Comparación de clonidina y dexmedetomidina para sedación por corto tiempo en la UCI
Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients.
Srivastava U, Sarkar ME, Kumar A, Gupta A, Agarwal A, Singh TK, Badada V, Dwivedi Y.
Indian J Crit Care Med. 2014 Jul;18(7):431-6. doi: 10.4103/0972-5229.136071.
Abstract
BACKGROUND AND OBJECTIVES: Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation. STUDY DESIGN: Prospective, randomized, controlled open-label study. MATERIALS AND METHODS: A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups. RESULTS: Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine. CONCLUSION: Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.
KEYWORDS:Clonidine; dexmedetomidine; intensive care unit sedation
http://www.ijccm.org/downloadpdf.asp?issn=0972-5229;year=2014;volume=18;issue=7;spage=431;epage=436;aulast=Srivastava;type=2
http://www.ijccm.org/temp/IJCCM187431-5422819_013022.pdf
Dexmedetomidina para intubación despierta y anestesia general libre de opioides en un paciente superobeso con sospecha de intubación difícil
Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation.
Gaszynski T, Gaszynska E, Szewczyk T.
Drug Des Devel Ther. 2014 Jul 7;8:909-12. doi: 10.2147/DDDT.S64587. eCollection 2014.
Abstract
Super-obese patients (body mass index [BMI] >50 kg/m(2)) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m(2)) female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM) as comorbidities as well as potential for a difficult intubation- neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".
KEYWORDS:dexmedetomidine; morbid obesity; non-opioid anesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094577/pdf/dddt-8-909.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients.
Srivastava U, Sarkar ME, Kumar A, Gupta A, Agarwal A, Singh TK, Badada V, Dwivedi Y.
Indian J Crit Care Med. 2014 Jul;18(7):431-6. doi: 10.4103/0972-5229.136071.
Abstract
BACKGROUND AND OBJECTIVES: Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation. STUDY DESIGN: Prospective, randomized, controlled open-label study. MATERIALS AND METHODS: A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups. RESULTS: Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine. CONCLUSION: Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.
KEYWORDS:Clonidine; dexmedetomidine; intensive care unit sedation
http://www.ijccm.org/downloadpdf.asp?issn=0972-5229;year=2014;volume=18;issue=7;spage=431;epage=436;aulast=Srivastava;type=2
http://www.ijccm.org/temp/IJCCM187431-5422819_013022.pdf
Dexmedetomidina para intubación despierta y anestesia general libre de opioides en un paciente superobeso con sospecha de intubación difícil
Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation.
Gaszynski T, Gaszynska E, Szewczyk T.
Drug Des Devel Ther. 2014 Jul 7;8:909-12. doi: 10.2147/DDDT.S64587. eCollection 2014.
Abstract
Super-obese patients (body mass index [BMI] >50 kg/m(2)) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m(2)) female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM) as comorbidities as well as potential for a difficult intubation- neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".
KEYWORDS:dexmedetomidine; morbid obesity; non-opioid anesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094577/pdf/dddt-8-909.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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