Online ISSN: 2515-8260

Keywords : Dexmedetomidine


A Comparative Study of Intrathecal Dexmedetomidine with Buprenorphine as Adjuvant to Bupivacaine in Spinal Anaesthesia

Boini Chiranjeevi, Sarpatwar Sailesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4738-4748

Background:Aim: To evaluate and compare the following factors in two groups –
intrathecal dexmedetomidine and intrathecal buprenorphine as an adjuvant to 0.5%
hyperbaric bupivacaine for lower abdominal surgeries and lower limb surgeries.
Materials and Methods: A clinical study was undertaken to compare the effects of
intrathecal Buprenorphine and dexmedetomidine as additives to 0.5 % hyperbaric
bupivacaine for spinal anaesthesia. This prospective, randomized, Double blind study
was conducted on 60 adult patients of ASA physical status 1 and 2 in the age group of
18 to 60 years, posted for elective lower abdominal surgeries at Osmania Medical
college Hospital, Hyderabad from the period 2017 – 2020. Patients were randomly
allocated into two groups namely, Group BB and Group BD of 30 each. Patients in
Group BB received 60mcg of Buprenorphine with 0.5% bupivacaine 15mg
intrathecally. Patients in Group BD received 5mcg of Dexmedetomidine with 0.5%
bupivacaine 15mg intrathecally. After connecting monitors, the required preloading
done to all patients. Subarachnoid block was carried out under aseptic precautions.
Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation were
recorded at 0, 2, 5 minutes and thereafter every 10 minutes up to 90 minutes
intraoperatively.
Results: The following parameters were observed - onset and duration of sensory block
and motor block, time for sensory regression to S1, degree of sedation, hemodynamic
stability and any side effects associated with these drugs. Collected data were analysed
using appropriate statistics. Demographic datas were not statistically significant. The
onsets of sensory and motor blockades were not statistically significant. The duration of
sensory blockade was prolonged in dexmedetomidine group (51%) compared to
buprenorphine group. The Motor blockade, sensory regression to S1 were also got
prolonged in Dexmedetomidine group Hemodynamic parameters were comparable
between the groups. In our study The onsets of sensory and motor blockades were not
statistically significance between the groups. The duration of both sensory and motor
blockades were prolonged in dexmedetomidine group compared to buprenorphine
group with the best statistical significance. Both groups had stable and comparable
hemo dynamics during the study. Compared to buprenorphine, intrathecal
administration of dexmedetomidine as additive to hyperbaric bupivacaine was
associated with fewer side effects.
Conclusion: Our study concludes that dexmedetomidine as an adjuvant to intrathecal
bupivacaine prolongs both sensory and motor block duration with fewer side effects
compared to buprenophine.

Dexmedetomidine in prevention of myoclonus: Side effects and haemodynamic study

Dr. Mohamed Faizuddin, Dr. Lokesh SB, Dr. Geetha M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 535-543

Dexmedetomidine the S-enantiomer of medetomidine a highly sedative and potent α2-
adrenergic agonists has a potentially useful role as a sedative agent. In healthy volunteers
dexmedetomidine increases sedation, analgesia and amnesia and decreases heart rate, cardiac
output and circulating catecholamine in a dose dependent fashion. Anaesthesia workstation
was checked. Appropriate size endotracheal tubes, working laryngoscope with medium and
large sized blades, stylet and working suction apparatus were kept ready before the induction
of general anaesthesia. Emergency drug tray consisting of atropine, adrenaline and
mephentermine were also kept ready for any eventuality. Post extubation Ramsay sedation
score was significantly higher in group D compared to group S at 30th, 60th and 90th minute
with p value = 0.001, 0.001 and 0.051 respectively. However no patients in group D required
intervention for sedation and were easily arousable. There was no statistically significance
between the groups immediately after extubation and at 120th minute postoperatively. 3
patients in group D (8.57%) and 3 patients in group S (8.57%) had vomiting immediately
following extubation which was statistically not significant (p = 0.721). 1 patients in group D
(2.86%) and 2 patients in group S (5.71%) had vomiting after 30 minutes of extubation which
was statistically not significant (p = 0.555).

Intranasal midazolam and dexmedetomidine as premedication on haemodynamic stability: A comparative study

Dr. Shilpa Agarwal, Dr. Neeti Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 160-166

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

A Randomized Controlled trial to compare Nitroglycerine with Dexmedetomidine for Controlled Hypotension during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma

Dr. Pacharla Indira,N.Anupama Priyadarshini,Dr.W.R.Pathanjali Rao, Dr.Seema,Dr. Rajola Raghu .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5340-5348

Background:Juvenile nasopharyngeal angiofibroma(JNA) is a locally invasive benign vascular tumor. Controlled hypotension is used to facilitate endoscopic resection to reduce the blood loss and stabilize the hemodynamics. Various agents are tried till now to achieve the goal.
Objective: To compare the effectiveness of Nitroglycerine withDexmedetomidine in terms of hemodynamics and blood loss during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma
Methods: Ethics Committee has approved this Randomized Controlled trial which was conducted among 40 patients randomly divided into two groups by simple randomization using computer generated random numbers.Informed consent was taken from all the eligible participants. Group D(n=20) receivedDexmedetomidine 1µg/kg over 15 min followed by a maintenance infusion at 0.5µg/kg/hourand GroupN (n=20)received (n=20), Nitroglycerine 0.5µg/kg/min and titrated in doses 0.5-5µg/kg/min for target blood pressure respectively. Standard guidelines were followed throughout the study protocol for data collection. Data was analyzed using mean and standard deviation in two groups.
Results:Both the groups were comparable for baseline parameters. There is statistically significant difference in mean pulse rate between two groups Group D: 66.09±2.83, Group N: 86.59±4.24 (p=0.0001). Blood loss was lower in Group D: 310.71±140.58 compared to Group N: 482.61±141.42, and is statistically significant (p=0.0004). SBP,DBPand MAP were lower in Group D throughout the surgery.
Conclusions:Dexmedetomidine is a better hypotensive agent with favorablehemodynamics and less blood loss when compared to Nitroglycerine. Hence we recommend use of Dexmedetomidine over nitroglycerine in patients during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma.

MONITORED ANAESTHESIA CARE–STUDY OF COMPARISON OF NALBUPHINE AND DEXMEDETOMIDINE FOR SEDATION IN MINOR PROCEDURES

Dr. PratikshaChitta, Dr.MrunaliniAlugolu, Dr Ramakrishna Shatagopam, Dr Bhanu Lakshmi, Dr Rekha Kone

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5971-5981

Aim: The purpose of this study is to analyze and compare the properties of
Dexmedetomidine with that of Nalbuphine regarding duration of sedation, recovery and
adverse effects in short surgical procedures.
Materials and methods: It is observational clinical study involving 60 patients belonging to
ASA grade 1 & 2 posted for elective minor surgical procedures lasting about 45 -60 minutes,
comparison between Dexmedetomidine and Nalbuphine was done and the onset of sedation,
duration of sedation and recovery from sedation including adverse effects of both drugs,
hemodynamic and respiratory parameters were evaluated. Patients were randomly divided
into 2 groups of 30 each .Group N( Nalbuphine) received 50 mcg /kg of Nalbuphine and
Group D(Dexmedetomidine) received 1 mcg/kg of Dexmedetomidine over 10 minutes .
Results: Demographic parameters in both groups were comparable (p>0.05).Nalbuphine and
Dexmedetomidine has comparable onset of time for sedation, duration of sedation and
recovery from the sedation. Onset of sedation is fast in Dexmedetomidine; total duration of
sedation is more with dexmedetomidine and has provided good sedation during the surgical
procedure. As reported in several studies dexmedetomidine offered good cardiovascular
stability without the risk of hypotension . No significant side effects were noted with
dexmedetomidine when compared with Nalbuphine.
Conclusions:Dexmedetomidine when used as a peri operative sedative agent has faster onset
of sedation ,longer duration of sedation ,and the recovery from sedation

Intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy: hemodynamic changes

Dr. Santosh Kumar, Dr. Deepak Vijay Kumar Kadlimatti, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1436-1444

In laparoscopic surgeries, marked hemodynamic changes occur due to the effect of absorption, positioning of the patient, anesthetic agents and pneumoperitoneum. When the intra-abdominal pressure is < 10mmHg, hemodynamic alteration is not significant. Significant alteration in hemodynamics occurs, when the intra-abdominal pressure is > 10 mmHg after insufflation. When the intra-abdominal pressure is >10mmhg, it will cause inferior vena cava compression and pooling of blood in the lower extremities, which decreases the venous return to the heart thereby reducing the cardiac output. On receiving patient in operating room, the patient monitoring included electrocardiogram (ECG), noninvasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SPO2). The baseline HR, NIBP, SpO2 scores were recorded. The hemodynamic parameters taken into consideration were the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure. Mean values of these parameters were analyzed from the baseline, every minute for the first 10 min thereafter for every 5 min till the end of surgery. The heart rate was significantly lower in dexmedetomidine group during the initial 10 min during infusion, lowest mean of 79.53±13.08, none of the patients from either group had bradycardia requiring atropine. Mean value of HR was higher in paracetamol group compared to dexmedetomidine group till 1 h postoperatively. Using preanesthetic dexmedetomidine 1μg/kg infusion followed by 0.5 μg/kg/h showed there was no difference in MAP between the groups, but heart rate of dexmedetomidine group was lower compared to the control group.

A clinical study of post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Nandini CV, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1431-1435

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

Comparative study of intrathecal fentanyl and dexmedetomidine as adjuvant with bupivacaine in elective lower abdominal surgeries

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1704-1711

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

A double blind randomized controlled study to evaluate the effect of dexmedetomidine in prevention of myoclonus occurring due to etomidate induction

Dr. Lokesh SB, Dr. Geetha M, Dr. Mohamed Faizuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 544-554

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

Clinical Efficacy of Dexmedetomidine Versus Fentanyl Added to Intrathecal Levobupivacaine for Orthopedic Surgery

V. Sreelatha, Padmaja, Sudheer Kumar Gowd, Divya Manogna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 892-913

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Comparison ofpremedication with oral pregabalin and i.v. Dexmedetomidine on hemodynamic changes in patients undergoing laproscopic surgery

Ashok Mittal, Vivek Tyagi , Pramod Chand3, Mahesh Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2144-2152

Background:The major problems during laparoscopic surgery are related to the
cardiopulmonary adverse effects of pneumoperitoneum, systemic carbon dioxide absorption,
and patient positioning. Due to the requirement of steep head-up position, the chances and
severity of unwanted hemodynamic responses such as hypertension and tachycardia are much
higher in laparoscopic cholecystectomy when compared with other laparoscopic
surgeries.Objective: The goal of anesthetic management in laparoscopic surgeries is to
minimize these hemodynamic responses along with adequate depth and pain control with the
target of minimal stress response and early discharge.
Materials & Methods:The present study was conducted in MLB Medical College and
hospital, Jhansi,UP.Participants of eithersex with ASA physical status grade I & II, aged 20
to 50 years and planned for elective laparoscopic cholecystectomy under general
anaesthesiawith tracheal intubationwere included in this study.This study was carried out in
100 participants. All selected participants under study were randomely divided into two
groups depending on the premedication used.Group A patients were given i.v.
dexmedetomidine in a dose of 1ug/kg over a period of 10 minutes, diluted with 100ml normal
saline,20minutes prior to induction of anaesthesia.Group B patients were given oral
pregabalin 75 milligrams with sips of water 1.5 hour before induction. Data was analysed in
SPSS 17.0 using unpaired students t test.
Result:We found that Systolic Blood Pressure and Heart Ratewere decreased after intubation
in both the groups but fall was significantly greater in group A when compared to group B
.There was also significant fall in Mean Arterial Pressure after intubation in group A as
compared to group B.

Dexmedetomidine 0.6 mcg/kg versus Magnesium Sulphate 50% 30 mg/kg for attenuation of Intubation Response

Velagalaburre Yalappa Srinivas, Mathikere Boregowda Sudarshan, Vivek Nayak, Kuzhippailil Vinod Kumar Harikrishnan, Narendra Babu Gowdagere Nagarajaiah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 814-824

Background: Direct laryngoscopy followed by endotracheal intubation is prone to
haemodynamic fluctuations which may be detrimental in subjects with coronary artery
disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare
Dexmedetomidine with Magnesium sulphate to determine the better drug with regard
to attenuation of the haemodynamic responses during laryngoscopy and endotracheal
intubation.

Comparison of Adjuvant Intrathecal Dexmedetomidine or Fentanyl to Hyperbaric Bupivacaine for Postoperative Analgesia - A Randomized, Double-Blind Controlled Study

Nishigandha Mahajan, Shilpa Sharda, Krishan Gopal Jangir, Swati Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1145-1153

Background: Various adjuvants have been used with local anaesthetics in spinal
anaesthesia to prolong postoperative analgesia. Dexmedetomidine, the new highly
selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this
study was to evaluate the onset and duration of sensory and motor block, hemodynamic
effect, postoperative analgesia, and adverse effects of dexmedetomidine, or fentanyl
when given intrathecally with hyperbaric 0.5% bupivacaine.
Materials and Methods: Ninety patients classified in American Society of
Anaesthesiologists classes I and II scheduled for lower abdominal surgeries requiring
spinal anaesthesia were studied. Patients were randomly allocated to receive either 12.5
mg hyperbaric bupivacaine plus 10 μg dexmedetomidine (group D, n=30) or 12.5 mg
hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30) intrathecal. The control
group received 12.5 mg hyperbaric bupivacaine intrathecally (n=30).
Results: Patients in the dexmedetomidine group (D) had a significantly longer sensory
and motor block time than patients in the fentanyl group (F) and control group (B).
VAS score at rescue analgesia was significantly higher in the control group. Duration of
analgesia was significantly more in the dexmedetomidine, and fentanyl group as
compared to control. The total duration of analgesia was longer with dexmedetomidine
than fentanyl. Sedation scores were significantly higher in the Dexmedetomidine group.
No hemodynamic changes were noted in any group.
Conclusion: Intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric
bupivacaine prolong sensory and motor block with minimal hemodynamic instability
and reduced demand for rescue analgesia. Intrathecal dexmedetomidine has a longer
duration of analgesia than fentanyl.

A study on addition of 10mcg of dexmedetomidine to bupivacaine heavy intrathecally in infraumbilical surgeries: A Prospective Study

Dr. Kschitiz Agrawal, Dr. Hemant Subhash Dambale, Dr. Nitin Dagdu Waghchoure, Dr. Shrikant Mangalmurti Upasani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1824-1829

Introduction: Spinal anesthesia is the most commonly performed anesthetic technique for
lower limb, abdominal, perineum surgeries. It has been seen that multiple drugs are being
added to the local anesthetics in subarachanoid blockade which results in better
haemodynamic stability, increased duration of surgical analgesia and even provide post
operative analgesia. Here we did a case series of adding intrathecal dexmedetomidine to
hyperbaric bupivacaine in cases which were posted for infraumbilical surgery and lasted for
more than 2 hours. Even two cases lasted for more than 5 hours were done comfortabily with
addition of dexmedetomidine.Dexmedetomidine is a selective alpha 2 adrenoceptor agonist
which can be used in low doses and it prolongs sensory block in a dose dependent manner
without major haemodynamic effects. Patient also had significant post operative analgesia
which reduced the requirement of rescue analgesia and also resulted in early recovery of the
patient.

A study on side effects of post-operative analgesia with intravenous paracetamol versus dexmedetomidinein patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Deepak Vijaykumar Kadlimatti, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1425-1430

Several theories have been proposed, the most consistent being that it acts in a similar fashion to NSAIDs by the inhibition of the cyclo-oxygenase pathways. However, paracetamol lacks both the peripheral anti-inflammatory and anti-platelet response seen with NSAIDs28. More recently, it has been suggested that paracetamol may also be linked with both direct and indirect stimulation of the cannabinoid, nitric oxide synthase, and serotonergic pathways. Patients satisfying the inclusion criteria were selected during the study period from the operation register on a daily basis. After obtaining a written informed consent, sixty patients were recruited for this study. They were allocated into two groups of 30 each. 10 patients in group D and 08 patients in group P complained of nausea, none of the patients in either group had vomiting, bradycardia, and hypotension

Comparison of IV dexmedetomidine & propofol versus IV dexmedetomidine & ketamine for daycare urological procedures: a randomized controlled study

Dr. Suresh Janapati,Dr. Kiran Kumar Suggala, Dr. DasariSamyuktha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 964-972

Background: Most urologic surgeries are performed in a narrow, limited space with
minimally invasive technique or cystoscope& anaesthesia for these procedures is
administered with the goals of safety, satisfactory procedural condition for the performance
of therapeutic or diagnostic procedures ensuring rapid recovery with minimal post-operative
complications. Therefore, we decided to compare the efficacy & safety of IV Propofol @1.5
mg/kg +Dexmedetomidine @1μg/kg versus IV Ketamine @ 1mg/kg + Dexmedetomidine @
1μg/kg in providing procedural sedation in urological procedures.
Material & Methods: This prospective randomized study was conducted in Department of
Anaesthesiology of Mamata medical hospital. In this study 50 patients scheduled for elective
daycare urological procedures were included and divided equally in two groups. Group Areceived
IV Propofol 1.5 mg/kg, then infusion of Dexmedetomidine@ 1μg/kgand group Breceived
IV Ketamine 1mg/kg, then Dexmedetomidine@ 1μg/kg.
Results: In our study, there is no significant difference in age, weight, gender. The
comparison of mean between two groups after giving dexmedetomidine was statistically
significant (p< 0.05) in heart rate, SBP, onset, duration of analgesia, VAS & Ramsay scores
but DBP & SpO2 was statistically not significant.
Conclusion: Comparison of baseline & intraoperative hemodynamics, showed that the values
were better maintained in Dexmedetomidine + propofol (Group-A) than Dexmedetomidine +
Ketamine (Group B). We have concluded that Dexmedetomidine + Propofol combination was
superior to Dexmedetomidine + Ketamine, providing early onset of sedation, prolonged
analgesia & stable intraoperative hemodynamics.

A comparative study between 0.2% ropivacaine with dexmedetomidine and 0.125% levobupivacaine with dexmedetomidine for post-operative epidural analgesia in patients undergoing total abdominal hysterectomy

Dr. T. Anusha,Dr. Kiran Kumar Suggala, Dr. Tejaswi T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 701-710

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

Comparison of the Effect of Adding Dexmedetomidine versus Midazolam to Intrathecal Bupivacaine on the Post-Operative Analgesia

Dr Ravi Shrivastav, Dr Sachin Kumbhare, Dr Arpit Khandelwal, Dr. Hemant Vanjare

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1225-1232

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

The effects of addition of dexmedetomidine to intrathecal hyperbaric 0.5% bupivacaine in elective lower segment caesarean section:A prospective, randomized, double blinded, placebo-controlled study

Dr. Ajay V Patil,Dr. SangameshKunakeri,Dr. Subodh S Kamtikar,Dr. Rajkumar GB

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 25-30

Background: Spinal anaesthesia is the most commonly used technique for lower abdominal
surgeries as it is very economical and easy to administer. Dexmedetomidine, a new highly
selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable
hemodynamic conditions, good quality of intraoperative and prolonged postoperative
analgesia with minimal side effects.
Methods: Prospective double blinded, placebo-controlled study was undertaken in 60
patients allocated randomly by envelop method, divided into 2 groups (30 in each) between
18-50 years of age of either gender belonging to ASA class I and II scheduled for elective
lower segment caesarean section. Group A received 2 mL of 0.5% hyperbaric bupivacaine
and 0.2ml dexmedetomidine and Group B received 2ml of 0.5% hyperbaric bupivacaine with
0.2ml normal saline. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 95% confidence interval. P<0.05 was
considered statistically significant.
Results: The addition of dexmedetomidine resulted in a dose dependent prolongation of
sensory regression to S1 segment, prolonged motor block, the time to first analgesic rescue
was significantly prolonged in Group B as compared to Group A and showed Lower pain
scores as compared to placebo group.
Conclusion: Based on study results we recommend addition of dexmedetomidine 5 μg to
intrathecal hyperbaric 0.5% Bupivacaine 9 mg in elective lower segment caesarean section.

COMPARATIVE STUDY OF DEXMEDETOMIDINE VS FENTANYL ON INTRAOPERATIVE HEMODYNAMIC CHANGES AND RECOVERY IN LAPAROSCOPIC GYNAECONCOLOGY SURGERIES IN STEEP TRENDELENBURG POSITION

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1578-1583

Introduction: Pneumoperitoneum from Carbon di oxide insufflation will result in increase plasma levels of catecholamines and vasopressin that leads to hemodynamic disturbances. These effects are exaggerated by the steep trendelenburg position. This study was designed to evaluate the effect of Dexmedetomidine and fentanyl on hemodynamics in laparoscopic gynaeconcolgy surgeries which requires steep trendelenburg position.
Methods: After obtaining Ethical committee clearance and patients consent, prospective randomised comparative study was done on 60 ASA I and II patients who were randomly assigned to receive either dexmedetomidine or fentanyl infusion. Patients with ASA III & IV, on β blockers were excluded. Intraoperative hemodynamics, recovery and emergence was assessed. Students ‘t’ test was used
Results: The study included 60 patients undergoing laparoscopic gynaecology oncology surgeries requiring steep trendelenburg positions. Dexmedetomidine group of patients had better intra operative hemodynamics throughout and postoperative recovery when compared with Fentanyl group of patients.
Conclusion: Using Dexmedetomidine infusion in patients will have stable hemodynamics and postoperative recovery also smooth as compared to fentanyl.
 

Dexmedetomidine Infusion in Patients Undergoing Elective Laparoscopic Cholecystectomy under General Anesthesia: Postoperative Analgesia and Complications

Dr. Prashantha Kumar HM, Dr. UshaSaha, Dr. RadhikaAgarwala

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1906-1911

LC combines the benefit of complete removal ofgall bladder with the advantage of limited
abdominal incisions, early recovery, shorter hospital stay and less postoperative complication.
Laparoscopic cholecystectomy can be associated with severe complications in the form of
arrhythmias,sudden intraoperative cardiovascular collapse, severe pulmonary edema and
postoperative thromboembolic phenomenon. All patients underwent a thorough
preanaesthetic check-up. Written informed consent was obtained from each patient after
explaining the procedure in a language that the patient understood. Patients were randomly
allocated into 2 groups of 40 each. Mean time to first analgesic in Group D was 4.38 ± 0.86
hrs and in Group C was 2.50 ± 0.68 hrs. On comparing, time to first analgesia was
significantly longer in Group D both statistically and clinically. Nausea and Vomiting was
noted in 5 patients in Group D and 14 patients in Group C. This incidence though statistically
not significant was clinically significant.

COMPARATIVE EVALUATION OF THE HYPOTENSIVE EFFECTS OF CLONIDINE TO DEXMEDETOMIDINE DURING FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN THE INDUCTION OF HYPOTENSION: AN INTERVENTIONAL STUDY

Dr Rajveer Basu, Dr Jugvendra Lahari, Kiran Lahari, Dr Preeti Lahari

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1941-1947

Background:Decreasing MAP (mean arterial blood pressure) using controlled hypotension, is introduced to improve visibility of the surgical site by reducing blood loss during FESS.
Aims:The present study was conducted to compare and assess the hemodynamic stability and hypotensive efficacy of Clonidine and Dexmedetomidine in FESS.
Materials and Methods:40 subjects were randomly divided into two groups of 20 subjects each. Subjects from Group I received 1 μg/kg dexmedetomidine, whereas, Group II subjects received 2 μg/kg Clonidine. Postoperative complications and Haemodynamic parameters were assessed at baseline, following the loading dose, 1- and 5-minutes following intubation, and every 10 minutes till recovery. These parameters were mean arterial pressure, systolic and diastolic blood pressures, oxygen saturation, and heart rate (HR).
Results:MAP and HR decreased significantly from baseline at all the time intervals of assessment (p<0.001). These values were statistically significant for both intragroup and intergroup for Group I and Group II. Also, statistically non-significant results were seen concerning the visibility of the surgical field. Emergence time was significantly higher for Group I (7.38±0.58 min) than Group II (6.44±0.72 min) with p=0.001. Sedation scores were higher significantly for group I (1.88±1.23) than Group II (1.37±0.12) with p=0.001. VAS scores were significantly lower for Group I (2.24±0.78) than Group II (3.01±0.14) at all time intervals with p=0.001. First rescue analgesia was significantly higher for Group I (110.45±12.25 min) than Group II (84.31±10.06) with the p-value of <0.0001
Conclusion:Present study concludes that, better hemodynamic stability was seen with dexmedetomidine compared to Clonidine. However, decreased blood loss and intraoperative visibility were comparable for both dexmedetomidine and Clonidine. Sedation and prolonged anesthesia were also better with dexmedetomidine.

Effect of Dexmedetomidine Infusion on Haemodynamic Responses to CapnoperitoneuminPatients Undergoing Elective Laparoscopic Cholecystectomy under General Anaesthesia

Dr. Prashantha Kumar HM, Dr. Usha Saha, Dr. Radhika Agarwala

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1896-1905

Dexmedetomidine (Dexmed) belongs to the imidazole subclass of α2 receptor agonists,
similar to clonidine. It is a potent and highly selective α2 adrenoreceptor agonist,approved
by FDA in 1999 for use in humans for analgesia and sedation. It has a greater affinity for
α2 receptors over α1 (1620:1). Its α2/α1 selectivity ratio is eight times higher than that of
clonidine. All patients underwent a thorough preanaesthetic check-up. Written informed
consent was obtained from each patient after explaining the procedure in a language that
the patient understood. Patients were kept NPO from midnight and advised Tab. Diazepam
(0.1-0.15 mg/kg) and Tab. Rantac 150 mg night before and at 6 AM on the morning of
surgery with sips of water. The mean Etsevo in Group D was 0.29±0.02% and in Group C, it
was 0.31±0.01% upto 5 mins after intubation. Thereafter, it showed an increasing trend in
both the groups.From 5 minutes post insufflation, mean Etsevo (0.48±0.20%) was higher in
Group C as compared to Group D (0.33±0.11%). The difference was very highly significant
upto about 30 minutes of CO2 insufflation. There after mean Etsevo (0.32±0.01%) was
comparable in both the groups till the end of surgery.

An Observational Study to See the Effect of Intravenous Dexmedetomidine Infusion on the Duration of Subarachnoid Block with Isobaric Ropivacaine in a Tertiary Care Hospital in Raichur

Dr. Sunil S. Kumar, Dr. Prashant Vadigeri, Dr. Achyutha J, Dr. Niranjan C. S

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1876-1883

Background: Choice of anaesthesia for surgery below the umbilicus is Subarachnoid block
with Bupivacaine traditionally. Dexmedetomidine is being used with Ropivacaine to avoid
side effects of Bupivacaine. The objective of this study is to compare the groups (group 1-
only Ropivacaine and group 2- Ropivacaine with Dexmedetomidine) with respect to
duration of sensory block and motor block, sedation, and complications.
Material and Methods: This is a prospective observational study and 30 patients in each
group were included. Duration of sensory block and motor block, scale of sedation and
complications were looked for. Patients with bradycardia, AV block, using beta blockers,
calcium channel blockers or anti-arrhythmic and hepatic or renal dysfunction were
excluded. Mean and standard deviation for continuous variables, frequencies and
percentages for categorial variables were determined. Chi-Square test, Paired T test,
Independent T test or Unpaired Test, and Wilcoxon Sum Rank Test were done.
Results: Mean age and weight of the group-1 were 38.80±4.2years and 62.23±5.43 kg and
that of group-2 were 39.67±5.9 years and 63.45±6.23 kg respectively. Mean duration of
sensory and motor blockade of the group-1 were 189±18.2 minutes and 158±18.77 minutes
respectively and that of group-2 were 230±19.7 minutes and 189±21.34 minutes
respectively (p<0.001). Ramsay sedation scores in the group with only Ropivacaine was 1.7
± 0.3 while in Dexmedetomidine group was 2.4±0.3 (p<0.001). 13 patients experienced
hypotension, 5 were from only Ropivacaine group and 8 were from Dexmedetomidine
group(p<0.001). 12 patients experienced bradycardia among which 4 were from only
Ropivacaine group and 8 from Dexmedetomidine group(p<0.001).
Conclusion: Intravenous dexmedetomidine in patients getting 0.75% isobaric ropivacaine
for subarachnoid block, increases time to two dermatomal regression of sensory blockade,
duration of sensory block, duration of motor block and provides good sedation.

Evaluation of The Efficacy of Dexmedetomidine And Dexamethasone When Used As Adjuvant To Ropivacaine In Supraclavicular Brachial Plexus Block for Upper Limb Surgeries

Dr Abhilash Dash; Dr Rabi Narayan Dhar; Dr Ramakanta Mohanty; Dr Sidharth Sraban Routray; Dr Soumyakant Mallick

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1166-1173

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone