Application value of dexmedetomidine in anesthesia for elderly patients undergoing radical colon cancer surgery

BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer

BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.

Influences of dexmedetomidine on stress responses and postoperative cognitive and coagulation functions in patients undergoing radical gastrectomy under general anesthesia

BACKGROUND Radical gastrectomy(RG)is commonly used in the treatment of patients with gastric cancer(GC),but this procedure may lead to stress responses,postoperative cognitive dysfunction,and blood coagulation abnormalities in patients.AIM To investigate the influences of dexmedetomidine(DEX)on stress responses and postoperative cognitive and coagulation functions in patients undergoing RG under general anesthesia(GA).METHODS One hundred and two patients undergoing RG for GC under GA from February 2020 to February 2022 were retrospectively reviewed.Of these,50 patients had received conventional anesthesia intervention[control group(CG)]and 52 patients had received DEX in addition to routine anesthesia intervention[observation group(OG)].Inflammatory factor(IFs;tumor necrosis factor-α,TNF-α;interleukin-6,IL-6),stress responses(cortisol,Cor;adrenocorticotropic hormone,ACTH),cognitive function(CF;Mini-Mental State Examination,MMSE),neurological function(neuron-specific enolase,NSE;S100 calciumbinding protein B,S100B),and coagulation function(prothrombin time,PT;thromboxane B2,TXB2;fibrinogen,FIB)were compared between the two groups before surgery(T0),as well as at 6 h(T1)and 24 h(T2)after surgery.RESULTS Compared with T0,TNF-α,IL-6,Cor,ACTH,NSE,S100B,PT,TXB2,and FIB showed a significant increase in both groups at T1 and T2,but with even lower levels in OG vs CG.Both groups showed a significant reduction in the MMSE score at T1 and T2 compared with T0,but the MMSE score was notably higher in OG compared with CG.CONCLUSION In addition to a potent inhibitory effect on postoperative IFs and stress responses in GC patients undergoing RG under GA,DEX may also alleviate the coagulation dysfunction and improve the postoperative CF of these patients.

Comparative Study and Safe Dose Analysis of Dexmedetomidine in the Prevention of Emergence Agitation and Emergency Delirium in Children Undergoing General Anesthesia

The purpose of this paper is to explore the safe and effective dose of dexmedetomidin for the prevention of agitation and delirium during the awakening period for children undergoing general anesthesia. Samples of 989 cases are collected from children with comprehensive treatment of dental caries, and were randomly divided into four groups. Group A, group B and group C were intravenously at constant speed （60 mL/h）, 0.5 and 0.25 infusion with 1 μg/kg dexmedetomidine. Group D （control group） was intravenously saline at the same speed. The score of 5-point scale and the incidence of ED （emergency delirium） and EA （emergence agitation） in four groups were compared. Comparison of four groups of CHIPPS （children and infants postoperative pain） score, the amount of operation time and record seven halothane （TO）, time to stop cover drug withdrawal of laryngeal anesthesia （TM）, eye opening time （TE）, independent records of children at the time of ICU stay after anesthesia （TP）. Results show that there was no significant difference between the four groups （p 〉 0.05）, among which the TM in B, C groups was significantly higher than that in A, D groups （p 〈 0.05）. Group C was significantly higher than group B （p 〈 0.05）. There was no significant difference in TE and TP between the A, B, D groups （p 〉 0. 05）. TE in group C was significantly higher than that in groups A, D （p 〉 0. 05）. The TP of group C was significantly higher than that of groups A, D （p 〈 0.05）, but there was no significant difference between the B, C groups （p 〉 0.05）. The incidence rates of EA and ED in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C and group C （p 〉 0.05）. The CHIPPS score and sevoflurane dosage in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C （p 〉 0.05）. Conclusion： the dose of dexmetomidine 0.5 μg/kg in children with general anesthesia can prevent restlessness and delirium after operation.

Investigating the application value of propofol combined with sufentanil and dexmedetomidine in cosmetic anesthesia

Objective:To investigate the effects of propofol combined wit h s u f e n t a n i l a n d dexmedetomidine in cosmetic anesthesia.Methods:The clinical data of 40 plastic surgery patients admitted to the hospital from June to November 2019 were retrospectively analyzed.According to the different anesthesia methods during surgery,they were divided into control group(propofol combined with sufentanil and normal saline,20 cases)and was compared with the observation group(propofol combined with sufentanil and dexmedetomidine,20 cases).The anesthetic effect,total dosage of propofol,spontaneous breathing recovery time,and adverse reactions were compared between the two groups.Results:The total dosage of propofol in the observation group was less than that in the control group,and the spontaneous breathing recovery time was shorter than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in the anesthetic effect and adverse reaction rate between the two groups(P>0.05).Conclusion:The application of propofol in combination with sufentanil and dexmedetomidine in cosmetic anesthesia can reduce the dosage of propofol,speed up the anesthesia recovery,and have better anesthetic effect and safety.

Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.40.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.

Tiletamine/zolazepam and dexmedetomidine with tramadol provide effective general anesthesia in rats

Background:Tiletamine/zolazepam is a dissociative anesthetic combination commonly used in small animals but information is limited in rats.The alpha-2 agonist,dexmedetomidine,has gained popularity in laboratory animal anesthesia.Tramadol is a weak opioid mu agonist.The aim of this study was to assess whether the tiletamine/zolazepam/dexmedetomidine(ZD)combination effectively provides a surgical anesthesia plane comparable to tiletamine/zolazepam/dexmedetomidine with tramadol(ZDT)in a minor procedure in rats.Methods:Rats were induced with ZD or ZDT.After the loss of paw withdrawal,a small incision was made on the rats’left thighs as a surgical stimulus.Rats were maintained under a surgical anesthesia plane by assessing the loss of the paw withdrawal reflex for 45 minutes,then atipamezole was administered.Monitored anesthesia parameters included:(a)physiological parameters-pulse rate(PR),respiratory rate(RR),tissue oxygen saturation(%SpO 2),and body temperature;(b)duration parameters-induction time,onset and duration of surgical anesthesia plane,onset of recovery,and recovery time.Results:PR was significantly lower at 10 minutes in ZD and 5 minutes in ZDT groups.No difference was observed for RR,%SpO 2,and body temperature.Likewise,there were no differences for duration parameters:induction time was less than 3 minutes;onset and duration of surgical anesthesia plane were approximately 5 and 45 minutes,respectively;onset of recovery(time to move)was 51 minutes;and recovery time was 52 minutes,respectively.Conclusion:These data suggest the ZD combination provides a surgical anesthesia plane comparable to ZDT in a rat incisional pain model.

Effects of Dexmedetomidine combined with Sufentanil on the hemodynamics and stress state in the wake of general anesthesia in elderly patients with lower limb fracture surgery

Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied.Methods:From June 2017 to July 2018, 95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected. According to their different anesthesia methods, 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group), and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group). Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor, E, FIns and HOMA-IR). The the changes of pain mediators (NO,β-EP, SP) and helper T cytokines (IFN-γ, TNF-α) were compared between the two groups before and 24 hours after surgery. Results:In the combined group, HR, SpO2, MAP and sufentanil groups showed little change in SpO2 during anesthesia, with no significant difference. The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3. The stress indicators Cor, E, FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance. The serum stress indexes of Cor, E, FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group. The IFN-γ level of the combined group was significantly higher than that of the sufentanil group, and the TNF-α level was significantly lower than that of the control group. Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery. Serum pain mediators NO,β-EP and SP in the combined group were significantly lower than those in the sufentanil group before and 24 h after surgery.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.

Effects of Continuous Intravenous Infusion of Dexmedetomidine on the Duration of Spinal Anesthesia: A Prospective, Double-Blind, Randomized, Controlled Trial

Background: Spinal anesthesia with sedation is a common anesthetic technique in infraumbilical surgeries. Dexmedetomidine has been widely used as a sedative during spinal anesthesia, and is recognized as an adjuvant that prolongs the duration of spinal anesthesia. We compared the effects of a continuous intravenous infusion of dexmedetomidine to provide intraoperative sedation on the duration of sensory and motor blockade induced by spinal anesthesia, with those of midazolam. Methods: A double-blind randomized controlled trial was performed on 40 patients, aged between 20 and 75 years, who requested intraoperative sedation, and were classified as American Society of Anesthesiologists (ASA) physical status I-II, and underwent elective surgeries under spinal anesthesia. After spinal anesthesia with 13 mg (2.6 ml) of 0.5% hyperbaric bupivacaine, patients were randomized to receive intravenous dexmedetomidine 3 μg/kg/h for 10 mins followed by an infusion of 0.5 μg/kg/h (Group D), or intravenous midazolam 0.15 mg/kg/h for 10 mins followed by an infusion of 0.025 mg/kg/h (Group M). Sedation was titrated to Observer’s Assessment of Alertness/Sedation (OAA/S) score of 3. Sensory and motor blockade was evaluated using the pinprick test and modified Bromage scale, respectively. Results: The time taken to achieve OAA/S score 3 was similar in the two groups. The maximal level of sensory blockade was 5.3 ± 1.3 min in group D and 4.1 ± 1.5 in group M (P = 0.03). No significant differences were observed in the time taken to achieve the maximal level or the two-segment regression time of sensory blockade between the two groups. The time to sensory regression to the L2 level was significantly longer in group D than in group M (234.6 ± 78.1 mins versus 172.4 ± 41.5 mins, respectively, P = 0.008). The time to motor regression to modified Bromage score 1 was significantly longer in group D than in group M (232.2 ± 79.3 versus 176.5 ± 48.8, respectively, P = 0.02). Conclusion: Continuous intravenous dexmedetomidine to provide sedation during spinal anesthesia significantly prolongs the duration of sensory and motor blockade induced by spinal anesthesia over that with midazolam.

Effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation

Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general anesthesia in the hospital between January 2017 and December 2017 were divided into the control group (n=109) and the dexmedetomidine group (n=109) by random number table method. Control group underwent routine propofol anesthesia induction and dexmedetomidine group underwent dexmedetomidine anesthesia induction on the basis of propofol. The differences in the severity of inflammatory response and stress response were compared between the two groups of patients after general anesthesia induction (T0), 1 min after endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and 10 min after endotracheal intubation (T3).Results:At T0, there was no statistically significant difference in serum levels of inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum inflammatory factors CRP, IL-1, IL-6, IL-8 and TNF-α levels of dexmedetomidine group were lower than those of control group;serum stress hormones ACTH, Cor, NE, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: Dexmedetomidine + propofol general anesthesia induction can effectively reduce the inflammatory stress response caused by endotracheal intubation.

Comparison of the Effect of Combined Cardiovascular Dexmedetomidine and Propofol in Minimally Invasive axillary Odor Surgery with Tumescent Anesthesia

Objective:The effects of combined dexmedetomidine hydrochloride and propofol in minimally invasive axillary odor surgery with tumescent anesthesia.Methods:A total of 46 patients underwent minimally invasive axillary odor surgery by tumescent anesthesia received in the hospital from May 2017 to January 2019 were divided into observation group(23 cases)and control group(23 cases)according to the random number table method.The control group used propofol,and the observation group underwent minimally invasive axillary odor combined with dexmedetomidine hydrochloride by tumescent anesthesia.The changes of arterial blood pressure(MAP),heart rate(HR)and postoperative complications before and after anesthesia were compared and analyzed between the two groups.Results:After anesthesia,MAP and HR in both groups were lower than before anesthesia,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).Compared with the control group,the postoperative complications were less in the observation group,but the difference was not statistically significant(P>0.05).Conclusion:Compared with the use of propofol,the effect of dexmedetomidine hydrochloride combined with minimally invasive axillary odor surgery by tumescent anesthesia is more obvious,and the postoperative recovery is faster with fewer complications.

Comparison of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia:a Meta-analysis of randomized controlled trial

Objective:To systematically review the efficacy of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia.Methods:We searched the Cochrane Library,PubMed,Embase,CNKI,VIP,WanFang Database,search time from the year of construction to December 2018 for all randomized controlled trials(RCTs)about the efficacy of dexmedetomidine versus fentanyl as adjuvants for ropivacaine for epidural anesthesia.The quality of the studies evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results:Eight RCTs involving 592 Patients were included in our Meta-analysis.The results of meta-analysis showed that compared with fentanyl,dexmedetomidine can reduce the incidence of postoperative nausea and vomiting in patients with ropivacaine epidural anesthesia[OR=0.43,95%CI(0.29,0.66),P<0.0001]and the incidence of post-cold[OR=0.34,95%CI(0.18,0.63),P<0.0001],accelerated onset of analgesia[MD=-2.78,95%CI(-4.81,-0.75),P<0.0001],prolonged time of analgesia[MD=99.04,95%CI(82.73,115.34),P<0.0001],enhanced sedation in non-cesarean section[MD=1.01,95%CI(0.87,1.15),P<0.0001],but increased the incidence of dry mouth[OR=5.63,95%CI(2.85,11.10),P<0.0001],shortening the duration of nerve block[MD=-4.35,95%CI(-7.31,-1.40),P<0.0001],sedation was not as good as fentanyl in cesarean section[MD=-0.89,95%CI(-1.39,-0.38),P<0.0001].Conclusion:Available evidence suggests that dexmedetomidine,as an adjuvant for ropivacaine for epidural anesthesia,has a better analgesic effect than fentanyl,and can reduce the incidence of nausea,vomiting,and chills,but should pay attention to its risk of dry mouth and the sedative effect on different operations.

The Applications of Dexmedetomidine Given Composite Dezocine Spinal Anesthesia in Patients Undergoing Total Hip Replacement Surgery

Objective:Objective:To evaluate the applications of dexmedetomidine given composite dezocine spinal anesthesia in patients undergoing total hip replacement surgery.Methods:120 cases ASAⅠ~Ⅱgrade elective surgery THA patients were divided into group A(n=40),group B(n=40),C group(n=40)from June 2015 to June 2016.Group A were routined with endotracheal intubation operation;Group B were gap into the line L2-3 spinal anesthesia,anesthesia after a fixed pumping 0.2 mg dezocine a mixture of 3 ml;Group C were threatmented with dextrose infusion 3μg Mi Ding mixture 3.5 ml.The levels of mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SPO2),endtidal carbon dioxide(PETCO2)and other hemodynamic parameters and plasma epinephrine(E),norepinephrine(NE),malondialdehyde(MDA)of three groups before and after 10 min of anesthesia 5min(T0),of anesthesia(T1),at the start of surgery(T2),1 Xiaoshi(T3)after completion of anesthesia,the end of the surgery(T4).The anesthetic complications occur of three groups were compared.Results:The levels of MAP,HR,SPO2,PETCO2,E,NE,MDA in T1~T4 time were increased than T0 stage(P<0.05).The levels of MAP,HR,SPO2,PETCO2,E,NE,MDA in T1~T4 time of Groups A were increased than Groups B,Group C(P<0.05).The levels of MAP,HR,SPO2,PETCO2,E,NE,MDA in T1~T4 time of Groups A and Groups B were compared.The cognitive disorders,nausea,vomiting,restlessness,chills,a high incidence of respiratory depression of Group A were higher than Group B,Group C(P<0.05),will high incidence of respiratory depression of Group B were higher than Groups C(P<0.05).Conclusion:dexmedetomidine given composite dezocine spinal anesthesia can effectively stabilize hemodynamics THA patients and reduce patient stress and blood vessels,its low incidence of postoperative complications,worthy of promotion application.

Clinical study on dexmedetomidine combined with hypobaric lumbar anesthesia for elderly patients with hip replacement

Objective:To study the effects of dexmedetomidine combined with hypobaric lumbar anesthesia on pain mediator secretion as well as inflammatory response and stress response activation in elderly patients with hip replacement.Methods: Elderly patients who were>70 years old and underwent hip replacement in Hancheng People's Hospital between March 2015 and June 2017 were chosen and randomly divided into the experimental group who accepted dexmedetomidine combined with hypobaric lumbar anesthesia and the control group who accepted hypobaric lumbar anesthesia alone. The levels of pain mediators and stress mediators in serum as well as the expression of inflammatory molecules in peripheral blood were measured before surgery, the same day after surgery and 3 d after surgery.Results:Compared with those of same group before surgery, CGRP,β-EP, SP, BK, TNF-α, ACTH, F-C, F-Ins, NE and MDA levels in serum as well as NLRP3, Caspase-1, TLR4 and NF-κB mRNA expression in peripheral blood of both groups significantly increased the same day after surgery and 3 d after surgery, and CGRP,β-EP, SP, BK, TNF-α, ACTH, F-C, F-Ins, NE and MDA levels in serum as well as NLRP3, Caspase-1, TLR4 and NF-κB mRNA expression in peripheral blood of experimental group the same day after surgery and 3 d after surgery were significantly lower than those of control group.Conclusion: Dexmedetomidine combined with hypobaric lumbar anesthesia for hip replacement in the elderly can reduce the secretion of pain mediators and relieve the inflammatory response and stress response.

Dexmedetomidine:chaperone of anesthesia

Aim:In this review,it will mainly focus on clarifying the pharmacology of dexmedetomidine and discussing the past,present and future clinical applications of dexmedetomidine as an adjunct in anesthesia.Method:We have searched and reviewed the articles about the use of dexmedetomidine in clinical anesthesia,intensive care unit(ICU),painless gastroenteroscopy and painless labor over the past two decades.Recent findings:Dexmedetomidine,a highly selective agonist of alpha2-adrenergic receptors(alpha2-AR),was primarily approved by the U.S.Food and Drug Administration(FDA)for sedation in ICU due to its pharmacological characteristics with sedative,analgesic and sympatholytic effects.These properties make up the limitations of anesthetics,and it produces a“dexmedetomidine assisted”anesthesia mode as an adjuvant combining with other anesthesia methods,which are all termed as“DEX+”.These new methods can reduce the anesthetics requirement but prolong the action period and alleviate the adverse reactions of anesthetics,thus improving the anesthesia more effectively and safely.Summary:Dexmedetomidine possesses the unique properties exerting synergistic effects and alleviating the side effects as an adjuvant in anesthesia through different administration routes.It is beneficial for the patients’long-term outcome and will be bound to be the leading innovator of anesthesia in future.

Transient involuntary movement disorder after spinal anesthesia: A case report

BACKGROUND Spinal anesthesia is commonly used for various surgeries.While many complications occur after induction of spinal anesthesia,involuntary movement is an extremely rare complication.CASE SUMMARY Herein,we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics.This patient had undergone metal implant removal surgery in both the lower extremities;7 h after intrathecal hyperbaric bupivacaine administration,involuntary raising of the left leg began to occur every 2 min.When the movement disorder appeared,the patient was conscious and cooperative.No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started;moreover,the patient's motor and sensory assessments were normal.The symptom gradually subsided.Twelve hours after the symptom first occurred,its frequency decreased to approximately once every three hours.Two days postoperatively,the symptoms had completely disappeared without intervention.CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause,such as electrolyte imbalance or epilepsy,since immediate action may be required for treatment.Furthermore,it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.

Combined sevoflurane-dexmedetomidine and nerve blockade on post-surgical serum oxidative stress biomarker levels in thyroid cancer patients

BACKGROUND The incidence of thyroid cancer is increasing annually.Clinical routine thyroid surgery can be performed under a cervical plexus block,but cannot mediate the stress response during the surgery.If thyroid surgery is performed under nerve block,an inappropriate level of blockade may occur.Similarly,the stress response caused by surgery is more serious than that caused by conventional anesthesia.Therefore,it is important to combine blockade with more effective anesthesia methods.AIM To investigate the effects of combining sevoflurane-dexmedetomidine inhalation general anesthesia with the cervical plexus nerve block on the post-surgical levels of the serum oxidative stress biomarkers levels in thyroid cancer patients.METHODS We enrolled 96 thyroid cancer patients admitted to the hospital between January 2019 and December 2020.Participants were divided into a control group(n=47)and an experimental group(n=49).The experimental group received a combination of inhaled sevoflurane-dexmedetomidine and cervical plexus block,while the control group received conventional general anesthesia.The groups were compared for serum levels of monocyte chemotactic protein-1(MCP-1)and glutathione peroxidase(GSH-Px)before and after surgery,and the adrenocorticotropic hormone(ACTH)and norepinephrine(NE)levels at 1 and 12 h postsurgery.The Bispectral index(BIS)and the incidence of anesthesia side effects were also compared.RESULTS Following surgery,MCP-1 was significantly lower in the experimental group compared to the control group,whereas GSH-Px was significantly higher than that in the control group(P<0.001).The serum ACTH and NE levels were significantly lower in the experimental group than those the control group at 1 and 12 h post-surgery(P<0.001).BIS was significantly lower in the experimental group than that in the control group at 20 minutes into the operation,but the direction of the difference was reversed at eye opening(P<0.001).The incidence of side effects was 10.20%(5/49)and 12.76%(6/47)in the experimental and control groups,respectively,the difference being non-significant.CONCLUSION Sevoflurane-dexmedetomidine inhalation general anesthesia combined with cervical plexus nerve block can reduce the postoperative stress and inflammatory responses in thyroid cancer patients,while maintaining high anesthesia effectiveness and safety.

immunomodulatory effects of dexmedetomidine: from bench to clinic

Dexmedetomidine is a central alpha2-adrenergic receptor agonist with sedative and analgesic properties that has a proven safety profile. It has several beneficial effects such as decreasing sympathetic tone, leading to reduced opiate use and anxiolysis, making it an attractive option for sedation in the perioperative and intensive care unit setting. These effects also modify favorably the time spent on a ventilator, intensive care unit length of stay and development of delirium. Recent studies also suggest that dexmedetomidine possesses wide-ranging immunomodulating properties. It has been associated with reduced inflammatory cytokine release, modulation of inflammatory transcription factors, oxidative stress and inflammatory cells. These properties could be beneficial in the context of inflammatory conditions that require sedation, such as sepsis, ischemia-reperfusion injury and ventilator-associated lung injury, among many others. In this review, we propose specific clinical scenarios where these properties could turn out to be clinically relevant.

Dexmedetomidine Causes Increased Hypotension in Older Adults When Used for Cataract Surgery Compared to Propofol

Purpose: This study evaluated the hemodynamic effects, suitability and safety of dexmedetomidine (DEX) compared with propofol (PRO) in older adults having outpatient cataract surgery under monitored anesthesia care. The patients, surgeon and the anesthesia staff evaluated satisfaction for both drugs.Method: This prospective, single blind, randomized study was conducted using forty-seven patients ≥55 years old undergoing cataract surgery. The two patient groups received either i.v. dexmedetomidine 1 μg/kg over 10 min;followed by maintenance i.v. infusion at 0.2 -0.7 μg/kg/hr (DEX group, N = 24), or propofol infused between 25 -120 μg/kg/min (PRO group, N = 23). Both agents were titrated to patient comfort. Results: Patients’ mean arterial pressures (SEM) at baseline were 104.7 (2.6) and 107.5 (2.7) mmHg for the DEX and PRO groups, respectively (p = 0.45). At discharge the pressures were 78.1 (2.5) and 98.1 (2.6) mmHg in DEX and PRO groups, respectively (p 0.05). Patients’ heart rates (SEM) at baseline were 74.8 (3.0) for the DEX group and 73.2 (2.8) bpm for the PRO groups (p = 0.71). At the time of discharge following surgery, the mean heart rate for the DEX group was 61.5 (2.2) bpm vs. 69.1 (2.3) bpm (p 0.05) for the PRO group. Three patients in the DEX group developed complications precluding discharge or requiring readmission while none of the patience in the PRO group had complications (p = 0.08). Patient and surgeon satisfaction scores were similar between the groups. Conclusion: Dexmedetomidine is a less suitable sedative compared with propofol use in older patients undergoing cataract surgery due to the decrease in hemodynamic parameters and noted increases in complication rates.