Markedly long pause due to sinus arrest during dexmedetomidine use and nasal continuous positive airway pressure in two infants with respiratory syncytial virus infection
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Dexmedetomidine
Objective To evaluate the effect of dexmedetomidine on sedation in patients with mechanically ventilated. Methods 51 patients supported with mechanical ventilation admitted to our hospital from February 2011 to June 2013 were randomly divided into midazolam group( group C,n = 25) and dexmedetomidine group( group D,n = 26). Group C was intravenously injected with midazolam,group D was intravenously injected with dexmedetomidine. The HR,BP,RR,SpO2were observed before sedation,after 10 min,30 min,2 hours of sedation. The occurrence of adverse events from sedation to 2 hours after treatment,recovery time and reoccurrence rate of sleep 2 hours after waking were recorded. Results The rate of delirium and reoccurrence of sleep 2 hours after waking in group D were lower than those of group C,recovery time shorter( P 0. 05). The HR,BP,RR,SpO2before sedation,after 10 min,30 min,2 hours of sedation between two groups showed no significant differences( P 0. 05). Conclusion The sedative efficacy of dexmedetomidine on mechanically ventilated is better than that of midazolam,and has similar efficacy on respiration,less impact on circulation,lower rate of delirium.
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Midazolam
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Purpose: In spinal anesthesia, adequate sedation offers a number of advantages to both the patients and physician. But there is not the study that comparison of midazolam commonly used sedative and dexmedetomidine relatively new sedative. The purpose of this study was to comparison of sedative effect, and changes in blood pressure, heart rate and oxygen saturation between midazolam and dexmedetomidine under spinal anesthesia. Methods: Forty four patients with American society of anesthesiologist physical status 1 or 2 that receive arthroscopic surgery under spinal anesthesia separated into two groups to receive midazolam (M group) or dexmedetomidine(D group). After block level is fixed, midazolam was given to the M group and dexmedetomidine was given to the D group. Bispectral index (BIS), modified observer’s assessment of alertness/sedation scale (MOAA/S), mean arterial pressure (MAP), heart rate(HR), and SpO2, were recorded. Sedative drug infusion was stopped when skin suture was finished. Adverse effects were also recorded. Result: Both drugs provided good sedation without respiratory depression. In M group, HR was significantly higher, and MAP was significantly lower than in D group. And in three cases of D group, there was significant bradycardia after infusion bolus dosage. Conclusion: We concluded that both drugs provided satisfactory sedation without respiratory depression. Especially midazolam is safe sedative that have cost benefit in the patients without underlying disease. And the further evaluation about safe initial bolus dose of dexmedetomidine under spinal anesthesia is needed.
Dexmedetomidine
Midazolam
Bispectral index
Bolus (digestion)
Respiratory Rate
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Objective: To evaluate the sedative effect and safety of dexmedetomidine combined with propofol for post-operative patients undergoing mechanical ventilation(MV) in intensive care unit(ICU).Methods: A total of 180 cases of post-operative patients undergoing MV with tracheal intubation in ICU were divided randomly and equally into three groups as dexmedetomidine plus propofol group(group A),dexmedetomidine group(group D),and propofol group(group P).In all groups fentanyl was given intravenously continually for analgesia,dose of fentanyl was kept on 0.30 μg/(kg·h).The dose of sedation was regulated according to Ramsay sedative scores maintaining in 3-4 sedative score.During the course,anesthesia up effect time,sedation dose,awakening time,heart rate(HR),mean artery pressure(MAP),respiratory rate(RR),pulse oxygen saturation(SPO 2),adverse reactions were observed and recorded continuously.Results: All groups could reach the goal of sedation needed for ICU patients.Changes of the circulatory system and the dosage of propofol in group A were less than in group P,and there were less adverse reactions in group A than in group P(P 0.05).The dosage of dexmedetomidine in group A was less than in group D.There was no significant difference in HR,MAP,RR,and SPO 2 between groups A and D(P 005).There was significant difference in extubation time between groups P and A or D(P 0.05).Conclusion: Dexmedetomidine combind with propofol can reach the goal of sedation needed for ICU patients,it helps to shorten the dosage of dexmedetomidine and propofol,maintains the respiratory and circulation parameters,and reduces adverse reactions.
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Mean arterial pressure
Midazolam
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BackgroundEfforts to find a better adjuvant in spinal anesthesia have been underway for a long time to achieve both effective analgesia and targeted sedation. We evaluated whether we can use dexmedetomidine in spinal anesthesia through its multiple modes of action and reduced adverse events in comparison with its intravenous use to achieve desirable patient comfort and sedation.Patients and methodsA total of 100 patients classified as American Society of Anesthesiologists class I and II scheduled for inguinal hernia repair were studied. Patients were allocated randomly to receive either 15 mg of 0.5% hyperbaric bupivacaine plus 0.5 ml normal saline intrathecally and an intravenous infusion of dexmedetomidine 1 mg/kg over 10 min (group V, n = 50) or 15 mg of 0.5% hyperbaric bupivacaine plus 5 mg of dexmedetomidine diluted in 0.5 ml normal saline intrathecally and an intravenous infusion of same volume normal saline over 10 min (group S, n = 50).ResultsPatients in both groups were comparable in the characteristics of the spinal block and sedation score.ConclusionIntrathecal dexmedetomidine can act both as an adjuvant to bupivacaine and as a sedative without the need for other intravenous sedation drugs.
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Summary Background: When electroencephalogram (EEG) activity is recorded for diagnostic purposes, the effects of sedative drugs on EEG activity should be minimal. This study compares the sedative efficacy and EEG effects of dexmedetomidine and midazolam. Subjects and methods: EEG recordings of 60 pediatric subjects with a history of simple febrile convulsions were performed during physiologic sleep. All of these patients required sedation to obtain follow‐up (control) EEGs. Subjects in Group D received 0.5 μg·kg −1 of dexmedetomidine, and those in Group M received 0.1 mg·kg −1 of midazolam. For rescue sedation, the same doses were repeated to maintain a Ramsey sedation score level of between 4 and 6. Results: The mean doses that were required for sedation were 0.76 μg·kg −1 of dexmedetomidine and 0.38 mg·kg −1 of midazolam. Diastolic blood pressure and HR were lower in Group D than in Group M ( P < 0.05). Hypoxia was observed in 11 (36.7%) subjects in Group M and none in Group D; this was statistically significant ( P < 0.001). Frontal and parieto‐occipital (PO) EEG frequencies were similar during physiologic sleep and dexmedetomidine sedation. However, EEG frequencies in these areas ( P < 0.001) and PO EEG amplitude ( P = 0.030) were greater during midazolam sedation than during physiologic sleep. Conclusions: Dexmedetomidine is a suitable agent to provide sedation for EEG recording in children. There is less change in EEG peak frequency and amplitude after dexmedetomidine than after midazolam sedation.
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Midazolam
Convulsion
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INTRODUCTION: Preoperative anxiety is a frequent condition. Comfortable anesthesia induction and maintenance can be achieved by controlling anxiety. Various agents are used to relieve anxiety and provide sedation. We conducted this study to compare the sedative effects of dexmedetomidine versus midazolam for patients undergoing spinal anesthesia. AIMS AND OBJECTIVES : To compare the sedative effect of both drugs and observe intraoperative and postoperative comfort level, cardiovascular and respiratory changes and side effects of both drugs. MATERIALS AND METHODS: Sixty patients between 18-65 years of age requiring spinal anaesthesia for their procedures were selected randomly and division was done in 2 groups (Each group having 30 patients). Group D was given Inj. Dexmedetomidine at the dose of 1 mcg/kg within 10 mins in 100 ml NS and group M was given Inj Midazolam at the dose of 0.04 mg/kg in 100 ml NS within 10 mins. DISCUSSION: Anxiety is more common among young patients, women, and people with negative experience of anesthesia or fear that arises just before the operation and anesthesia my lead to psychological trauma. Various agents such as phenothiazines, bezodiazepines, barbiturates, opioids, propofol, ketamine, dexmedetomidine or clonidine and antihistamines are used to relieve anxiety and provide sedation. Midazolam is a benzodiazepine,commonly used as an intravenous sedative agent for pre-operative sedation. Dexmedetomidine is an alpha-2 agonist which acts on adrenoreceptors in many tissues including the nervous, cardiovascular and respiratory systems. Unlike midazolam, dexmedetomidine does not affect the ventilatory response to carbon dioxide, it also produces analgesia which could potentially alleviate pain.
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Objective
To compare the sedative efficacy and untoward effect of dexmedetomidine and midazolam in drunken patients after general anesthesia.
Methods
Thirty-eight drunken patients having underwent mechanical ventilation after general anesthesia were enrolled. The patients were divided into dexmedetomidine group and midazolam group with 19 cases each according to random digital table method. The sedation onset time, dysphoria, percentage of with good sleep quality, duration of mechanical ventilation, ICU length of staying and untoward effect were compared.
Results
The sedation onset time and duration of mechanical ventilation in dexmedetomidine group were significantly shorter than those in midazolam group: (45.6±8.9) s vs. (112.5±20.3) s and (9.4±2.1) h vs. (18.6±5.1) h, the patients of dysphoria in dexmedetomidine group was significantly less than that in midazolam group: 6 cases vs. 14 cases, the patients of good sleep quality in dexmedetomidine group was significantly more than that in midazolam group: 12 cases vs. 4 cases, and there were statistical differences (P 0.05) . The patients of bradyarrhythmia in dexmedetomidine group was significantly more than that in midazolam group: 9 cases vs. 2 cases, but the patients of respiratory depression in dexmedetomidine group was significantly less than that in midazolam group: 4 cases vs. 12 cases, and there were statistical differences (P 0.05) .
Conclusion
Compared with midazolam, dexmedetomidine is highly recommended to be used for the sedation of drunken patients after general anesthesia, but the incidence of circulatory adverse reactions should be paid attention to.
Key words:
Dexmedetomidine; Midazolam; General anesthesia; Sedation
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Midazolam
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Objective To evaluate the sedative effect of dexmedetomidine and propofol and the correlation of the conscious condition and BIS in ophthalmic surgery.Methods Forty patients,ASA Ⅰ～Ⅱ,who underwent elective ophthalmic surgery,were randomly divided into two groups based on the medications used for sedation:the dexmedetomidine group(Group D) and the propofol group(Group P).In Group D,the loading dose was 0.8 μg/kg,followed by 0.3 μg/(kg·h).In Group P,the loading dose was 0.5 mg/kg,followed by 2.5 mg/(kg·h).BIS,HR,MAP and Ramsay score were observed and recorded before and during the operation.Results The Ramsay scores were same in the two groups and BIS were lower in Group D compared with Group P(P 0.05).HR in Group D was also lower than Group P(P 0.05).Side effects of hopoxemia were observed only in Group P.Conclusion Compared with propofol,dexmedetomidine appears to have more advantages in patients with ophthalmic surgery under local anesthesia.In addition,the BIS is lower with dexmedetomidine sedation than propofol at the same sedative level.
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