The feasibility of dexmedetomidine-led anesthesia maintenance strategy during major abdominal surgery
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ABSTRACT:
SUBMITTER: Ni C
PROVIDER: S-EPMC10912630 | biostudies-literature | 2024 Feb
REPOSITORIES: biostudies-literature
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Project description:Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia.
| S-EPMC4355120 | biostudies-other
Project description:ObjectiveTo assess the feasibility of a prehabilitation program and its effects on physical performance and outcomes after major abdominal surgery.MethodsIn this prospective pilot study, patients underwent prehabilitation involving three training sessions per week for 3 weeks preoperatively. The feasibility of delivering the intervention was assessed based on recruitment and adherence to the program. Its impacts on fitness (oxygen uptake (VO2)) and physical performance (Timed Up and Go Test, 6-Minute Walk Test) were evaluated.ResultsFrom May 2017 to January 2020, 980 patients were identified and 44 (4.5%) were invited to participate. The main obstacles to patient recruitment were insufficient time (<3 weeks) prior to scheduled surgery (n = 276, 28%) and screening failure (n = 312, 32%). Of the 44 patients, 24 (55%) declined to participate, and 20 (23%) were included. Of these, six (30%) were not adherent to the program. Among the remaining 14 patients, VO2 at ventilatory threshold significantly increased from 9.7 to 10.9 mL/min/kg. No significant difference in physical performance was observed before and after prehabilitation.ConclusionAlthough prehabilitation seemed to have positive effects on exercise capacity, logistic and patient-related difficulties were encountered. The program is not feasible in its current form for all-comers.
| S-EPMC8649915 | biostudies-literature
Project description:Opioid-free anesthesia decreases postoperative nausea and vomiting, emergence agitation, prolonged sedation, ileus, and urinary retention. The feasibility of the use of dexmedetomidine as sole analgesic agent has been shown in patients undergoing bariatric and gynecological laparoscopic surgery. We explored its use for robotic urological surgery.Thirty patients were randomized to receive either dexmedetomidine (Group D) or fentanyl (Group F) along with total intravenous anesthesia with propofol. The hemodynamic parameters and number of doses of rescue analgesics used intraoperatively and postoperatively were noted. Recovery parameters at the end of surgery were also recorded.The dose of intraoperative rescue fentanyl was not significantly different between groups (P = 0.13). The hemodynamic profile of patients in the two groups was comparable except the heart rate was significantly more in Group D after intubation and at 60 min. The mean arterial pressure was significantly lower after the initial loading dose of study drug in Group D. The recovery profiles were not significantly different between groups.The study reveals that dexmedetomidine has equal analgesic efficacy as fentanyl for intraoperative use and can be used as the sole analgesic agent in patients undergoing robotic urological surgery.
| S-EPMC5520590 | biostudies-other
Project description:BackgroundPatients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery.MethodsEligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications.ResultsEighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63-77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low-with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions.ConclusionOur prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery.Trial registrationAustralian New Zealand Clinical Trials Registry ( ACTRN12620000073909 ) retrospectively registered.
| S-EPMC9396890 | biostudies-literature
Project description: Not available
| S-EPMC10521028 | biostudies-literature
Project description:BackgroundQuantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h.MethodsUrine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite "fluid retention index" (FRI) in 97 patients prior to major abdominal surgery. Goal-directed fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid fluid, was used.ResultsThe median preoperative FRI was 3.0. Fluid retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) fluids. Despite the larger blood loss, the total fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; P < 0.02).ConclusionsPreoperative fluid retention, as detected in a urine sample, was associated with a greater blood loss and a more positive fluid balance during major abdominal surgery.Trial registrationClinicalTrials.gov, NCT01458678.
| S-EPMC5581451 | biostudies-literature
Project description: Not available
| S-EPMC11745849 | biostudies-literature
Project description:BackgroundIn clinical practice, blood pressure is used as a resuscitation goal on a daily basis, with the aim of maintaining adequate perfusion and oxygen delivery to target organs. Compromised perfusion is often indicated as a key factor in the pathophysiology of anastomotic leakage. This study was aimed at assessing the extent to which the microcirculation of the bowel coheres with blood pressure during abdominal surgery.MethodsWe performed a prospective and observational cohort study. In patients undergoing abdominal surgery, the serosal microcirculation of either the small intestine or the colon was visualized using handheld vital microscopy (HVM). From the acquired HVM image sequences, red blood cell velocity (RBCv) and total vessel density (TVD) were calculated using MicroTools and AVA software, respectively. The association between microcirculatory parameters and blood pressure was assessed using Pearson's correlation analysis. We considered a two-sided P-value of <0.050 to be significant.ResultsIn 28 patients undergoing abdominal surgery, a total of 76 HVM images were analyzed. The RBCv was 335 ± 96 µm/s and the TVD was 13.7 ± 3.4 mm/mm2. Mean arterial pressure (MAP) was 71 ± 12 mm Hg during microcirculatory imaging. MAP was not correlated with RBCv (Pearson's r = -0.049, P = 0.800) or TVD (Pearson's r = 0.310, P = 0.110).ConclusionIn 28 patients undergoing abdominal surgery, we found no association between serosal intestinal microcirculatory parameters and blood pressure.
| S-EPMC9923946 | biostudies-literature
Project description:Effects of perioperative cervical level neuraxial blocks on the dissemination of cancer metastases have become a matter of substantial interest. However, experience with these catheters has been limited and data on feasibility and efficacy is sparse.Data from 39 patients scheduled to undergo breast cancer surgery while awake with a cervical epidural alone was retrospectively analyzed.In 26 patients (66,7%, 95% CI 51,7-81,7) the cervical epidural catheter was sufficient for surgery. In one patient (2.6%, 95% CI 0-7.6) identification of the epidural space was not possible. Four patients (10.3%, 95% CI 0,7-19,9) had an insufficient sensory block. Seven patients (17.9%, 95% CI 5,7-30,1) had a partially insufficient sensory block. Rates of failed epidural blocks were not significantly different between different insertion levels. 21 patients (80.8%, 95% CI 65,4-96,1) developed hypotension and required an intravenous vasopressor. One patient developed nausea. In one patient the dura was accidentally punctured. No neurological damage was observed. No other major complications were observed.Epidural punctures in the cervical region are feasible but do bear potential for major complications. Anesthesiologists should familiarize themselves with high epidural block techniques.
| S-EPMC5540389 | biostudies-other
Project description:ObjectiveTo evaluate the impact of dexmedetomidine (Dex) on agitation and inflammatory response during recovery from anesthesia in young children following cochlear implantation surgery.MethodsWe randomly divided 80 children who underwent unilateral cochlear implantation into two equal groups. Group D received an intravenous infusion of Dex after induction of anesthesia, while those in group C received an equal volume of saline infusion. The mean arterial pressure (MAP) and heart rate (HR) of children in the two groups were recorded at four different time intervals: before induction of anesthesia (T0); 30 min after intravenous infusion of Dex (T1); upon admission to the post-anesthesia care unit (PACU) (T2); and at the time of being transferred out of the PACU (T3). At T3, we also recorded general information.ResultsThe MAP and HR in group D showed more consistent trends during the anesthesia recovery period when compared to those in group C. Children in group D had a significantly lower crying, requires increased O2 administration, increased vital signs, expression and sleepless score (CRIES score), pediatric anesthesia emergence delirium (PAED) score, and incidence of agitation than in group C (P < 0.01). The rate of supplementary pain relief for the children was lower in group D than in group C (P < 0.01). At T3, serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were lower in children in group D than in group C (P < 0.01). Compared to T0, the levels of serum IL-6 and TNF-α were higher in both groups at T3 (P < 0.01).ConclusionWe found that the use of Dex helped reduce the occurrence and severity of agitation during anesthesia recovery in children after cochlear implantation surgery and improved postoperative inflammatory reactions.Clinical registration numberRegistration website: https://www.chictr.org.cn/searchproj.html .Registration numberChiCTR2400080937.
| S-EPMC11852807 | biostudies-literature