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Laparoscopic appendectomy under spinal anesthesia with dexmedetomidine infusion.

Jun GW, Kim MS, Yang HJ, Sung TY, Park DH, Cho CK, Kwon HU, Kang PS, Moon JI - Korean J Anesthesiol (2014)

Bottom Line: Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine.Bradycardia occurred in seven (26.9%) patients.Spinal anesthesia with dexmedetomidine infusion may be feasible for LA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Background: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion.

Methods: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated.

Results: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients.

Conclusions: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.

No MeSH data available.


Related in: MedlinePlus

Changes in bispectral index (BIS) after intravenous infusion of dexmedetomidine. BIS values decreased significantly compared to baseline beginning 10 min after infusion of dexmedetomidine. Data are means ± standard deviations. *P < 0.05 compared to baseline.
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Figure 1: Changes in bispectral index (BIS) after intravenous infusion of dexmedetomidine. BIS values decreased significantly compared to baseline beginning 10 min after infusion of dexmedetomidine. Data are means ± standard deviations. *P < 0.05 compared to baseline.

Mentions: Adverse effects observed during surgery are shown in Table 2. Seventeen patients received intravenous fentanyl or ketamine injections; seven patients required both. Twelve patients required an intravenous fentanyl injection for management of referred shoulder pain or abdominal discomfort. The average fentanyl requirement in all patients was 35 µg (range, 0-150 µg), and the median fentanyl requirement in patients who were given fentanyl was 50 µg (interquartile range [IQR], 50-90 µg). Twelve patients received ketamine injections; seven patients were coadministered fentanyl to manage pain or discomfort; five (19.2%) had no pain or discomfort, but they were injected with ketamine following a decision by the attending anesthesiologist because they showed a BIS > 85 despite a 20 min dexmedetomidine infusion. The average ketamine requirement in all patients was 24.8 mg (range, 0.0-110.0 mg), and the median ketamine requirement in patients who were given ketamine was 50 mg (IQR, 32.5-67.5 mg). None of the patients reported hallucinations. The changes in the BIS over time are shown in Fig. 1. The BIS significantly decreased from 10 min after initiation of the loading dose for dexmedetomidine infusion compared with baseline (P < 0.05). The changes in the BIS over time showed statistical significance (P < 0.001).


Laparoscopic appendectomy under spinal anesthesia with dexmedetomidine infusion.

Jun GW, Kim MS, Yang HJ, Sung TY, Park DH, Cho CK, Kwon HU, Kang PS, Moon JI - Korean J Anesthesiol (2014)

Changes in bispectral index (BIS) after intravenous infusion of dexmedetomidine. BIS values decreased significantly compared to baseline beginning 10 min after infusion of dexmedetomidine. Data are means ± standard deviations. *P < 0.05 compared to baseline.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216786&req=5

Figure 1: Changes in bispectral index (BIS) after intravenous infusion of dexmedetomidine. BIS values decreased significantly compared to baseline beginning 10 min after infusion of dexmedetomidine. Data are means ± standard deviations. *P < 0.05 compared to baseline.
Mentions: Adverse effects observed during surgery are shown in Table 2. Seventeen patients received intravenous fentanyl or ketamine injections; seven patients required both. Twelve patients required an intravenous fentanyl injection for management of referred shoulder pain or abdominal discomfort. The average fentanyl requirement in all patients was 35 µg (range, 0-150 µg), and the median fentanyl requirement in patients who were given fentanyl was 50 µg (interquartile range [IQR], 50-90 µg). Twelve patients received ketamine injections; seven patients were coadministered fentanyl to manage pain or discomfort; five (19.2%) had no pain or discomfort, but they were injected with ketamine following a decision by the attending anesthesiologist because they showed a BIS > 85 despite a 20 min dexmedetomidine infusion. The average ketamine requirement in all patients was 24.8 mg (range, 0.0-110.0 mg), and the median ketamine requirement in patients who were given ketamine was 50 mg (IQR, 32.5-67.5 mg). None of the patients reported hallucinations. The changes in the BIS over time are shown in Fig. 1. The BIS significantly decreased from 10 min after initiation of the loading dose for dexmedetomidine infusion compared with baseline (P < 0.05). The changes in the BIS over time showed statistical significance (P < 0.001).

Bottom Line: Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine.Bradycardia occurred in seven (26.9%) patients.Spinal anesthesia with dexmedetomidine infusion may be feasible for LA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Background: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion.

Methods: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated.

Results: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients.

Conclusions: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.

No MeSH data available.


Related in: MedlinePlus