Combinación de ketofol-dexmedetomidina en terapia electroconvulsiva para depresión y aguitación
Ketofol-Dexmedetomidine combination in ECT: A punch for depression and agitation.
Shams T, El-Masry R.
Indian J Anaesth. 2014 May;58(3):275-80. doi: 10.4103/0019-5049.135037.
Abstract
BACKGROUND AND AIMS: The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression. METHODS: 40 patients aged 18-60 years were scheduled for ECT for treatment of depression. Dexmedetomidine (0.5 μg/kg) diluted to a volume of 10 ml with 0.9% saline or 10 ml 0.9% saline were infused intravenously over 10 minutes before induction of anaesthesia with ketamine and propofol (ketofol). Statistical analysis was carried out using the Statistical Software for the Social Sciences (SPSS) package. RESULTS: Motor seizure duration in ketofol group was significantly less compared to ketofol-dex group (35.8 ± 6.6s versus 38.9 ± 4.9s). Total ketofol used was significantly less in ketofol-dex group compared to ketofol group (78.5 ± 10.8mg versus 90 ± 13.2mg). The number of patients with agitation score >2 was significantly lower in ketofol-dex group (1.4%) compared to ketofol group (8.6%). There was significant decrease (P = 0.000) in mean arterial pressure (MAP) and heart rate (HR) in ketofol-dex group compared to ketofol group at 20, 30, and 40 minutes for MAP and at 10, 20, 30, and 40 minutes for HR. CONCLUSIONS: Ketofol-dex mixture in ECT is associated with longer mean seizure duration, effective anti-depression, less incidence of agitation, more patient satisfaction, and acceptable decreases in blood pressure and HR when compared to ketofol alone.
KEYWORDS: Agitation; depression; dexmedetomidine; electroconvulsive therapy; ketofol
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2014;volume=58;issue=3;spage=275;epage=280;aulast=Shams;type=2
Comparación de dos esquemas de dosis de la dexmedetomidina por vía intravenosa en pacientes ancianos durante la anestesia espinal.
Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia.
Park SH, Shin YD, Yu HJ, Bae JH, Yim KH.
Korean J Anesthesiol. 2014 May;66(5):371-6. doi: 10.4097/kjae.2014.66.5.371. Epub 2014 May 26.
Abstract
BACKGROUND:As the number of elder patients grows, spinal anesthesia for such patients are increasing significantly. Any effort is needed to use the least anesthetic drug for maintaining the anesthesia while avoiding hazards of cardio-pulmonary complications. METHODS:American Society of Anesthesiologists physical status classification I and II, Forty five elderly patients (≥ 60 years) who received transurethral resection of the prostate or transurethral resection of the bladder tumor were allocated randomly into three treatment groups. The DMT 0.5 group was designed as with dexmedetomidine 0.5 µg/kg while the DMT 1.0 group has a 1 µg/kg intravenous injection over 10 min before anesthetic induction. The Control group was designed to get a normal saline. Each group was compared regarding the maximum sensory block level, extension of anesthesia, degree of motor block, level of sedation, VAS score and complications.
RESULTS: There were no significant differences among the 3 treatment groups regarding the maximum level of sensory block and motor block. However, the duration of sensory block was significantly longer in DMT 1.0 group than in the control group (P = 0.045). Both DMT 1.0 group (median = 3, range = 2-6) and DMT 0.5 group (median = 3, range = 1-6) showed a mean value of 3-4 Ramsay sedation score, which resulted in more excessive sedation and significantly greater incidence of bradycardia compared to the control group. No complications such as hypotension, nausea, tremor, and hypoxia were found during this investigation. CONCLUSIONS: In elder patients, the DMT 1.0 group is effective in duration of sensory block and is superior in the aspect of prolonged duration of sensory block compared to the DMT 0.5 group.
KEYWORDS:Dexmedetomidine; Spinal anesthesia
http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-66-371.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Ketofol-Dexmedetomidine combination in ECT: A punch for depression and agitation.
Shams T, El-Masry R.
Indian J Anaesth. 2014 May;58(3):275-80. doi: 10.4103/0019-5049.135037.
Abstract
BACKGROUND AND AIMS: The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression. METHODS: 40 patients aged 18-60 years were scheduled for ECT for treatment of depression. Dexmedetomidine (0.5 μg/kg) diluted to a volume of 10 ml with 0.9% saline or 10 ml 0.9% saline were infused intravenously over 10 minutes before induction of anaesthesia with ketamine and propofol (ketofol). Statistical analysis was carried out using the Statistical Software for the Social Sciences (SPSS) package. RESULTS: Motor seizure duration in ketofol group was significantly less compared to ketofol-dex group (35.8 ± 6.6s versus 38.9 ± 4.9s). Total ketofol used was significantly less in ketofol-dex group compared to ketofol group (78.5 ± 10.8mg versus 90 ± 13.2mg). The number of patients with agitation score >2 was significantly lower in ketofol-dex group (1.4%) compared to ketofol group (8.6%). There was significant decrease (P = 0.000) in mean arterial pressure (MAP) and heart rate (HR) in ketofol-dex group compared to ketofol group at 20, 30, and 40 minutes for MAP and at 10, 20, 30, and 40 minutes for HR. CONCLUSIONS: Ketofol-dex mixture in ECT is associated with longer mean seizure duration, effective anti-depression, less incidence of agitation, more patient satisfaction, and acceptable decreases in blood pressure and HR when compared to ketofol alone.
KEYWORDS: Agitation; depression; dexmedetomidine; electroconvulsive therapy; ketofol
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2014;volume=58;issue=3;spage=275;epage=280;aulast=Shams;type=2
Comparación de dos esquemas de dosis de la dexmedetomidina por vía intravenosa en pacientes ancianos durante la anestesia espinal.
Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia.
Park SH, Shin YD, Yu HJ, Bae JH, Yim KH.
Korean J Anesthesiol. 2014 May;66(5):371-6. doi: 10.4097/kjae.2014.66.5.371. Epub 2014 May 26.
Abstract
BACKGROUND:As the number of elder patients grows, spinal anesthesia for such patients are increasing significantly. Any effort is needed to use the least anesthetic drug for maintaining the anesthesia while avoiding hazards of cardio-pulmonary complications. METHODS:American Society of Anesthesiologists physical status classification I and II, Forty five elderly patients (≥ 60 years) who received transurethral resection of the prostate or transurethral resection of the bladder tumor were allocated randomly into three treatment groups. The DMT 0.5 group was designed as with dexmedetomidine 0.5 µg/kg while the DMT 1.0 group has a 1 µg/kg intravenous injection over 10 min before anesthetic induction. The Control group was designed to get a normal saline. Each group was compared regarding the maximum sensory block level, extension of anesthesia, degree of motor block, level of sedation, VAS score and complications.
RESULTS: There were no significant differences among the 3 treatment groups regarding the maximum level of sensory block and motor block. However, the duration of sensory block was significantly longer in DMT 1.0 group than in the control group (P = 0.045). Both DMT 1.0 group (median = 3, range = 2-6) and DMT 0.5 group (median = 3, range = 1-6) showed a mean value of 3-4 Ramsay sedation score, which resulted in more excessive sedation and significantly greater incidence of bradycardia compared to the control group. No complications such as hypotension, nausea, tremor, and hypoxia were found during this investigation. CONCLUSIONS: In elder patients, the DMT 1.0 group is effective in duration of sensory block and is superior in the aspect of prolonged duration of sensory block compared to the DMT 0.5 group.
KEYWORDS:Dexmedetomidine; Spinal anesthesia
http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-66-371.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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