Anesthesiology Commons^™

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Do Patients Who Receive Dexmedetomidine As An Adjunct To Spinal Anesthesia For Cesarean Delivery Achieve Longer Block Duration Compared To Those Who Receive Spinal Anesthesia With Local Anesthetic Alone?, Liana S. Garrison

Theses, Dissertations and Capstones

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used …

Whipple’S Procedure Under Combined Segmental Spinal And Epidural Anesthesia With Enhanced Recovery: A Case Report, Abhirami Ravindran, Imran Ahmed Khan, Naresh Wamanrao Paliwal

Digital Journal of Clinical Medicine

The Whipple’s procedure (pancreaticoduodenectomy), is a complex surgery performed for various indications, usually under general anesthesia (GA). However, GA carries a significant perioperative risk, especially in patients with comorbidities. Combined segmental spinal and epidural anesthesia (CSSE) with low doses of local anesthetics and adjuvants may be a feasible alternative owing to hemodynamic stability, potentially reducing complications and promoting enhanced recovery.

We present a 43-year-old male with periampullary adenoma with high-grade dysplasia who underwent a Whipple’s procedure under CSSE due to high-risk features (e.g., severe jaundice, low blood pressure, and anemia) and chronic smoking and alcoholism. Thoracic epidural (T7–T8) and spinal …

Anesthesia For Bronchoscopy-An Update, Basavana Goudra, Lalitha Sundararaman, Prarthna Chandar, Michael Green

Department of Anesthesiology Faculty Papers

The field of interventional pulmonology has grown immensely and is increasingly recognized as a subspecialty. The new procedures introduced in the last decade pose unique challenges, and anesthesiologists need to readapt to their specific demands. In this review, we extensively discuss the pathophysiology, technical aspects, preprocedural preparation, anesthetic management, and postprocedural challenges of many new procedures such as navigational bronchoscopy, endobronchial valve deployment, and bronchial thermoplasty. Majority of these procedures are performed under general anesthesia with an endotracheal tube. Total intravenous anesthesia with rocuronium as a muscle relaxant seems to be the standard US practice. The easy availability and proven …

Effects Of Dexmedetomidine As An Adjunct To General Anesthesia On Postoperative Pain And Opioid Consumption In Major Abdominal Surgery, Ahmad H. Elrefahy

Rowan-Virtua Research Day

This review examines the impact of dexmedetomidine, an alpha-2 adrenergic receptor agonist, on postoperative pain and opioid consumption in major abdominal surgery. Dexmedetomidine, known for its sedative, analgesic, and opioid-sparing properties, is increasingly used as an adjunct to anesthesia. Analyzing existing literature, the review found that dexmedetomidine administration alongside general anesthesia significantly improves postoperative pain management and reduces opioid consumption. Patients receiving dexmedetomidine reported decreased postoperative pain ratings and required fewer opioids during the recovery phase. Additionally, intraoperative dexmedetomidine use correlated with reduced postoperative pain severity and increased patient satisfaction compared to control groups. However, potential side effects such as …

Do Pediatric Patients That Receive Dexmedetomidine As Premedication Experience Less Emergence Delirium Than Pediatric Patients That Receive Midazolam As Premedication?, Shelby Mccloud

Theses, Dissertations and Capstones

Title: Do pediatric patients that receive dexmedetomidine as premedication experience less emergence delirium than pediatric patients that receive midazolam as premedication?

Problem Statement: Midazolam remains the current choice within the practice for premedication in the prevention of emergence delirium, however as research continues there could possibly be a gap between the research and current practice. Throughout the practice of pediatric anesthesia most providers choose to premedicate with midazolam while there may be a more beneficial option of dexmedetomidine.

Results: The study found a significant variance in the incidence of emergence delirium among pediatric patients, ranging from 18.1% to 89%, depending …

Benefits And Barriers Of Using Prefilled Precedex Syringes In The Operating Room: A Cost Comparison, Ashley White

Graduate Theses, Dissertations, and Problem Reports (ETD)

According to a report published by the Institute of Medicine, at least 44,000 and possibly up to 98,000 Americans die each year because of medical errors in hospitals. More than 7,000 of those deaths are from medication errors alone (Stucki et al., 2013). Anesthesia providers in the operating room (OR) are at even greater risk to commit medication errors due to their easy access to medications and their autonomy to make independent choices for medication administration. A small rural community hospital in Pennsylvania lacks a protocol for Precedex preparation. Evidence-based research show the benefit of prefilled ready-to-administer syringes, but the …

Evaluation Of The Effect Of New Multimodal Analgesia Regimen For Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study, Lin Jin, Yafen Liang, Ying Yu, Peng Miao, Yihao Huang, Liying Xu, Huilin Wang, Chunsheng Wang, Jiapeng Huang, Kefang Guo

Faculty, Staff and Student Publications

OBJECTIVE: To investigate the feasibility of multimodal regimen by paracetamol, gabapentin, ketamine, lidocaine, dexmedetomidine and sufentanil among cardiac surgery patients, and compare the analgesia efficacy with conventional sufentanil-based regimen.

DESIGN: A single-center, prospective, randomized, controlled clinical trial.

SETTING: One participating center, the cardiovascular center of the major integrated teaching hospital.

PARTICIPANTS: A total of 115 patients were assessed for eligibility: 108 patients were randomized, 7 cases were excluded.

INTERVENTIONS: The control group (group T) received conventional anesthesia management. Interventions in the multimodal group (group M) were as follows in addition to the standard of care: gabapentin and acetaminophen 1 hour …

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus …