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sábado, 28 de mayo de 2016

Dexmedetomidina en UCI / Dexmedetomidine in ICU

Abril 6, 2016. No. 2288

Efecto de dosis diferentes de dexmedetomidina sobre la frecuencia cardiaca y presión arterial en pacientes de UCI

Effects of different doses of dexmedetomidine on heart rate and blood pressure in intensive care unit patients.

Zhang X, Wang R, Lu J, Jin W, Qian Y, Huang P, Tian R, Li Y.

Exp Ther Med. 2016 Jan;11(1):360-366. Epub 2015 Nov 17.

Abstract

The aim of the present study was to observe and compare the sedative effect of different doses of DEX on heart rate (HR) and blood pressure (BP) in critically ill patients admitted to intensive care units (ICUs). The study included patients that were retained in ICUs and required sedation between January and March 2014. Patients were excluded if they had a BP of >200 mmHg, a HR of <60 bpm or were in a state of shock. The included patients were randomized into three groups: Group A, 1.0 µg/kg/10 min DEX; group B, 0.5 µg/kg/10 min DEX; and group C, 0.4 µg/kg/h DEX. After receiving these initial designated doses of DEX via an intravenous (IV) infusion pump for 10 min, the patients were maintained continuously at an identical dose of 0.4 µg/kg/h DEX. Ramsay score, HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), breathing rate (BR) and peripheral capillary oxygen saturation (SpO2) were recorded prior to the IV pump infusion and at 2, 4, 6, 8, 10, 60, 120, 180 and 240 min following infusion. Patients in groups A and B achieved sedation more rapidly compared with those in group C (P<0.05). HR decreased more significantly at 8 and 60 min after the initial IV pump infusion with DEX in groups A and B compared with group C (P<0.05). SBP decreased significantly at 10 min after IV pump infusion in group A compared with groups B and C (P<0.05). No significant difference existed in the SBP reduction trend between the three groups during the maintenance period. Therefore, the routine dose of DEX (0.4 µg/kg/h) provides an ideal sedative effect in ICU patients. The recommended loading dose for a more rapid sedation is 0.5 µg/kg/h. High loading doses of DEX via IV pump infusion should be avoided in elderly individuals, patients with acute exacerbation of chronic obstructive pulmonary disease and anemic patients, in whom combination medication, such as midazolam or propofol, may be considered when necessary.

KEYWORDS: bradycardia; dexmedetomidine; intensive care; sedation

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Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Propofol-dexmedetomidina

Abril 7, 2016. No. 2289

Comparación de propofol-hidromorfona y propofol-dexmedetomidina en pacientes intubados después de cirugía plástica maxilofacial

Comparison of propofol-hydromorphone and propofol-dexmedetomidine in patients with intubation after maxillofacial plastic surgery.

Peng W, Zhang T, Wang Y.

Ther Clin Risk Manag. 2016 Mar 8;12:373-7. doi: 10.2147/TCRM.S99262. eCollection 2016.

Abstract

OBJECTIVE: To compare the sedation and analgesic effects between propofol-hydromorphone and propofol-dexmedetomidine in patients with postoperative intubation after maxillofacial plastic surgery. METHODS: Forty-two patients undertaking maxillofacial plastic surgery with intubation were randomly assigned into propofol plus hydromorphone (P-H) group or propofol plus dexmedetomidine (P-D) group, receiving intravenous infusion of P-H or P-D, respectively. Cerebral state index, Ramsay sedation score, arterial blood gas analysis, and physiology indices were recorded before admission (T0), 30 minutes (T1), 1 hour (T2), 2 hours (T3), 6 hours (T4), and 12 hours after admission (T5) to intensive care unit, and 10 minutes after extubation (T6). Blood interleukin-6 was measured with enzyme-linked immunosorbent assay. RESULTS: There was no significant difference in arterial blood gas analysis, oxygen saturation, mean arterial pressure, and respiratory rate between two groups at all time-points (P>0.05). The changes of heart rate (at T4, T5, and T6), cerebral state index (T1, T2, T3, T4, and T5), and Ramsay score (at T3) in P-H group were significantly different from that in P-D group (P<0.05). The plasma interleukin-6 at T4 in P-H group was significantly lower than that in P-D group (P<0.05). CONCLUSION: The P-H approach takes advantages over P-D approach in relieving the pain and discomfort, reducing the overstimulation of sympathetic nerve and the stress level, and enhancing the tolerance of postoperative intubation after maxillofacial plastic surgery.

KEYWORDS: dexmedetomidine; hydromorphone; intubation; maxillofacial plastic surgery; propofol

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Los pacientes varones requieren mayor concentración óptima en el sitio de efecto del propofol durante la inserción i-gel

Male patients require higher optimal effect-site concentrations of propofol during i-gel insertion withdexmedetomidine 0.5 μg/kg.

Choi JJ, Kim JY, Lee D, Chang YJ, Cho NR, Kwak HJ.

BMC Anesthesiol. 2016 Mar 22;16(1):20. doi: 10.1186/s12871-016-0186-1.

Abstract

BACKGROUND: The pharmacokinetics and pharmacodynamics of an anesthetic drug may be influenced by gender. The purpose of this study was to compare effect-site half maximal effective concentrations (EC50) of propofol in male and female patients during i-gel insertion withdexmedetomidine 0.5 μg/kg without muscle relaxants.

CONCLUSIONS: During i-gel insertion with dexmedetomidine 0.5 μg/kg without muscle relaxant, male patients had higher effect-site EC50 forpropofol using Schnider's model. Based on the results of this study, patient gender should be considered when determining the optimal dose of propofol during supraglottic airway insertion.

KEYWORDS: Dexmedetomidine; I-gel; Propofol

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