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Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study

BACKGROUND: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient sedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was to compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine...

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Autores principales: Chun, Eun Hee, Han, Myeong Jae, Baik, Hee Jung, Park, Hahck Soo, Chung, Rack Kyung, Han, Jong In, Lee, Hun Jung, Kim, Jong Hak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970235/
https://www.ncbi.nlm.nih.gov/pubmed/27484227
http://dx.doi.org/10.1186/s12871-016-0211-4
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author Chun, Eun Hee
Han, Myeong Jae
Baik, Hee Jung
Park, Hahck Soo
Chung, Rack Kyung
Han, Jong In
Lee, Hun Jung
Kim, Jong Hak
author_facet Chun, Eun Hee
Han, Myeong Jae
Baik, Hee Jung
Park, Hahck Soo
Chung, Rack Kyung
Han, Jong In
Lee, Hun Jung
Kim, Jong Hak
author_sort Chun, Eun Hee
collection PubMed
description BACKGROUND: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient sedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was to compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF) combination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC). METHODS: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF. All patients received 1 μg.kg(−1) dexmedetomidine over 10 min followed by 0.2–1.0 μg.kg(−1)h(−1) in order to maintain 3 or 4 of modified Observer's Assessment of Analgesia and Sedation score checked every 3 min. At the start of dexmedetomidine infusion, patients in group DK or DMF received 0.5 mg.kg(−1) ketamine or 0.05 mg.kg(−1) midazolam + 0.5 μg.kg(−1) fentanyl intravenously, respectively. When required, rescue sedatives (0.5 mg.kg-1 of ketamine or 0.05 mg.kg-1 of midazolam) and analgesics (0.5 mg.kg-1 of ketamine or 0.5 μg.kg-1 of fentanyl) were given to the patients in DK or DMF group, respectively. The primary outcome of this study was the recovery parameters (time to spontaneous eye opening and the length of the recovery room stay). The secondary outcomes were parameters indicating quality of sedation/analgesia, cardiorespiratory variables, and satisfaction scores. RESULTS: There were no significant differences in the onset time, time to spontaneous eye opening, recovery room stay, the incidences of inadequate analgesia, hypotension and bradycardia between the two groups. Despite lower infusion rate of dexmedetomidine, more patients in the DMF group had bispectral index (BIS) < 60 than in the DK group and vice versa for need of rescue sedatives. The satisfaction scores of patients, surgeon, and anesthesiologist in the DMF group were significantly better than the DK group. CONCLUSIONS: The DK and DMF groups showed comparable recovery time, onset time, cardiorespiratory variables, and analgesia. However, the DMF group showed a better sedation quality and satisfaction scores despite the lower infusion rate of dexmedetomidine, and a higher incidence of BIS < 60 than the DK group. TRIAL REGISTRATION: Clinical Trial Registry of Korea KCT0000951, registered 12/12/2013
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spelling pubmed-49702352016-08-03 Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study Chun, Eun Hee Han, Myeong Jae Baik, Hee Jung Park, Hahck Soo Chung, Rack Kyung Han, Jong In Lee, Hun Jung Kim, Jong Hak BMC Anesthesiol Research Article BACKGROUND: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient sedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was to compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF) combination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC). METHODS: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF. All patients received 1 μg.kg(−1) dexmedetomidine over 10 min followed by 0.2–1.0 μg.kg(−1)h(−1) in order to maintain 3 or 4 of modified Observer's Assessment of Analgesia and Sedation score checked every 3 min. At the start of dexmedetomidine infusion, patients in group DK or DMF received 0.5 mg.kg(−1) ketamine or 0.05 mg.kg(−1) midazolam + 0.5 μg.kg(−1) fentanyl intravenously, respectively. When required, rescue sedatives (0.5 mg.kg-1 of ketamine or 0.05 mg.kg-1 of midazolam) and analgesics (0.5 mg.kg-1 of ketamine or 0.5 μg.kg-1 of fentanyl) were given to the patients in DK or DMF group, respectively. The primary outcome of this study was the recovery parameters (time to spontaneous eye opening and the length of the recovery room stay). The secondary outcomes were parameters indicating quality of sedation/analgesia, cardiorespiratory variables, and satisfaction scores. RESULTS: There were no significant differences in the onset time, time to spontaneous eye opening, recovery room stay, the incidences of inadequate analgesia, hypotension and bradycardia between the two groups. Despite lower infusion rate of dexmedetomidine, more patients in the DMF group had bispectral index (BIS) < 60 than in the DK group and vice versa for need of rescue sedatives. The satisfaction scores of patients, surgeon, and anesthesiologist in the DMF group were significantly better than the DK group. CONCLUSIONS: The DK and DMF groups showed comparable recovery time, onset time, cardiorespiratory variables, and analgesia. However, the DMF group showed a better sedation quality and satisfaction scores despite the lower infusion rate of dexmedetomidine, and a higher incidence of BIS < 60 than the DK group. TRIAL REGISTRATION: Clinical Trial Registry of Korea KCT0000951, registered 12/12/2013 BioMed Central 2016-08-02 /pmc/articles/PMC4970235/ /pubmed/27484227 http://dx.doi.org/10.1186/s12871-016-0211-4 Text en © Chun et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chun, Eun Hee
Han, Myeong Jae
Baik, Hee Jung
Park, Hahck Soo
Chung, Rack Kyung
Han, Jong In
Lee, Hun Jung
Kim, Jong Hak
Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title_full Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title_fullStr Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title_full_unstemmed Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title_short Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
title_sort dexmedetomidine-ketamine versus dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a prospective randomized study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970235/
https://www.ncbi.nlm.nih.gov/pubmed/27484227
http://dx.doi.org/10.1186/s12871-016-0211-4
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