Effects of Dexmedetomidine and Fentanyl Premedication on Quality of Extubation in Children undergoing Tonsillectomy: A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47441.14469 ◽

2021 ◽

Author(s):

Chathoth Anjana ◽

Suseela Indu ◽

Prabhakaran Vineetha

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Sedation Score ◽

Paediatric Anaesthesia ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

American Society

Introduction: Smooth extubation in children is a challenging task, especially those undergoing tonsillectomy. Dexmedetomidine, an alpha-2 receptor agonist has been found to be beneficial in paediatric anaesthesia due to its anxiolytic, sedative and analgesic properties. It also attenuates haemodynamic stress response and airway reflexes to intubation and extubation. Fentanyl, a synthetic opioid is also extensively used in paediatric anaesthesia. Aim: To compare the effects of dexmedetomidine and fentanyl premedication on quality of extubation and extubation haemodynamics. Materials and Methods: The prospective cohort study was conducted in 120 children divided into two groups of 60 each, aged 5-12 years, belonging to American Society of Anaesthesiologists’ (ASA) physical status I and II, posted for elective tonsillectomy under general anaesthesia. Group F received fentanyl 2 μg/kg intravenously and group D, dexmedetomidine 0.5 μg/kg as intravenous infusion over 10 minutes as premedication. The time from discontinuation of anaesthetics to extubation and to opening the eyes in response to verbal stimuli were noted. The quality of extubation was evaluated according to the 5 point extubation score and postoperative sedation assessed using Ramsay sedation score. The haemodynamic parameters were monitored immediately after discontinuation of anaesthetics and at 1, 3, 5 and 10 minutes postextubation. Any complications like airway obstruction, bradycardia, and hypotension were noted and treated appropriately. Statistical Package for Social Sciences (SPSS) software version 22 was used for statistical analysis and categorical outcomes compared with Chi-square test/Fisher’s-Exact test. Results: Extubation was smoother in group receiving dexmedetomidine. The median time from discontinuation of anaesthetics to extubation and eye opening was significantly shorter in dexmedetomidine group compared to fentanyl group (p<0.001). Postoperative sedation score was comparable between the two groups. Heart Rate (HR) and Mean Arterial Pressure (MAP) monitored showed significantly stable values in the dexmedetomidine group (p<0.001) when compared to fentanyl soon after discontinuation of anaesthetics and 1, 3, 5 and 10 minutes postextubation. Conclusion: Premedication with dexmedetomidine 0.5 μg/kg intravenously provides better quality and haemodynamics of extubation compared to fentanyl 2 μg/kg in children undergoing tonsillectomy, without causing significant sedation.

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Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0241849 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241849

Author(s):

Fernanda Raphael Escobar Gimenes ◽

Flávia Fernanda Luchetti Rodrigues Baracioli ◽

Adriane Pinto de Medeiros ◽

Patricia Rezende do Prado ◽

Janine Koepp ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Adverse Events ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mechanical Device ◽

Chi Square ◽

Factors Associated ◽

Level Of Consciousness ◽

Chi Square Test

Aims To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. Materials and methods A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization’s International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher’s exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. Results 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. Conclusion Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.

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