravidity and parity on those women in whom misoprostol was not effective was studied.Results: The overall success rate of misoprostol for the management was 62.14% in 2010 and 53.8% 2014. In nulliparous woman the success rate of misoprostol was slightly higher than parous women. There was no apparent effect of gravidity and parity of ≥ 5 or ≥ 5 on the success of misoprostol.Conclusions: Misoprostol reduced the rate of surgical evacuation among the study subjects. In highly parous and multigravid women (≥ para 5 and gravida ≥5) the success was not significantly different compared to less parous women.

Download Full-text

Evaluation of the Effect of Dexmedetomidine on Hemodynamic Changes and Recovery Time in Patients Undergoing Dilatation and Curettage

10.47275/0032-745x-157 ◽

2019 ◽

Vol 105 (5) ◽

Cited By ~ 1

Author(s):

Hossein Sattari ◽

Morteza Hashemian ◽

Mehrdad Noroozi ◽

Azita Khaloueipour

Keyword(s):

Recovery Time ◽

Hemodynamic Changes ◽

Dilatation And Curettage

Download Full-text

Anxiety Control Training

Advances in Psychiatric Treatment ◽

10.1192/apt.1.2.57 ◽

1994 ◽

Vol 1 (2) ◽

pp. 57-61 ◽

Cited By ~ 1

Author(s):

Philip Snaith

Keyword(s):

Recovery Time ◽

Diagnostic Procedure ◽

Somatic Symptoms ◽

Acute Illness ◽

Normal Limits ◽

Muscular Tension ◽

Anxiety Control ◽

Wide Range ◽

Illness Anxiety ◽

Sedative Drugs

Anxiety pervades every aspect of human activity and experience. It is a normal state and a spur to action, but readily exceeds normal limits in intensity, duration and appropriateness to the stimulus or situation. Anxiety is manifest by the mood of fearfulness, behaviour marked by restlessness and avoidance of situations, increased arousal with insomnia, excessive preoccupation with thoughts on the theme of insecurity, and a wide range of somatic symptoms which are based on muscular tension, hyperventilation leading to paraesthesiae and faintness, and symptoms based on overactivity of the autonomic nervous system. Excessive anxiety and situational avoidance leads to diminution of performance and limitation of endeavour. In the context of physical illness, anxiety increases the distress of symptoms, may confuse diagnostic procedure, prolong recovery time from acute illness, cause failure to comply with effective treatment and promote destructive habits such as reliance on alcohol or excessive use of sedative drugs.

Download Full-text