Background: During emergence from anesthesia for partial and total laryngectomy, severe airway reflex and systemic hypertension during recovery may lead to pneumoderm, hemorrhage, pneumomediastinum or pneumothorax. Dexmedetomidine is a selective α2-adrenoreceptor agonist that has sedative, analgesic, and sympatholytic properties. It has been reported dexmedetomidine can attenuate coughing reflex and prevent emergence agitation without delaying recovery and respiratory depression from general anesthesia. The purpose of this study was to investigate the effect of dexmedetomidine compared with midazolam on cough suppression and recovery quality during emergence from general anesthesia after partial and total laryngectomy. Methods American Society of Anesthesiologists physical status I-II male adults undergoing elective laryngectomy under sevoflurane anesthesia were recruiting and randomly allocated to receive either dexmedetomidine(Group D, n = 60) infusion at 0.5 µg•kg-1 for 10 min before tracheotomy, then adjusted to 0.3µg•kg-1•h-1 or midazolam (Group M, n = 60) infusion at 0.05 mg•kg-1 ten minutes before tracheotomy, then adjusted to 0.02mg•kg-1•h-1. The primary outcome measure was the incidence and severity of cough. Hemodynamics, pain intensity \[Visual Analogue Scale (VAS)\] and Ramsay sedation scale (RSS) were also evaluated at awake, patients returning to ward from post anesthesia care unit (PACU),2h after surgery. postoperative sufentanil consumption, recovery time and the incidence of concerning adverse effects were recorded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
120
dexmedetomidine infusion at 0.5 µg•kg-1 for 10 min before tracheotomy then adjusted to 0.3µg•kg-1•h-1
midazolam infusion at 0.05 mg•kg-1 ten minutes before tracheotomy then adjusted to 0.02mg•kg-1•h-1
Department of Anesthes iology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University
Shanghai, Shanghai Municipality, China
The severity of cough
Coughing severity was classified using the 3-point scale.:1=mild (single) cough, 2=moderate (≤5 s) cough, and 3=severe (\>5 s) cough.
Time frame: Time0:2hours after surgery
HR
Heart rate
Time frame: Time0: 0 minute after arriving the operation room
SBP
Systolic blood pressure
Time frame: Time0: 0 minute after arriving the operation room
DBP
Diastolic blood pressure
Time frame: Time0: 0 minute after arriving the operation room
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time0: 0 minute after arriving the operation room
HR
Heart rate
Time frame: Time1:0 minute after drug administration
SBP
Systolic blood pressure
Time frame: Time1:0 minute after drug administration
DBP
Diastolic blood pressure
Time frame: Time1:0 minute after drug administration
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time1:0 minute after drug administration
HR
Heart rate
Time frame: Time2:0 minute after intubation
DBP
Diastolic blood pressure
Time frame: Time2:0 minute after intubation
SBP
Systolic blood pressure
Time frame: Time2:0 minute after intubation
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time2:0 minute after intubation
HR
Heart rate
Time frame: Time3:0 minute after medicine intervention
DBP
Diastolic blood pressure
Time frame: Time3:0 minute after medicine intervention
SBP
Systolic blood pressure
Time frame: Time3:0 minute after medicine intervention
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time3:0 minute after medicine intervention
HR
Heart rate
Time frame: Time4:0 minute after laryngectomy
DBP
Diastolic blood pressure
Time frame: Time4:0 minute after laryngectomy
SBP
Systolic blood pressure
Time frame: Time4:0 minute after laryngectomy
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time4:0 minute after laryngectomy
HR
Heart rate
Time frame: Time5:0 minute after the completion of surgery
SBP
Systolic blood pressure
Time frame: Time5:0 minute after the completion of surgery
DBP
Diastolic blood pressure
Time frame: Time5:0 minute after the completion of surgery
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time5:0 minute after the completion of surgery
HR
Heart rate
Time frame: Time6:0 minute after awareness
SBP
Systolic blood pressure
Time frame: Time6:0 minute after awareness
DBP
Diastolic blood pressure
Time frame: Time6:0 minute after awareness
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time6:0 minute after awareness
HR
Heart rate
Time frame: Time7:0 minute after departure from the PACU
SBP
Systolic blood pressure
Time frame: Time7:0 minute after departure from the PACU
BDP
Diastolic blood pressure
Time frame: Time7:0 minute after departure from the PACU
SpO2
Oxygen saturation using pulse oximetry
Time frame: Time7:0 minute after departure from the PACU
Pain intensity
Assessed by Visual Analogue Scale (VAS), (0, no pain; 10, the worst pain intolerable)
Time frame: Time0:2hours after surgery
Sedation
Assessed by Ramsay sedation scale (RSS),1, Anxious or restless or both,2, Cooperative, orientated and tranquil,3,Responding to commands,4,Brisk response to stimulus,5,Sluggish response to stimulus,6, No response to stimulus.
Time frame: Time0: 2hours after surgery
the incidence of adverse effects
desaturation,shivering,drowsiness, delirium,hypertension,hypotension,itching,arrhythmia,respiratory depression
Time frame: Time0:2hours after surgery
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