Humans ; Benzodiazepines ; Hypnotics and Sedatives/therapeutic use* ; Intensive Care Units ; Midazolam

Humans ; Dexmedetomidine/therapeutic use* ; Hypnotics and Sedatives ; Cognitive Dysfunction/drug therapy*

BACKGROUNDSedation for the coblation-assisted upper airway procedure has lacked easy modulation between appropriate pain control and airway protection. This study aimed to compare the effectiveness of dexmedetomidine versus target controlled propofol infusion in providing sedation during a coblation-assisted upper airway procedure.

METHODSIn a prospective, randomized trial, 60 adult patients with obstructive sleep apnea syndrome due to undergoing a coblation-assisted upper airway procedure were enrolled and randomly allocated to receive dexmedetomidine, 1.0 µg/kg over 10 minutes and maintain dosage 0.7 µg×kg(-1)×h(-1) (n=30) or propofol target controlled infusion (n=30). Satisfaction with the analgesia and tolerance of the procedure by the patient, as assessed by a visual analogue scale, were evaluated as primary outcomes. Cardiopulmonary parameters and some side effects were monitored and recorded.

RESULTSBoth groups of 30 patients had comparable demographics and initial parameters. Patients in the propofol group reported more pain (P<0.05), tolerated the procedure less well (P<0.05), and were less satisfied with the different stages of procedure (P<0.05 or P<0.01). Changes in mean arterial pressure and heart rate were more dramatic in the propofol group (P<0.05). The dexmedetomidine group experienced fewer airway events and less respiratory depression than did the propofol group.

CONCLUSIONDexmedetomidine in conjunction with local anesthesia offered better analgesia and conscious sedation for a coblation-assisted upper airway procedure as well as less airway obstruction, apnea and greater haemodynamic stability.

Adult ; Conscious Sedation ; methods ; Dexmedetomidine ; therapeutic use ; Female ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Middle Aged ; Propofol ; therapeutic use

OBJECTIVE: To explore the application of the Dexmedetomidine utend drug induced sleep endoscopy. METHOD: Forty-four OSAHS patients diagnosed by PSG randomly were divided into group A (Dexmedetomidine group) and group B (Propofol group), each group of 22 cases. Group A: pump the Dexmedetomidine (1 microg/kg) over 15 minutes. Once the patient reached a satisfactory level of sedation, the electronic nasopharyngoscope was introduced into the nasal cavity group B: the propofol (2 mg/kg) was intravenous injected, use the same exmination after the object patients falling asleep. If not, double the injection dose of the two group. Observe and record the patient vital signs, EEG and sleep time, and handle the complications. RESULT: The study was successfully completed both in group A and B. Mean arterial pressure (MAP) in group B was lower than group A during the examination significantly (P < 0.05). The time falling to sleep in two groups were (13.4 +/- 2.5) min and (6.6 +/- 1.2) min, and the time in group A was much longer than that in group B. The lowest oxygen saturation during the examination in two groups were 0.835 +/- 0.096 and 0.691 +/- 0.095, and the difference was statistically significant. There was no incidence of adverse reactions in two groups. CONCLUSION Compared with propofol, Dexmedetomidine is a safer sleep-inducing drug, and it can be used for clinical sleep endoscopy.
Adult ; Dexmedetomidine ; therapeutic use ; Endoscopy ; Feasibility Studies ; Female ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Middle Aged ; Propofol ; therapeutic use ; Sleep

OBJECTIVETo explore the feasibility and safety of dexmedetomidine combined with remifentanil for lower eyelid blepharoplasty.

METHODS50 patients undergoing lower eyelid blepharoplasty ASA I - II were randomly divided into 2 groups (25 in each group) as observation group and control group. Dexmedetomidine (0.3 microg x kg(-1) x h(-1)) and remifentanil (0.05 microg x kg(-1) x min(-1)) were used in observation group. Local anesthesia by lidocaine (1%) combined with midazolam (0.04 mg/kg) intravenous sedation were used in control group. HR, mean arterial pressure (MAP), heart rate (HR), breathing rate (RR), pulse oxygen saturation (SpO2) change were monitored and recorded before and after the administration of the drug, as well as at the beginning of operation, during the operation, at the end of the operation, and 5 minutes after the operation. Patients sedation degree was evaluated by Ramsay. Operation time, recovery time, the incidence of adverse reactions, the satisfaction of patients and doctors were also recorded.

RESULTSPatients had no obvious difference of intraoperative MAP, RR, SpO2, operation time and postoperative recovery time between the two groups (P > 0.05). Compared with control group, HR during the operation were decreased significantly [(64.2 +/- 8.2) bpm, P < 0.05] in observation group. In control group, there were 18 cases of patients with agitation, but they endured the operation anyway. In observation group, 24 cases of patients underwent operation without agitation. The satisfaction of patients and the operation doctors (96%) in observation group were markedly higher than that in control group (P < 0.05).

CONCLUSIONDexmedetomidine combined with remifentanil is practical and safe. The effect of reducing HR should be noticed.

Adult ; Blepharoplasty ; Dexmedetomidine ; therapeutic use ; Double-Blind Method ; Female ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Middle Aged ; Piperidines ; therapeutic use

Algorithms ; Conscious Sedation ; methods ; Deep Sedation ; adverse effects ; Dexmedetomidine ; adverse effects ; therapeutic use ; Humans ; Hypnotics and Sedatives ; adverse effects ; therapeutic use

OBJECTIVETo compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU).

METHODSEighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events.

RESULTSSatisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (P<0.05). Both groups showed decreases in heart rate (HR), mean arterial pressure (MAP), and spontaneous breathing frequency (RRs) after treatment. However, the remifentanil+midazolam group had significantly greater decreases in HR at 3-24 hours after treatment and MAP and RRs at 3-12 hours after treatment than the midazolam group (P<0.05). Compared with the midazolam group, the remifentanil+midazolam group had significantly higher ventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (P<0.05). The remifentanil+midazolam group had significantly shorter time to awake, extubation time, duration of mechanical ventilation, and length of PICU stay than the midazolam group (P<0.05). There were no significant differences in PICU cost, incidence of adverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (P<0.05).

CONCLUSIONSFor children with mechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.

Analgesics ; therapeutic use ; Blood Glucose ; analysis ; Female ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Infant ; Intensive Care Units, Pediatric ; Male ; Midazolam ; therapeutic use ; Piperidines ; therapeutic use ; Respiration, Artificial

OBJECTIVETo compare the sedative effects of different doses of dexmedetomidine (DEX) and midazolam (MDZ) in dental implant surgery:

METHODSSixty patients undergoing dental implantation were selected and divided randomly into six groups (10 in each group). In group 1 (G1), a highdose of MDZ alone was administered intravenously. In group 2 (G2), a relatively low dose of MDZ and DEX was administered intravenously. In group 3 (G3), a highdose of MDZ and DEX was administered intravenously. In group 4 (G4), a lowdose of MDZ and a highdose of DEX were administered. In group 5(G5), a highdose of MDZ and a low dose of DEX were administered. In group 6 (G6), a highdose of DEX alone was administered intravenously. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation values were measured. Sedation was assessed by determining the Ramsay sedation scores(RSS) during infiltration anesthesia (T1), incision (T2), cutting (T3), and suturing (T4). Before discharging from the hospital, patients were asked if they remembered the T1 to T4 procedures. The visual analogue scale (VAS) and the degree of patient satisfaction were assessed at the same time.

RESULTSIn T1 to T4, the systolic blood pressure (SBP) in G3 was the lowest and was significantly different from that in G1 and G2 (P < 0.05). In G1, the SBP was higher than that in G6 at the T3 and T4 points (P < 0.05). HR was below the preoperative (P < 0.05) in the G3 only. RSS was the lowest in G1 during the whole procedure. In G2, most patients obtained scores of 2-3. In G3, sedation was deeper, had more cases ofup to 5. In G4, most patients obtained scores of 3-4. In G5, some patients had a score of up to 5. The RSS in G6 was lower than that in G3 and G4 or G5 in T1 to T2, closer to G4 in T2. An evaluation of the VAS and the degree of patient satisfaction did not show any differences among the groups.

CONCLUSIONThe combination of DEX and MDZ is superior to a single intravenous injection. Low-dose MDZ combined with high-dose DEX achieved the highest quality of sedation in this study.

Anesthesia ; Blood Pressure ; Dental Care ; Dental Implants ; Dexmedetomidine ; therapeutic use ; Heart Rate ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Midazolam ; therapeutic use ; Pain Measurement ; Patient Satisfaction ; Prospective Studies

OBJECTIVETo compare the safety and efficacy of midazolam and estazolam in hypertensive patients with chronic insomnia.

METHODSIn this multicentre, open labeled, randomized clinical trial, 217 adult (18 - 75 years) hypertensive patients (BP range 140 mm Hg or= 3 times/week for more than 1 month) were randomly divided into midazolam (7.5 - 15 mg before sleep, n = 113) or estazolam group (1 - 2 mg before sleep, n = 104). Patients took medication according to own need. Sleep diary should be completed within 15 minutes after getting up next morning. Follow-up analysis was performed in patients completed 8 sleep diaries or received midazolam or estazolam for 1 month. Patients' sleep diaries were evaluated, blood pressure and heart rate before and after therapy were measured and adverse events were recorded.

RESULTS(1) Blood pressure was equipotent reduced after both treatments (-11.8/7.3 mm Hg for midazolam group, and -9.1/5.6 mm Hg for estazolam group, all P < 0.05 vs. before treatment). (2) The total sleep score was also significantly decreased in both groups after medication (P < 0.01) and midazolam was significantly superior to estazolam in shortening sleep latency, reducing awakening frequency, improving objective sleep evaluation and decreasing daytime sleepiness, but there were no differences in dream frequency and total sleep time. (3) The adverse reactions such as dizziness, headache and nausea was similar in midazolam (3%) and estazolam group (7%, P > 0.05).

CONCLUSIONSIt is safe to take midazolam or estazolam for hypertensive patients with chronic insomnia and both drugs reduced blood pressure. Midazolam is superior to estazolam in shortening sleep latency, reducing awakening frequency, improving objective sleep evaluation and decreasing daytime sleepiness.

Aged ; Estazolam ; therapeutic use ; Female ; Humans ; Hypertension ; complications ; Hypnotics and Sedatives ; therapeutic use ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; drug therapy ; etiology

OBJECTIVE: To observe the clinical effect of dexmedetomidine on patients during the extubation in general anesthesia.
 METHODS: A total of 90 patients scheduled for general anesthesia were divided into 3 groups (n=30): A dexmedetomidine group (DEX group), a midazolam group (MID group), and a control group(C group). Anesthesia drugs were stopped 10 minutes before the end of the operation. 
At the same time, the patients in the DEX group were given dexmedetomidine at the rate of 
1 g/(kg.h) for 10 min by vein first, which was continuously pumped at the rate of 0.3 g/(kg.h) for 20 min after the operation. The patients in the MID group were given midazolamin at 0.5 mg/kg for 60 s by vein first, which was continuously pumped at the rate of the 0.04 mg/(kg.h) for 20 min after the operation. The patients in the C group were not given any drug. Awakening time and extubation time after the operation were recorded. Ramsay scores, heart rate, mean arterial blood pressure, respiratory rate, and SpO₂were recorded at time of extubation, 10 min or 1 h after extubation. Chills, nausea, vomiting and other side effects after the operation were recorded.
 RESULTS: Awakening and extubation time were not affected in the DEX group, while delayed recovery occurred in the MID group (P<0.05). Compared with the C group, patients in the DEX and MID groups gained better sedative effect, with 2-4 Ramsay scores (P<0.05). The blood pressure and heart rate were steady in the DEX and MID groups, while inhibition of respiration appeared in the MID group.
 CONCLUSION Dexmedetomidine can provide an effective sedation for the patients without affecting the awakening and extubation time. The hemodynamics could be stably maintained by using dexmedetomidine in patients during the extubation in general anesthesia.
Airway Extubation ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine ; therapeutic use ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Midazolam ; therapeutic use