Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial† ‡ N Goettel, S Bharadwaj,

Slides:

Advertisements

Similar presentations

Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial J.N. Darvall, M Handscombe, K Leslie British.

Advertisements

Plasma concentrations and sedation scores after nebulized and intranasal midazolam in healthy volunteers A.S.M. McCormick, V.L. Thomas, D. Berry, P.W.

Comparison of continuous non-invasive finger arterial pressure monitoring with conventional intermittent automated arm arterial pressure measurement in.

Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children K.-Z. Chen, M. Ye, C.-B.

When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients† P Van de Putte, L Vernieuwe, A Jerjir, L Verschueren,

J.H. Ryu, S.W. Lee, J.H. Lee, E.H. Lee, S.H. Do, C.S. Kim

Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing continuous infusion vs patient-controlled intraperitoneal.

I. Garutti, L. Puente-Maestu, J. Laso, R. Sevilla, A. Ferrando, I

SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management.

Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: a randomized controlled trial G.S. Murphy,

Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation J.-S. Nho, S.-Y. Lee,

Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized,

Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation† G.A. Hans, S.M. Lauwick, A.

Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial T.M. Hemmerling, E. Arbeid, M. Wehbe,

Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate J.A. Alhashemi, A.M. Kaki British Journal.

Prospective randomized observer-blinded study comparing the analgesic efficacy of ultrasound-guided rectus sheath block and local anaesthetic infiltration.

Effect of combining tramadol and morphine in adult surgical patients: a systematic review and meta-analysis of randomized trials V. Martinez, L. Guichard,

Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery S.Y. Kim, J.M. Kim, J.H. Lee,

Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia J.H. Lee, B.-N. Koo, J.-J.

A different use of visual analytic techniques in anaesthetics

J. Ahonen, R. Jokela, K. Uutela, M. Huiku

J.-Y. Hwang, H.-S. Na, Y.-T. Jeon, Y.-J. Ro, C.-S. Kim, S.-H. Do

Impact of sleep deprivation on anaesthesia residents’ non-technical skills: a pilot simulation-based prospective randomized trial A. Neuschwander, A.

T. Ledowski, J. Burke, J. Hruby British Journal of Anaesthesia

Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty† Davies A.F. , Segar E.P. , Murdoch J.

Bispectral index, serum drug concentrations and emergence associated with individually adjusted target-controlled infusions of remifentanil and propofol.

Dexmedetomidine pharmacodynamics in healthy volunteers: 2

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries British Journal of Anaesthesia

Comparison of remifentanil and alfentanil during anaesthesia for patients undergoing direct laryngoscopy without intubation E. Wiel, M. Davette, L. Carpentier,

BIS guided sedation with propofol during spinal anaesthesia: influence of anaesthetic level on sedation requirement Ozkan-Seyhan T. , Sungur M. Orhan.

Glycopyrrolate during sevoflurane–remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease K. Reyntjens,

Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial C.-H. Koo, S. Yoon, B.-R.

Sumatriptan improves postoperative quality of recovery and reduces postcraniotomy headache after cranial nerve decompression L. Venkatraghavan, L. Li,

Preoperative butorphanol and flurbiprofen axetil therapy attenuates remifentanil-induced hyperalgesia after laparoscopic gynaecological surgery: a randomized.

R. E. Kallionpää, A. Scheinin, R. A. Kallionpää, N. Sandman, M

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind,

J.E. Hall, T.D. Uhrich, T.J. Ebert British Journal of Anaesthesia

Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous.

I.V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study K.

Effects of intraoperative i. v. acetaminophen vs i. m

Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded.

Comparative study of topical anaesthesia with lidocaine 2% vs levobupivacaine 0.75% in cataract surgery S.A. Fernández, E. Dios, J.C. Diz British Journal.

D. Fletcher, V. Martinez British Journal of Anaesthesia

Impact of balanced tetrastarch raw material on perioperative blood loss: a randomized double blind controlled trial† A Joosten, R Tircoveanu, S Arend,

Anaesthesia for awake craniotomy—evolution of a technique that facilitates awake neurological testing A. Sarang, J. Dinsmore British Journal of Anaesthesia

Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a randomized clinical.

Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial† A Harsten, H Kehlet, S Toksvig-Larsen

Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures: a prospective observational study

Influence of variations in arterial PCO2 on surgical conditions during laparoscopic retroperitoneal surgery M. Boon, C. Martini, M. Hellinga, R. Bevers,

Spinal analgesia for laparoscopic colonic resection using an enhanced recovery after surgery programme: better analgesia, but no benefits on postoperative.

B. Mora, K. Skhirtladze, M. Dworschak British Journal of Anaesthesia

Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position P.F. Soeding, S Hoy, G Hoy,

H. Krenn, E. Deusch, H. Jellinek, W. Oczenski, R.D. Fitzgerald

Pain assessment in conscious healthy volunteers: a crossover study evaluating the analgesia/nociception index Q. Yan, H.Y. An, Y. Feng British Journal.

Thoracic paravertebral blocks in abdominal surgery – a systematic review of randomized controlled trials K. El-Boghdadly, C. Madjdpour, K.J. Chin British.

Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients

Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial J.N. Darvall, M Handscombe, K Leslie British.

Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean.

Hypercapnia and surgical site infection: a randomized trial†

Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty† Förster J.G. , Rosenberg P.H.

Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial K.B. Kaufmann, L Stein,

D Anton, P Friederich British Journal of Anaesthesia

Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of.

Effects of magnesium sulphate on intraoperative neuromuscular blocking agent requirements and postoperative analgesia in children with cerebral palsy

Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate† J.-H. Ryu, I.-S. Sohn, S.-H. Do British Journal.

Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover.

Association between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units:

Closed-loop control of propofol anaesthesia using bispectral index™: performance assessment in patients receiving computer-controlled propofol and manually.

Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing.

Presentation transcript:

Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial† ‡ N Goettel, S Bharadwaj, L Venkatraghavan, J Mehta, M Bernstein, P.H. Manninen British Journal of Anaesthesia Volume 116, Issue 6, Pages 811-821 (June 2016) DOI: 10.1093/bja/aew024 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 CONSORT flow diagram. Fifty subjects were randomized; one subject (DEX group) was eliminated because of incorrect allocation, and one subject (DEX group) was eliminated because of unexpected intraoperative conversion to a general anaesthetic. DEX group, dexmedetomidine group; GA, general anaesthetic; P-R group, propofol-remifentanil group. British Journal of Anaesthesia 2016 116, 811-821DOI: (10.1093/bja/aew024) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 (a) Modified Observer's Assessment of Alertness/Sedation (OAA/S) scale (numeric value), (b) visual analogue scale for pain (VAS pain, numeric value), and (c) visual analogue scale for anxiety (VAS anxiety, numeric value) were assessed at consecutive time points (T0–T12). Study drug infusions were started at T0 and ended at T10. Results are shown as means (sd). DEX group, dexmedetomidine group; P-R group, propofol-remifentanil group; T0, intraoperative baseline; T1, headpin insertion; T2, 5 min after T1; T3, local anaesthetic infiltration to incision; T4, skin incision; T5, craniotomy (bone work); T6, dura opening; T7, brain mapping; T8, start of tumour resection; T9, 30 min after T8; T10, skin closure; T11, admission to PACU; T12, 120 min after T11. *P<0.05. British Journal of Anaesthesia 2016 116, 811-821DOI: (10.1093/bja/aew024) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 (a) Mean arterial pressure (MAP, mm Hg), (b) heart rate (HR, beats min−1), (c) respiratory rate (RR, bpm), and (d) peripheral oxygen saturation ( S p O 2 , %) were assessed at consecutive time points (T0–T12). Study drug infusions were started at T0 and ended at T10. Repeated-measures anova showed a significantly lower HR [mean difference (95% CI): −13.8 (−19.3, −8.4) beats min−1, P<0.001] over time in the DEX group. Ranges of recorded values for MAP, HR, RR and S p O 2 in the DEX group were 50–135 mm Hg, 39–110 beats min−1, 5–25 bpm and 86–100%, respectively; ranges for MAP, HR, RR and S p O 2 in the P-R group were 49–136 mm Hg, 46–150 beats min−1, 6–26 bpm and 90–100%, respectively. Results are shown as means (sd). DEX group, dexmedetomidine group; P-R group, propofol-remifentanil group; T0, intraoperative baseline; T1, headpin insertion; T2, 5 min after T1; T3, local anaesthetic infiltration to incision; T4, skin incision; T5, craniotomy (bone work); T6, dura opening; T7, brain mapping; T8, start of tumour resection; T9, 30 min after T8; T10, skin closure; T11, admission to PACU; T12, 120 min after T11. *P<0.05; **P<0.001; ***P<0.0001. British Journal of Anaesthesia 2016 116, 811-821DOI: (10.1093/bja/aew024) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Patient satisfaction and recall of the surgical procedure (awake craniotomy) were assessed at 24 h using Likert scales. In a structured interview, patients were asked to rate their intraoperative experience by answering to the five following questions: (a) How satisfied were you with your pain management and overall level of comfort? (b) If you were to have surgery again, would you opt for the same method of management? (c) Recall of the intraoperative experience. (d) Recall of the level of intraoperative pain. (e) Recall of the level of intraoperative discomfort and anxiety. DEX group, dexmedetomidine group; P-R group, propofol-remifentanil group. British Journal of Anaesthesia 2016 116, 811-821DOI: (10.1093/bja/aew024) Copyright © 2016 The Author(s) Terms and Conditions