Nurse-led dexmedetomidine sedation for magnetic resonance imaging in children: a 6-year quality improvement project

We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.     

Dexmedetomidine protects rats from postoperative cognitive dysfunction via regulating the GABABR‐mediated cAMP‐PKA‐CREB signaling pathway

This work attempts to discuss whether dexmedetomidine (Dex) can protect rats from postoperative cognitive dysfunction (POCD) through regulating the γ‐aminobutyric acid‐_B receptor (GABA_BR)‐mediated cyclic adenosine monophosphate (cAMP) – protein kinase A (PKA) – cAMP‐response element binding (cAMP‐PKA‐CREB) signaling pathway. Sprague‐Dawley rats were divided into a non‐surgical group (Control), a surgical group (Model), a surgical group treated with Dex (Model + Dex), a surgical group treated with GABA_BR antagonist (Model + CGP 35348) and a surgical group treated with Dex and GABA_BR agonist (Model + Dex + Baclofen). Cognitive and memory functions were evaluated by Y‐maze test and open‐field test. The neuronal morphology of the hippocampus was observed by hematoxylin and eosin staining and neuronal apoptosis was by terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick‐end labeling method. Inflammatory factors and cAMP levels were detected by enzyme‐linked immunosorbent assay while expressions of GABA_BR and PKA‐CREB pathway‐related molecules by Western blot. Compared with control rats, the model rats exhibited reduced alternation rates with a prolonged time spent in the central zone; meanwhile, levels of tumor necrosis factor‐α and interleukin‐1β and the apoptotic index, as well as GABA_BR1 and GABA_BR2 expressions were increased in the model rats, but the cAMP‐PKA‐CREB pathway was inhibited (all P < 0.05). When treated with either Dex or CGP 35348, the surgical rats displayed an opposite tendency concerning the above factors as compared to the model rats (all P < 0.05). Furthermore, Baclofen, the agonist of GABA_BR, could reverse the protective effect of Dex against POCD in rats. Dex protects rats from POCD possibly via suppressing GABA_BR to up‐regulate the cAMP‐PKA‐CREB signaling pathway, thereby alleviating the hippocampal inflammation caused by surgical trauma.     

基于VAS评价右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床效果

目的:研究右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床应用效果。方法:将2015年7月至2018年7月在本院行宫颈癌根治术的86例患者随机分为对照组和观察组各43例。对照组术后镇痛采用舒芬太尼和格拉司琼，观察组术后镇痛加用右美托咪定。采用视觉模拟评分法（VAS）评价患者术后1 h、6 h、12 h、24 h、48 h疼痛情况，采用Ramesay评分法评价患者不同时间点镇静状况，记录并比较两组患者不同时间点收缩压、舒张压、心率及呼吸频率变化，比较两组患者不良反应发生情况。结果:观察组患者术后6 h、12 h、24 h、48 h VAS评分均明显低于对照组（P＜0.05），Ramesay评分均明显高于对照组（P＜0.05）；观察组和对照组患者术后不同时间点呼吸频率比较，差异无统计学意义，但术后6 h、12 h、24 h观察组患者收缩压、心率均明显低于对照组（P＜0.05），术后1 h、6 h观察组患者舒张压明显低于对照组（P＜0.05）；观察组患者恶心呕吐、高血压发生率较对照组明显减低。结论:右美托咪定用于宫颈癌根治术后镇痛，可以提高镇痛镇静效果，稳定患者血流动力学，有助于术后快速康复。     

预注右旋美托咪啶用于喉显微手术麻醉的研究

目的研究分析预注右旋美托咪啶用于喉显微手术麻醉中的临床效果。方法选取2017年12月—2018年12月本院收治的80例行喉显微手术治疗的患者为观察对象,并将其随机分为普通组与观察组,每组各40例,普通组中患者行常规诱导麻醉,观察组中患者行预注右旋美托咪啶诱导麻醉,比较两组麻醉应用效果。结果在T1、T4、T5时段,观察组患者HR、MAP水平均低于普通组,其血流动力学稳定,且不良反应发生率相比普通组降低,两组间比较差异有统计学意义(P<0.05)。结论对行喉显微手术患者在应用预注右旋美托咪啶麻醉,能改善患者血流动力学指标水平,减少患者不良反应。     

Dexmedetomidine in the prevention of postoperative delirium in elderly patients following non-cardiac surgery: A systematic review and meta-analysis

The efficacy of dexmedetomidine in the prevention of postoperative delirium (POD) remains ambiguous, however, it has been used to reduce the incidence of delirium in elderly patients. Here, we conducted a meta-analysis study for assessing the effects of dexmedetomidine on POD among elderly patients following non-cardiac surgery. A systematic literature search was performed against the PubMed, EMBASE, Cochrane Library, and Web of Science databases, and all relevant literature published till November 30, 2019, were considered. Our analysis included 16 randomised controlled trials conducted with 4534 patients for exploring the effects of dexmedetomidine on POD in elderly patients following non-cardiac surgery. It was observed that the overall incidence of POD was significantly lower in the dexmedetomidine group than in the control group (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.43–0.61, P < .01). Similar results were obtained from subgroup analysis upon comparison of the placebo (RR 0.52, 95% CI 0.41–0.66, P < .01, moderate quality of evidence), propofol-treated (RR 0.55, 95% CI 0.38–0.78, P < .01, low quality of evidence), and midazolam-treated (RR 0.38, 95% CI 0.20–0.71, P < .01, low quality of evidence) groups. Trial sequential analysis revealed that the cumulative z-value superseded the monitoring boundary and reached the required information size. However, patients who received dexmedetomidine had a higher incidence of bradycardia and hypotension. In conclusion, the meta-analysis revealed that dexmedetomidine appears to decrease the risk of POD in elderly patients following non-cardiac surgery. However, as some of the studies were heterogeneous and of low quality, high-quality trials are necessary for drawing more definitive conclusions.     

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

Background: The primary management of alcohol withdrawal involves the administration of a γ-aminobutyric acid agonist, such as benzodiazepines, for management of symptoms and to prevent further progression to seizure or delirium tremens. Despite escalating doses of benzodiazepines, published literature indicates that some patient’s alcohol withdrawal syndrome symptoms do not respond, and that the use of adjunctive agents may be beneficial in these patients. Dexmedetomidine, an α₂-agonist, serves as a potential adjunctive agent through management of associated autonomic symptoms. Understanding of recent literature evaluating its use is necessary for appropriate selection. Objective: To review available literature supporting the use of adjunctive dexmedetomidine for management of severe alcohol withdrawal syndrome. Methods: A total of 13 published articles evaluating the efficacy and safety of dexmedetomidine as an adjunctive agent for the treatment of alcohol withdrawal in adult patients were identified from a MEDLINE search using the key words alcohol withdrawal, delirium tremens and dexmedetomidine. Results: Evaluation of the literature indicates that dexmedetomidine is associated with a decrease in short-term benzodiazepine requirements after initiation, and improvement in hemodynamic parameters in relation to the adrenergic drive present in alcohol withdrawal. Conclusion: The use of dexmedetomidine in the management of severe alcohol withdrawal should be considered as an adjunctive agent. Dexmedetomidine appears to be well tolerated, with an expected decrease in blood pressure and heart rate. Seizures have occurred in patients with alcohol withdrawal despite the use of dexmedetomidine, with and without benzodiazepines, due to lack of γ-aminobutyric acid agonist administration.     

颅内动脉瘤介入患者术中及苏醒期血流动力学变化趋势及临床药物干预效果

目的 探讨颅内动脉瘤介入患者术中及苏醒期血流动力学变化趋势及临床药物干预效果。方法 选取该院颅内动脉瘤介入手术患者86例（2017年11月—2019年6月），随机数字表法分为研究组（n=43）与对照组（n=43）。对照组采取瑞芬太尼+七氟醚，研究组在对照组基础上加用右美托咪定。统计两组围术期[麻醉诱导前（T0）、气管插管后（T1）、麻醉后15 min （T2）、术毕（T3）]血流动力学指水平、脑氧代谢情况、拔管、睁眼及恢复自主呼吸用时、不良反应。结果 （1）血流动力学：①不同时间点的HR、MAP、SBP、SPO₂有差别（P<0.05），②组间HR、MAP、SBP、SPO₂有差别（P<0.05），③研究组与对照组的HR、MAP、SBP、SPO₂变化趋势有差别（P<0.05）；（2）脑氧代谢：①不同时间点的CERO₂、Da-jvO₂有差别（P<0.05），②组间CERO₂、Da-jvO₂有差别（P<0.05），③研究组与对照组的CERO₂、Da-jvO₂变化趋势有差别（P<0.05）；（3）拔管、睁眼及恢复自主呼吸用时：研究组拔管时间短于对照组（P<0.05），睁眼时间、恢复自主呼吸时间与对照组比较，差异无统计学意义（P>0.05）；（4）不良反应：研究组不良反应发生率（13.95%）低于对照组（32.56%）（P<0.05）。结论 颅内动脉瘤介入手术患者术中及苏醒期血流动力学异常波动，通过右美托咪定复合七氟醚可抑制其波动程度，并能改善脑氧代谢状态，缩短术后拔管时间，且不良反应发生率较低，此方法安全可靠。