lunes, 24 de noviembre de 2014

Dexmedetomidina iv en raquia/IV dexmedetomidine in spinal anaesthesia

La comparación de anestesia monitoreada (MAC) con dexmedetomidina y anestesia espinal durante cirugía para venas varicosas

The comparison of monitored anesthesia care with dexmedetomidine and spinal anesthesia during varicose vein surgery.
Moon EJ1, Kang KW1, Chung JY1, Kang JM1, Park JH2, Joh JH3, Park HC3, Yi JW1.
Ann Surg Treat Res. 2014 Nov;87(5):245-52. doi: 10.4174/astr.2014.87.5.245. Epub 2014 Oct 24.
PURPOSE: The purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery. METHODS: Forty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 µg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 µg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups. RESULTS: Systolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery. CONCLUSION: We believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition.
KEYWORDS: Dexmedetomidine; Monitored anesthesia care; Sedation; Spinal anesthesia

Efectos de dexmedetomidina intravenosa sobre la anestesia espinal. Comparación de dosis diferentes de clonidina

The effects of intravenous dexmedetomidine on spinal anesthesia: comparision of different dose of dexmedetomidine.
Lee MH, Ko JH, Kim EM, Cheung MH, Choi YR, Choi EM.
Korean J Anesthesiol. 2014 Oct;67(4):252-7. doi: 10.4097/kjae.2014.67.4.252. Epub 2014 Oct 27
BACKGROUND: In this prospective, randomized, double-blind, placebo-controlled trial, we tried to find out appropriate amounts of single-dose dexmedetomidine to prolong the duration of spinal anesthesia in a clinical setting. METHODS:Sixty patients who were scheduled for unilateral lower limb surgery under spinal anesthesia were randomized into three groups receiving normal saline (control group, n = 20) or 0.5 or 1.0 ug/kg dexmedetomidine (D-0.5 group, n = 20; D-1, n = 20) intravenously prior to spinal anesthesia with 12 mg of bupivacaine. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score (RSS), and side effects of dexmedetomidine were assessed. RESULTS: The two-dermatome pinprick sensory regression time (57.6 ± 23.2 vs 86.5 ± 24.3 vs 92.5 ± 30.7, P = 0.0002) and duration of the motor block (98.8 ± 34.1 vs 132.9 ± 43.4 vs 130.4 ± 50.4, P = 0.0261) were significantly increased in the D-0.5 and D-1 groups than in the control group. The RSS were significantly higher in the D-0.5 and D-1 groups than in the control group. However, there were no patients with oxygen desaturation in dexmedetomidine groups. The incidences of hypotension and bradycardia showed no differences among the three groups. CONCLUSIONS: Both 0.5 and 1.0 ug/kg of dexmedetomidine administered as isolated boluses in the absence of maintenance infusions prolonged the duration of spinal anesthesia.
KEYWORDS: Bupivacaine; Dexmedetomidine; Spinal anesthesia

Apendicectomía laparóscopica con raquia e infusión de dexmedetomidina

Laparoscopic appendectomy under spinal anesthesia with dexmedetomidine infusion.
Jun GW1, Kim MS1, Yang HJ1, Sung TY1, Park DH1, Cho CK1, Kwon HU1, Kang PS1, Moon JI2.
Korean J Anesthesiol. 2014 Oct;67(4):246-51. doi: 10.4097/kjae.2014.67.4.246. Epub 2014 Oct 27.
BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient'spain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated.RESULTS:
No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to opensurgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients.CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
KEYWORDS: Dexmedetomidine; Laparoscopic appendectomy; Spinal anesthesia

Anestesiología y Medicina del Dolor
Publicar un comentario