lunes, 25 de agosto de 2014

Más sobre dexmedetomidina/More on dexmedetomidine

Efectos de dexmedetomidina intravenosa sobre bupivacaína hiperbárica espinal. Estudio radomizado


Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study.
Dinesh CN, Sai Tej NA, Yatish B, Pujari VS, Mohan Kumar RM, Mohan CV.
Saudi J Anaesth. 2014 Apr;8(2):202-8. doi: 10.4103/1658-354X.130719.
Abstract
BACKGROUND AND OBJECTIVES:The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. MATERIALS AND METHODS:One hundred American Society of Anesthesiologists (ASA) physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 μg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 μg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. RESULTS:The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D (220.7 ± 16.5 min) compared to group C (131 ± 10.5 min) (P < 0.001). The level of sensory block was higher in group D (T 6.88 ± 1.1) than group C (T 7.66 ± 0.8) (P < 0.001). The duration for two-dermatomal regression of sensory blockade (137.4 ± 10.9 min vs. 102.8 ± 14.8 min) and the duration of sensory block (269.8 ± 20.7 min vs. 169.2 ± 12.1 min) were significantly prolonged in group D compared to group C (P < 0.001). Intraoperative Ramsay sedation scores were higher in group D (4.4 ± 0.7) compared to group C (2 ± 0.1) (P < 0.001). Higher proportion of patients in group D had bradycardia (33% vs. 4%) (P < 0.001), as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C (P < 0.001). CONCLUSION: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia.Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia.
KEYWORDS:Dexmedetomidine; Ramsay sedation scale; hyperbaric bupivacaine; intrathecal; spinal anesthesia
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=2;spage=202;epage=208;aulast=Dinesh;type=2



Administración perineural de dexmedetomidina combinada con ropivacaína prolonga el bloqueo braquial axilar

Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block.
Zhang Y, Wang CS, Shi JH, Sun B, Liu SJ, Li P, Li EY.
Int J Clin Exp Med. 2014 Mar 15;7(3):680-5. eCollection 2014.
Abstract
To evaluate the hypothesis that adding dexmedetomidine to ropivacaine prolongs axillary brachial plexus block. Forty-five patients of ASA I~II and aged 25-60 yr who were scheduled for elective forearm and hand surgery were randomly divided into 3 equal groups and received 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (50 μg) (Group DR1), 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (100 μg) (group DR2) or 40 ml of 0.33% ropivacaine + 1 ml saline (group R) in a double-blind fashion. The onset and duration of sensory and motor blocks and side effects were recorded. The demographic data and surgical characteristics were similar in each group. Sensory and motor block onset times were the same in the three groups. Sensory and motor blockade durations were longer in group DR2 than in group R (P < 0.05). There was no significant difference in the sensory blockade duration between group DR1 and group R. Bradycardia, hypertension and hypotension were not observed in group R and occurred more often in group DR2 than in group DR1. Dexmedetomidine added to ropivacaine for an axillary brachial plexus block prolongs the duration of the block. However, dexmedetomidine may also lead to side effects such as bradycardia, hypertension, and hypotension.
KEYWORDS: Dexmedetomidine; brachial plexus; ropivacaine

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992408/pdf/ijcem0007-0680.pdf



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

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