ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.
ObjectiveTo systematically review the efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery. MethodsThe PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on dexmedetomidine for controlled hypotension in orthognathic surgery from inception to May, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 RCTs involving 371 patients were included. The results of meta-analysis showed that the operation time of dexmedetomidine group was not significantly different from that of hypotensive drug group, but was shorter than that of saline group (MD=?23.20, 95%CI ?44.05 to ?2.35, P=0.03). There were no statistically significant differences in the mean arterial pressure and the intraoperative blood loss between dexmedetomidine group and the control group. Compared with those in the control group, the heart rate (MD=?18.78, 95%CI ?30.80 to ?6.77, P=0.002) and the incidence of postoperative adverse events (OR=0.25, 95%CI 0.08 to 0.76, P=0.01) in dexmedetomidine group were less than those in the control group significantly. ConclusionCurrent evidence shows that dexmedetomidine can be used effectively for controlled hypotension in orthognathic surgery. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
ObjectiveTo investigate the effect of dexmedetomidine on systemic vascular resistance in patients undergoing cardiopulmonary bypass.
MethodsThirty-one patients undergoing cardiac surgery with cardiopulmonary bypass from January to April, 2012 were randomized into experimental group (n=16) and control group (n=15). The flow rate was kept at 2.4 L/(min·m2) and moderate hypothermia was maintained. Equivalent dexmedetomidine and 0.9% sodium chloride solution were pumped for the experimental group and control group, respectively. The mean artery pressure (MAP), systemic vascular resistance (SVR), Cortisol, epinephrine and norepinephrine were determined before (T0) and at 10 and 20 minutes (T1,T2) after dexmedetomidine administration.
ResultsCompared with T0, there were significant decreases in MAP and SVR at T1 and T2 (P<0.05). MAP and SVR were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05); cortisol, epinephrine and norepinephrine were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05).
ConclusionDexmedetomidine reduces SVR and causes decrease in MAP. It can effectively inhibit the stress reaction in patients undergoing cardiopulmonary bypass.
ObjectiveTo observe the effects and security of dexmedetomidine in combined spinal epidural anesthesia (CSEA) for laparoscopic total extraperitoneal hernia repair (TEP).
MethodsFrom January 2010 to January 2013, we selected 90 patients who were going to receive TEP surgery as our study subjects. The patients were divided into three groups:M1, M2 and M3 with 30 patients in each. The patients had left lateral position, and anesthesia was done between 3-4 lumbar epidural line. Injection of 0.5% bupivacaine 2 mL was carried out, and epidural catheter was 3-5 cm. Anesthesia plane was adjusted from the chest 4 or 6 vertebra to the sacral vertebra. The three groups of patients were treated with micro pump using dexmedetomidine given at a pre-charge of 0.5 μg/kg, and then group M1 was maintained by 0.3 μg/(kg·h), M2 by 0.5 μg/(kg·h), and M3 by 0.7 μg/(kg·h). The changes of mean arterial pressure (MAP), heart rate, respiration and pulse oximetry (SpO2) were observed at each time point, and bispectral index (BIS) monitor and Ramsay sedation score test were also conducted.
ResultsThe changes of MAP, heart rate and respiration in group M1 were not obvious; the Ramsay score for group M1 was 2 to 3, and BIS value after pre-charge was 65-84. For group M2, MAP, heart rate and respiration had a slight decline; Ramsay score was 3-5 points, and BIS value was 60-79. In group M3, patients had a milder decline in their MAP and respiration; the heart rate declined obviously after receiving dexmedetomidine and one patient with severe decline of the heart rate alleviated after active treatment; Ramsay score was 5 to 6 points, and BIS value was between 55 and 75. There was little change in SpO2 in all the three groups, and the difference was not statistically significant (P>0.05).
ConclusionContinuous injection of dexmedetomidine at 0.3-0.5 μg/(kg·h) in CSEA is an alternative way for anesthesia, which can effectively promote sedation and reduce pain and discomfort.
ObjectiveTo investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. MethodsClinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. ResultsA total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ2=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.
Objective
To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures.
Methods
A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected.
Results
There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05).
Conclusion
For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
ObjectiveTo systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries.
MethodsWe searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.
ResultsA total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01).
ConclusionCurrent evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
Objective
To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit (ICU).
Methods
From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group (group D) and midazolam group (group M). Adverse events such as cardiovascular events during sedation were observed.
Results
There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate <50 beats per minute in group D (4.86%) was less than that in group M (6.29%), but there was no statistical difference ( P=0.681). Group D had lower blood pressure (40.28% vs. 72.73%), tachycardia (18.75% vs. 41.96%), arrhythmia (16.67% vs. 34.97%) and 28- day mortality (22.22% vs. 42.66%) than those in group M (P<0.01). No cardiac arrest, sinus arrest, hypertension, hyperglycemia, or hypoglycemia were found in the two groups.
Conclusion
The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.
ObjectiveTo evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension.
MethodsA total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D1), moderate-dose dexmedetomidine hydrochloride injection group (group D2), and high-dose dexmedetomidine hydrochloride injection group (group D3). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T1), immediately after administration (T2), extubation after administration (T3), one minute after extubation (T4), and 5 minutes after extubation (T5). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected.
ResultsCompared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1 (P<0.05), while the correspondent difference was not statistically significant in group D2 and D3 (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1 (P>0.05). However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1 (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3.
ConclusionIntravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
