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      Comparison of the efficacy and safety of sedation protocols with the use of dexmedetomidine–remifentanil and propofol–remifentanil during percutaneous closure of atrial septal defects: a randomized clinical trial

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          Abstract

          Background

          The study was aimed to compare the efficacy and safety of different sedation protocols of dexmedetomidine–remifentanil and propofol–remifentanil for percutaneous closure of atrial septal defects (ASD) under transthoracic echocardiography (TTE) guidance.

          Material and methods

          From March 2020 to January 2021, of 114 patients screened, 59 ASD patients scheduled for percutaneous closure under TTE guidance were randomly allocated into the dexmedetomidine–remifentanil (D–R) group (n = 29) and the propofol–remifentanil (P–R) group (n = 30). The incidence of hemodynamic and respiratory adverse events, arterial blood gas analysis, induction and recovery time, pain score, infusion rate of remifentanil, satisfaction of the surgeon and patient, additional sedatives were collected for analysis and comparison.

          Results

          The induction time was longer in the D–R group than that in the P–R group (17.66 ± 2.65 min vs 11.43 ± 1.48 min; difference, 6.22 min; 95% CI 5.10 to 7.35; P < 0.001). No differences were observed in the 2 groups in terms of the additional sedatives, infusion rate of remifentanil, pain score, recovery time ( P > 0.05). There was no difference between the two groups regarding the incidence of cardiovascular adverse events (6 [20.7%] vs 4 [13.3%]; difference, 7.4%; 95% CI − 11.7 to 26.5%; P = 0.506). Respiratory adverse events occurred in 1 patient (3.4%) in the D–R group, and 8 patients (26.7%) in the P–R group (difference, 23.3%; 95% CI 6.2 to 40.5%; P = 0.026). The incidence of hypercapnia was significantly lower in the D–R group (4 [13.8%]) than in the P–R group (13 [43.3%]; difference, 29.5%; 95% CI 7.8 to 51.2%; P = 0.012).

          Conclusions

          Except for more rapid the induction time and higher the surgeon satisfaction score in the propofol–remifentanil protocol, the efficacy was similar between two sedation protocols. The hemodynamic stability was comparable, the dexmedetomidine–remifentanil protocol had superior airway security due to fewer hypercapnia and respiratory adverse events.

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          Most cited references28

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          Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis.

          How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds.
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            Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam.

            The Observer's Assessment of Alertness/Sedation (OAA/S) Scale was developed to measure the level of alertness in subjects who are sedated. This scale was tested in 18 subjects in a three-period crossover study to assess its reliability and its criterion, behavioral, and construct validity. After receiving either placebo or a titrated dose of midazolam to produce light or heavy sedation, each subject was administered two sedation scales (OAA/S Scale and a Visual Analogue Scale) and two performances tests (Digit Symbol Substitution Test and Serial Sevens Subtraction). Two raters individually evaluated the subject's level of alertness on each of the two sedation scales. The results obtained on the OAA/S Scale were reliable and valid as measured by high correlations between the two raters and high correlations between the OAA/S Scale and two of the three standard tests used in this study. The OAA/S Scale was sensitive to the level of midazolam administered; all pairwise comparisons were significant (p less than 0.05) for all three treatment levels at both test periods.
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              Dexmedetomidine

                Author and article information

                Contributors
                zhangguican123@163.com
                Journal
                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central (London )
                1749-8090
                3 May 2022
                3 May 2022
                2022
                : 17
                : 100
                Affiliations
                [1 ]GRID grid.256112.3, ISNI 0000 0004 1797 9307, Department of Intensive Care Unit, the First Affiliate Hospital, , Fujian Medical University, ; Fuzhou, 350004 Fujian Province People’s Republic of China
                [2 ]GRID grid.256112.3, ISNI 0000 0004 1797 9307, Anesthesiology Research Institute, the First Affiliated Hospital, , Fujian Medical University, ; Fuzhou, 350004 Fujian Province People’s Republic of China
                [3 ]GRID grid.411176.4, ISNI 0000 0004 1758 0478, Department of Cardiovascular Surgery, , Fujian Medical University Union Hospital, ; Fuzhou, 350001 Fujian Province People’s Republic of China
                Author information
                http://orcid.org/0000-0003-1695-7555
                Article
                1834
                10.1186/s13019-022-01834-6
                9066928
                35505367
                c21a1b6f-49ed-46e3-9c02-60fb38b68aea
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

                History
                : 20 June 2021
                : 17 April 2022
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2022

                Surgery
                atrial septal defects,sedation,dexmedetomidine,propofol,remifentanil
                Surgery
                atrial septal defects, sedation, dexmedetomidine, propofol, remifentanil

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