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      Dexmedetomidina intranasal en sedación para ginecoobstetricia Translated title: Intranasal dexmedetomidine in sedation for OB/GYN

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          Abstract

          Objetivos: evaluar el uso de la dexmedetomidina intranasal como coadyuvante para sedación en LUI y AMEU asociado al sistema de infusión controlado por objetivo. Métodos: ensayo clínico no controlado, prospectivo y simple ciego. Muestra de 48 pacientes que cumplen los criterios de inclusión. Grupo CD se administró Dexmedetomidina IN a dosis de 0,9 µg/kg y otro grupo de control. Para el análisis estadístico de variables continuas se usó media y DE; para variables ordinales se calculó frecuencia. Además de prueba T de Student y Chi χ2. Nivel de confianza de 95 % y margen de error 12%. Resultados: edad media de 32 ± 7 años; en el grupo CD la dosis de inducción y mantenimiento de remifentanil fue de 2 ± 0,7 ng/ml y en el grupo SD la dosis de inducción fue de 4,1 ± 0,7 ng/ml y de mantenimiento 3,9 ± 0,5 ng/ml; para el propofol la dosis de inducción y mantenimiento fue 3,7 ± 0,5 mcg/ml en el grupo SD mientras que, en el grupo CD la dosis de inducción y mantenimiento fue de 2,1 ± 0,5 mcg/ml. La frecuencia cardiaca de 64 - 62 y en el grupo SD fue de 70 - 67 latidos/min. La PAM asociado al dexme está por 73 mmHg y el grupo de SD es de 78 mmHg. No se verifico complicaciones por la administración de la Dexmedetomidina. Conclusiones: la dexmedetomidina IN permite disminuir la dosis de los fármacos, con estabilidad de los cambios hemodinámicos, la dosis utilizada no produce complicaciones.

          Translated abstract

          Objectives: to evaluate the use of intranasal dexmedetomidine as an adjunct for sedation in LUI and AMEU associated with the objective controlled infusion system. Methods: uncontrolled, prospective, single-blind clinical trial. Sample of 48 patients who meet the inclusion criteria. Group CD was administered Dexmedetomidine IN a dose of 0.9 µg / kg and another control group. For the statistical analysis of continuous variables, mean and SD were used; For ordinal variables, frequency was calculated. In addition to Student’s T-test and Chi χ2. 95% confidence level and 12% margin of error. Results: age of 32 ± 7 years; in the CD group the induction and maintenance dose of remifentanil was 2 ± 0.7 ng / ml and in the SD group the induction dose was 4.1 ± 0.7 ng / ml and maintenance dose 3.9 ± 0.5 ng / ml; for propofol the induction and maintenance dose was 3.7 ± 0.5 mcg / ml in the SD group, while in the CD group the induction and maintenance dose was 2.1 ± 0.5 mcg / ml. The heart rate was 64-62 and in the SD group it was 70-67 beats / min. The MAP associated with dexme is 73 mmHg and the SD group is 78 mmHg. No complications were verified by the administration of Dexmedetomidine. Conclusions: dexmedetomidine IN allows to decrease the dose of drugs, with stability of hemodynamic changes, the dose used does not cause complications.

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          Most cited references21

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          Bioavailability of dexmedetomidine after intranasal administration.

          The aim of this proof-of-concept study was to characterize the pharmacokinetics and pharmacodynamics of intranasal dexmedetomidine compared with its intravenous administration in a small number of healthy volunteers. Single doses of 84 μg of dexmedetomidine were given once intravenously and once intranasally to seven healthy men. Plasma dexmedetomidine concentrations were measured for 10 h, and pharmacokinetic variables were calculated with standard noncompartmental methods. Heart rate, blood pressure, concentrations of adrenaline and noradrenaline in plasma, and central nervous system drug effects (with the Maddox wing, Bispectral Index, and three visual analog scales) were monitored to assess the pharmacological effects of dexmedetomidine. Six individuals were included in the analyses. Following intranasal administration, peak plasma concentrations of dexmedetomidine were reached in 38 (15-60) min and its absolute bioavailability was 65% (35-93%) (medians and ranges). Pharmacological effects were similar with both routes of administration, but their onset was more rapid after intravenous administration. Dexmedetomidine is rather rapidly and efficiently absorbed after intranasal administration. Compared with intravenous administration, intranasal administration may be a feasible alternative in patients requiring light sedation.
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            Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy

            Abstract Dexmedetomidine is a highly selective α2 receptor agonist, this study aimed to investigate the effects of different doses of intranasal dexmedetomidine on the preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia (TIVA) for adenoidectomy with or without tonsillectomy. This is a double-blind placebo-controlled randomized trial. Pediatric were randomly divided into the D1, D2, and S groups, each group contained 30 patients. Twenty-five to 40 minutes before surgery, the D1 and D2 groups received intranasally dexmedetomidine 1 μg kg−1 or 2 μg kg−1, respectively, while the S group received saline of the same volume. A unified protocol of TIVA induction and maintenance was used for the three groups. The preoperative sedation, behavior of separation from parents, postoperative agitation, and postoperative pain of the children were evaluated. The proportions of satisfactory sedation in the D1, D2, and S groups were 63.3%, 76.7%, and 0%, respectively. There was a statistically significant difference between D1 and S groups (P = .000) and D2 versus S groups (P = .000), while there was no statistically significant difference between D1 and D2 groups (P = .399). As for scale on the behavior of separation from parents, there was a statistically significant difference between D1 and S groups (P = .009) and D2 versus S groups (P = .009), whereas there was no significant difference between D1 and D2 groups (P = 1). The incidence of postoperative agitation in the D1, D2, and S groups was 43.3%, 30.0%, and 63.3%, respectively, and there was a statistical difference between D2 and S groups (P = .010). There was a significant difference in the Pediatric Anesthesia Emergence Delirium (PAED) scale between D2 and S groups (P = .029). The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) in the D2 group was significantly lower than the S group (P = .013). The intranasal dexmedetomidine of 1 or 2 μg kg−1 25 to 40 minute before induction of anesthesia both could deliver effective preoperative sedation, reducing the children's distress of separation from parents. Moreover, intranasal dexmedetomidine of 2 μg kg−1 could deliver more effective postoperative analgesia and reduce postoperative agitation, without prolonging postoperative recovery or causing severe adverse events.
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              A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients.

              Sedation for burn patients is provided by a variety of techniques determined usually by institutional preferences. The available pool of drugs has recently expanded to include dexmedetomidine (DEX), a α2-adrenergic receptor agonist with analgesic and sedative potential. Beneficial effects of DEX in burn patients have been described in many studies published over the last 5 years. The aim of this study is to perform a systematic review and meta-analysis of the available literature to determine the role of DEX for analgosedation of burn patients. We searched any article that matched the keywords "dexmedetomidine" and "burn", published before October 01, 2012. The methodological quality of studies was assessed using the recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM). Our search yielded eleven total citations, of which four studies (266 patients) met the inclusion criteria of DEX for analgosedation in burn patients. There are no meta-analyses published that met our inclusion criteria. Even though there were only a small number of clinical trials available, the meta-analysis shows evidence for deeper and better sedation as well as for prevention of hypertension when using DEX as an adjunct during burn procedures. No evidence was found for reduced pain scores in this setting. The authors recommend the development of a prospective, randomized, controlled multicenter trial with an adequate number of patients to further elucidate the potentially beneficial effects of DEX for the management of burn patients.
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                Author and article information

                Journal
                gmb
                Gaceta Médica Boliviana
                Gac Med Bol
                Facultad de Medicina de la Universidad Mayor de San Simón (Cochabamba, , Bolivia )
                1012-2966
                August 2020
                : 43
                : 1
                : 28-33
                Affiliations
                [01] Cochabamba orgnameHospital Obrero N° 2 Caja Nacional de Salud Bolivia wonderful122.paa@ 123456gmail.com
                Article
                S1012-29662020000100006 S1012-2966(20)04300100006
                64f92eed-313a-49a9-91c1-11d6807da98f

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 20 May 2020
                : 22 February 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 6
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                SciELO Bolivia

                Categories
                Artículo Original

                Curettage,Deep sedation,Intranasal administration,Dexmedetomidine,legrado,sedación profunda,administración intranasal,Dexmedetomidina

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