Dexmedetomidine as a Sole Sedative Agent versus Propofol for Sedation during Upper and Lower Gastrointestinal Endoscopies | Crimson Publishers

Dexmedetomidine as a Sole Sedative Agent versus Propofol for Sedation during Upper and Lower Gastrointestinal Endoscopies by Alaa Ali Elzohry in Developments in Anaesthetics & Pain Management

Introduction and objectives: Diagnostic and therapeutic procedures recently are done in gastroenterology setup as a part of fast-track concept. A major volume of gastrointestinal procedures are performed routinely on daycare basis under sedation as upper and lower GIT endoscopy. Many anesthetic agents used to provide sedation for these procures. Propofol, opioids, and midazolam form the backbone of the various regimes employed in the endoscopic suites all over the world. Dexmedetomidine is a pharmacologically active selective α 2-adrenergic receptor agonist. It was approved it in the intensive care unit (ICU) for sedation and analgesia for the duration of less than 24 hours. The aim of this study was to study efficacy and safety of Dexmedetomidine efficacy as sole sedating agent versus propofol for sedation during upper and lower GIT endoscopy.

Methods: This randomized controlled trial was carried out on 60 patients of either sex, aged 21-70 years of age undergoing upper and lower GIT endoscopy, with ASA I-II. Patients were randomly assigned into two groups, (30 patients in each group).

Dex group: Sedation was induced by loading dose of (dexmedetomidine 1μg/kg) followed by infusion of (dexmedetomidine 0.8μg/kg /h) Propofol group: Sedation was initially started by bolus dose of 0.5mg/kg propofol IV Then, infusion was started at the rate of 50μg /kg/min. Upper and lower GIT endoscopies were carried out in the usual standard manner for all patients, then patients were discharged to PACU after attaining an Aldrete Recovery Scale Score of 9-10 Time taken to achieve this score was recorded. The patient’s vital signs, Respiratory complications, VAS score for pain measurement, PONV, and any other adverse events were recorded.

Results: There was significant decrease in (HR and MAP) but not respiration rate (RR) and SpO2, in (Dex group) during the procedure and early post-operative (P. value 0.000**). But during the remaining of post-operative periods (HR and MAP) were comparable. VAS pain scores in both groups were decreased in comparable manner at all measured time points. But complications (atthythmia, air way obstruction, nausea, and vomiting) was significantly increased in Propofol group (P. value 0.001**). Mean time to achieve RSS 3-4 was 6 (±1.5) min in Dex group versus 9 (±1.9) min in Propofol group (P< 0.005) and to achieve an Aldrete Recovery Scale Score of 9-10 was 8 (±2.1) min in Dex group versus 6 10 (±1.6) min in Propofol group (P< 0.029).

Conclusion: In conclusion, there is evidence to support dexmedetomidine as a potential sole sedative agent in small diagnostic and therapeutic procedures like GIT endoscopies, our study support these evidences and although dexmedetomidine resulted in longer onset and recovery, more side effects but sufficient levels of sedation and analgesia are good advantages to use it as sole sedating agent.

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Emerging Role of Bedside Ocular Ultrasound in Emergency Department and Intensive Care Unit_Journal of Anesthesiology And Journal of Anesthesiology_Crimson Publishers

Emerging Role of Bedside Ocular Ultrasound in EmergencyDepartment and Intensive Care Unit by Surjya Prasad Upadhyay*, Piyush N Mallick, Waleed Elmatite, Vasu Kumar and Amit Jain 

in Developmentsin Anaesthetics & Pain Management

Ultrasonography (US) is being increasingly used outside the radiology suites into various areas like operative room (OR), intensive care (ICU) and emergency department (ED) both as diagnostic tool as well to guide interventions. The popularity and application of US for vascular catheterization, thoracic and abdominal assessment in ED and ICU has increased dramatically over the last decade. The orbital US is one the simple, quick and potential imaging tool to assess not only ocular pathology, but also act as window for intracranial pathology which provide bedside, real time information. Ultrasound has become integral part of ED and ICU and can be applied as bed side point of care in variety of traumatic or non-traumatic ocular condition. This review provides updated information on the emerging application of orbital US in ED and ICU for various ocular and intracranial pathology.  

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Multi-Modal Neuro-Monitoring and Anesthesia during Neurosurgery in a Child with Wolf-Parkinson-White Syndrome: A Case Report - Crimson Publishers

Multi-Modal Neuro-Monitoring and Anesthesia duringNeurosurgery in a Child with Wolf-Parkinson-White Syndrome: A Case Report by Bassel Zebian, Pedro Coelho, Merate-Kristos Place, Ali Ansaripour, Ayala Shirazi, Alison Goodwin and Chulananda Goonasekera* in Developments in Anaesthetics & Pain Management

Wolff Parkinson White (WPW) syndrome associates with life-threatening tachy-arrhythmias. We report anesthetic management of a child with WPW syndrome requiring neurosurgery to resect 3 tumourdeposits (in cerebral hemisphere, cerebellum and spinal cord) under the guidance of intra- operative neuro-physiological monitoring (IONM). Our purpose of this case report is to elucidate the anesthetic limitations in facilitating multiple modes of neuro-monitoring whilst minimizing the risk of triggering an arrhythmia in a child with WPW syndrome. We conclude that multiple modes of IONM is safely possible with a tailor made, proportionately adjusted, inhalational and intravenous general anesthetic with particular attention to the cumulative doses of intravenous agents used

http://crimsonpublishers.com/dapm/fulltext/DAPM.000504.php

Developments in Anaesthetics & Pain Management (DAPM)

Developments in Anaesthetics and Pain Management (DAPM) journal is an open access, peer-reviewed, online journal to improve the care giving to patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research content on all aspects of general and regional anaesthesia. The research articles can include topics like cardiovascular anesthesia, thoracic anesthesia, trauma- transfusion and it’s ethics, clinical and experimental research of anesthetic mechanisms, administration and efficacy, technology, monitoring and associated economic issues, intensive care and pain therapy,critical care, perioperative care, pain management and even research on equipment. DAPM publishes various papers in all branches of Anaesthetics and Pain Management like research papers, review papers, mini reviews, case reports short communication and opinions in all the concerned areas.
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