miércoles, 27 de noviembre de 2013

Dexmedetomidina iv y raquia/IV dexmedetomidine and spinal anesthesia


Se ha demostrado que dexmedetomidina y clonidina intravenosas prolongan significativamente la anestesia espinal, con buen efecto de sedación y estabilidad hemodinámica. En 2003 Rhee y cols.( Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand. 2003;47:1001-1005.) publicaron el primer artículo con clonidina por vía intravenosa para prolongar la anestesia espinal. Tres 3 μg clonidina /kg durante 10 minutos inmediatamente después del bloqueo subaracnoideo o 50 min después de la raquia, prolongaron significativamente la duración del bloqueo motor y sensorial durante aproximadamente una hora. En 2007, encontramos que la dexmedetomidina intravenosa también mejora la anestesia espinal con bupivacaína hiperbárica. Otros autores han confirmado nuestros resultados iniciales utilizando dosis intravenosa de dexmedetomidina 0.25 hasta 0.5 mcg/kg como un bolo inicial, seguida o no, de una infusión de 0.5 mcg/kg/h. Dos meta- análisis mostraron que la dexmedetomidina intravenosa prolongó la duración de la anestesia espinal y la mejora de la analgesia postoperatoria sin aumentar la incidencia de hipotensión y los eventos adversos. Bradicardia transitoria y reversible son un efecto secundario leve.
Le enviamos algunos artículos disponibles en la web sobre este fascinante tema. Disfrute de su lectura.

It has been shown that intravenous dexmedetomidine and clonidine significantly prolong bupivacaine spinal anaesthesia, with good sedation effect and hemodynamic stability. In 2003 Rhee et al (Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand. 2003;47:1001-1005.)published the first clinical article with intravenous clonidine to prolong spinal anaesthesia; iv. clonidine 3µg/ kg-1 during 10 min immediately after the subarachnoid block or at 50 min after de spinal anaesthesia, prolonged significantly duration of motor and sensory block for approximately one hour. In 2007 we found that dexmedetomidine i.v. also improves bupivacaine spinal anaesthesia. Other authors have confirmed our initial results using i.v. dexmedetomidine doses from 0.25 to 0.5 μg/kg as an initial bolus, followed or not by an infusion of 0.5 μg/kg/h. Two meta-analysis showed that i.v. dexmedetomidine prolonged the duration of spinal anaesthesia and improved postoperative analgesia without increasing the incidence of hypotension and adverse events. Transient reversible bradycardia was a mild side effect.

We e-mail you some articles available on the web about this fascinating subject. Enjoy your reading.




Dexmedetomidina i.v. versus clonidina i.v. para prolongar la anestesia raquídea con bupivacaína. Estudio doble ciego


Intravenous Dexmedetomidine vs. Intravenous Clonidine to prolong Bupivacaine Spinal Anesthesia. A Double Blind Study
Whizar-Lugo V, Gómez-Ramírez IA, Cisneros-Corral R, Martínez-Gallegos N

Anest Mex 2007;19:143-146.
Abstract
Background and goals. Oral, intrathecal, and intravenous clonidine prolong bupivacaine spinal anesthesia. There is no information on the effect of intravenous dexmedetomidine to lengthen duration of spinal bupivacaine anesthesia. Our theory was that intravenous dexmedetomidine given after intrathecal bupivacaine may prolong spinal anesthesia. Material and methods: An double-blind, placebo controlled, prospective study was designed to evaluate the effect on spinal anesthesia of intravenous dexmedetomidine vs. intravenous clonidine. Patients scheduled for abdominal hysterectomy were medicated with 2 mg sublingual lorazepam 1 hour before they were lumbar spinally injected with 15 mg 0.5% hyperbaric bupivacaine, and randomly divided into three groups (n = 25 each); Group D received and infusion of 1 µg/Kg dexmedetomidine given in 20 min, followed by 0.5 µg/kg/h dexmedetomidine drip until end of surgical procedure. Group C received clonidine 4 µg/kg, given as 20 min infusion started 20 min after the spinal
block, and followed by a 0.9% saline drip until the end of surgery. Patients in Group P were managed with 0.9% saline infusion started 20 min after the spinal block. Sensory block was evaluated by pinprick and duration was defined as the time for sensory block to regress to L5-S2 dermatome. Motor block was evaluated using Bromage scale. Results. Initial dexmedetomidine mean dose was 70±7.5 µg, and mean maintenance dose 34±4 µg/kg/h. Clonidine mean dose was 268±32 µg. Sensory block duration was longer in both D and C groups, 208±43.5 and 225±58.8 min respectively, vs. placebo group 137±121.9 min (P= 0.05). Motor block duration was longer in Group D and C (191±49.8 and 172±36.4) vs. placebo group (172±36.4) without significative statistical difference. Hemodynamic changes (bradycardia, hypotension) were similar in all groups, and without clinical relevance. Discussion. Intravenous dexmedetomidine as well as intravenous clonidine given after spinal bupivacaine anesthesia were able to prolong
spinal anesthesia compared to placebo.
Key words. Intravenous clonidine, dexmedetomidine, spinal anesthesia
http://www.anestesiaenmexico.org/RAM9/RAM2007-19-3/005.pdf






Dexmedetomidina intravenosa prolonga la analgesia de bupivacaína espinal

Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia.

Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al-Barazangi BA, Massad IM, Al-Ghanem SM.

Dept. of Anesthesia & Intensive Care, Faculty of Medicine, Univ. of Jordan, Amman, Jordan. mahmoud_juh@hotmail.com

Middle East J Anesthesiol. 2009 Jun;20(2):225-31.

Abstract

BACKGROUND:The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha 2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized thatdexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. METHODS:48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C (the control group) received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS:The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05). The duration of motor block was longer in dexmedetomidine group than control group (199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05). CONCLUSION:Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability.

http://www.meja.aub.edu.lb/downloads/20_2/p225-232.pdf



Efecto de dexmedetomidina i.v. sobre la duración de anestesia espinal con prilocaína: Estudio doble ciego, prospectivo en adultos quirúrgicos
Effect of Dexmedetomidine IV on the Duration of Spinal Anesthesia with Prilocaine: A Double-Blind, Prospective Study in Adult Surgical Patients
Murat Tekin, Ismail Kati, Yakup Tomak, and Erol Kisli.
Department of Anesthesiology and Reanimation, Yuzuncu Yil University, Van,
Turkey; and Department of General Surgery, Yuzuncu Yil University, Van, Turkey
Current Therap Reseach 2007;68:313-324.

http://download.journals.elsevierhealth.com/pdfs/journals/0011-393X/PIIS0011393X07000872.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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