lunes, 25 de mayo de 2015

Dexmedetomidina para intubación despierto/Awake intubation and dexmedetomidine

Comparación entre dexmedetomidina y fentanilo sobre las condiciones durante fibrobroncoscopía con paciente despierto
Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study.
Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A.
J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):212-6. doi: 10.4103/0970-9185.155151.
BACKGROUND AND AIMS: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI.MATERIAL AND METHODS: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups. RESULTS: Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B. CONCLUSION: Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI.
KEYWORDS: Awake intubation; dexmedetomidine hydrochloride; fentanyl citrate

Comparison entre remifentanil y dexmedetomidina para sedación durante intubación fibroptica con paciente despierto
Comparison between remifentanil and dexmedetomidine for sedation during modified awake fiberoptic intubation.
Liu HH, Zhou T, Wei JQ, Ma WH.
Exp Ther Med. 2015 Apr;9(4):1259-1264. Epub 2015 Feb 13.Abstract
Cricothyroid membrane injections and the application of a coarse fiberoptic bronchoscope (FOB) below the vocal cords for topical anesthesia have a number of limitations for certain patients. Thus, the aim of the present observational study was to assess the effect of a novel modified topical anesthesia method using the effective sedation drugs, remifentanil (Rem) or dexmedetomidine (Dex), during awake fiberoptic orotracheal intubation(AFOI). In total, 90 adult patients, who had been classified as American Society of Anesthesiologists I-II, were included in the study. The patients had anticipated difficult airways and were to undergo orotracheal intubation for elective surgery. The patients were enrolled in the double-blinded randomized pilot study and received Rem or Dex for sedation during the modified AFOI procedure. The two groups received 2% lidocaine for topical anesthesia via an epidural catheter, which was threaded through the suction channel of the FOB. The main clinical outcomes were evaluated by graded scores representing the conditions for intubation and post-intubation. Additional parameters analyzed included airway obstruction, hemodynamic changes, time required for intubation, amnesia level and subjective satisfaction. All 90 patients were successfully intubated using the modified AFOI technique. The comfort scores and airway events during intubation did not significantly differ between the two groups. However, the Rem group experienced less coughing, and less time was required for tracheal intubation when compared with the Dex group. No statistically significant differences were observed in the changes to the mean arterial pressure and heart rate at any time point between the two groups. Therefore, the current study demonstrated that the modified AFOI method is feasible and effective for difficult airway management, and that Dex and Rem exhibit similar efficacy as adjuvant therapies.
KEYWORDS: awake fiberoptic intubation; dexmedetomidine; local anesthesia; remifentanil

Dexmedetomidina para intubación despierta y anestesia general sin 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.
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 surgicaltreatment 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
Anestesia y Medicina del Dolor
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