Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery

BACKGROUND: In endoscopic sinus surgery, visualization of the surgical field is a major concern, as surgical bleeding is the cause of many complications. The purpose of this study was to compare the effects of dexmedetomidine and remifentanil on the visualization of the surgical field in endoscopic sinus surgery. METHODS: Forty-three patients were prospectively enrolled and randomly allocated to the dexmedetomidine or remifentanil group and general anesthesia was induced and maintained using a propofol target-controlled infusion. In the dexmedetomidine group, dexmedetomidine was loaded for 5 min and a continuous infusion was administered. In the remifentanil group, a remifentanil target-controlled infusion was used. After completion of the operation, the satisfaction with the visualization of the surgical field was assessed on a numeric rating scale, from 0 (= worst) to 10 (= best). The mean blood pressure, heart rate, recovery profiles, and postoperative pain score were recorded. RESULTS: Satisfaction score for visualization by numeric rating scale was not significantly different between the two groups (P = 0.95). There were no differences in the mean blood pressure and heart rate. The extubation time was significantly shorter in the dexmedetomidine group (8.4 ± 1.8 min) than in the remifentanil group (11.9 ± 5.4 min) (P = 0.04). Except for the extubation time, the recovery profiles of the two groups were comparable. CONCLUSIONS: Continuous infusions of dexmedetomidine provide a similar visualization of the surgical field and hemodynamic stability as remifentanil target-controlled infusions in patients undergoing endoscopic sinus surgery.ope

Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery.

BACKGROUND: Opioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery. METHODS: One hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery. RESULTS: The number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance. CONCLUSIONS: Combination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.ope

유양돌기 후방 개두술로 미세혈관감압술을 시행받은 환자에서 Ramosetron과 Ondansetron의 항구토 효과에 대한 비교

Dept. of Medicine/석사Background: Microvascular decompression (MVD) with retromastoid craniotomy (RMC) has an especially high risk of postoperative nausea and vomiting (PONV). In this study, we compared the efficacy of ramosetron and ondansetron on PONV in patients undergoing RMC.Methods: Using a balanced anesthesia with sevoflurane in air and remifentanil infusion, ondansetron 8 mg (group O, n = 31) or ramosetron 0.3 mg (group R, n = 31) was administered at the dural closure. The frequency and severity of PONV and required rescue medications and frequency of side effects were measured at post anesthetic care unit (PACU), 6, 24 and 48 hours postoperatively. Independent t-tests and Chi-square test or Fisher’s exact test were used for statistical analyses. Binary logistic regression was used to calculate OR (95% CI). For multiple comparisons, Bonferroni correction was used.Results: There were no differences in demographic data between groups except a slightly longer anesthetic duration of group R (p = 0.01). The overall postoperative 48 hour incidence of nausea and vomiting was 90.3% and 61.3% (group O) and 87.1% and 54.8% (group R), respectively. There were no statistical differences of any measured variables between groups at measured intervals, but patients of group R were in trends of less severe degree of nausea (OR = 0.30; 95% CI, 0.10-0.85; adjusted p = 0.08) and lower incidence of dizziness (OR = 0.34; 95% CI, 0.12-0.96; adjusted p = 0.16) between 6 and 24 hours.Conclusions: The antiemetic efficacy of ramosetron alone was not satisfactory and superior to that of ondansetron in patients undergoing MVD with RMC for at least 48 hours after surgery.ope

Claude Debussy의 「Douze etudes」에 대한 연구

학위논문(석사)--서울대학교 대학원 :음악과 피아노전공,1996.Maste

Haemodynamic changes and incisional bleeding after scalp infiltration of dexmedetomidine with lidocaine in neurosurgical patients

BACKGROUND: The purpose of this randomised controlled study is to compare the haemodynamic changes and the degree of incisional bleeding after scalp infiltration of lidocaine and dexmedetomidine versus lidocaine and epinephrine for patients with hemi-facial spasm undergoing microvascular decompression. METHODS: Fifty-two patients were injected with 5 mL of 1% lidocaine with either dexmedetomidine (2 μg/mL) or epinephrine (1:100,000 dilution) to reduce scalp bleeding. Mean blood pressure and heart rate were recorded every minute for 15 minutes after scalp infiltration. The primary outcome was the incidence of predefined hypotension, which was treated with administration of 4 mg ephedrine as often as needed. The number of administrations and total amount of ephedrine administered were also recorded as a measure of the severity of hypotension. The neurosurgeon scored incisional bleeding by numeric rating scale from 0 (worst) to 10 (best). RESULTS: The incidence of hypotension (68% vs. 34.8%, P = 0.02) and the frequency (P = 0.02) and total dose (P = 0.03) of ephedrine administered were lower in the dexmedetomidine group than in the epinephrine group. In addition, there was no difference in mean blood pressure between the two groups but heart rates were lower in the dexmedetomidine group (P = 0.01). Incisional site bleeding was better with epinephrine (median [interquartile range] of the numeric rating Score: 6 [4] in the dexmedetomidine group and 8 [2] in the epinephrine group; P < 0.001). CONCLUSION: The dexmedetomidine-lidocaine combination may be recommended as a substitute for epinephrine-lidocaine for scalp infiltration in neurosurgical patients, especially neurologically compromised patients.restrictio