Research Journal of Pharmacy and Technology

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Hysteroscopic Procedure as Day Care Cases under Tiva with Dexmedetomidine Vs Ketamine


Affiliations
1 Professor, Department of Anaesthesia, (DMIMS), Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital Sawangi,Wardha, Maharashtra 442001, India
2 2Post Doctoral (Dr NB Critical Care Medicine), Senior Resident., India
     

   Subscribe/Renew Journal


Background: Day care surgery under total intravenous anaesthesia where the patient is discharged the same day has made hysteroscopy, a form of minimally invasive surgery, the most frequently performed gynaecological procedure. Aim and objective: Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having dose dependent sedation, analgesic properties and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties have been chosen to compare their efficacy, evaluate the requirement of rescue sedative and/or analgesic, haemodynamic changes and any complication per-operatively for day care hysteroscopic procedures. Methods: 25 patients in each group in the range of age 20 to 55yrs, weight 40-60kg, height 145-155cm, ASA I and II were administered dexmedetomidine (D) 100μg IV or Ketamine (K) 75mg IV both over 10 mins, at the onset of the procedure. Maintenance of anaesthetia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide. Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value <0.0001. The requirement of rescue sedative propofol, midazolam and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p value <0.01, statistically highly significant. Group K had suffered more per-operative complications. Conclusion: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice.


Keywords

Dexmedetomidine, Gynaecological day care, Hysteroscopy, Ketamine.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Jonas Pontusson and Damian Raess.The Politics of Economic Crisis in Historical-Comparative Perspective.Swiss Political Science Review 18(4): 502–507

  • Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol 2011; 27: 297-302.

  • Parikh DA, Kolli SN, Karnik HS, Lele SS, Tendolkar BA. A prospective randomized double-blind study comparing

  • Dexmedetomidine vs. combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care. J Anaesthesiol Clin Pharmacol 2013; 29: 173-8

  • Kamibayashi T,Maze M.Clinical uses of alpha2-adrenergic agonists. Anesthesiology. 2000; 93: 1345-1349

  • Priyanka Sethi, Sunil Sindhi, Ankita Verma, K. L.Tulsani Dexmedetomidine versus propofol in dilatation and curettage: An open-label pilot randomized controlled trial .Saudi J Anaesth. 2015; 9(3): 258–262.

  • Lee S,Kim BH, LimK, Stalker D,et al.Pharmacokinetics and pharmacodynamics]of intravenous dexmedetomidine in healthy Korean subjects.J clin Phar Ther. 2012; 37: 698-703

  • Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled Sedation with alphaxalone-alphadolone. Br Med J 22: 656-659 8. D. Gould et al. Visual Analogue Scale (VAS). Journal of Clinical Nursing 2001; 10: 697-706

  • Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970; 49: 924–34.

  • Jun Oto,Katsunori Yamamoto et al .Sleep quality of mechanically ventilated patients sedated with dexmedetomidine. Intensive Care Medicine.December 2012; 38(12): pp 1982–1989.

  • Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A review of clinical applications. Curr Opin Anesthesiol. 2008; 21: 457–61

  • Gurbet A, Basagan-Mogol E, Turker G, Ugun F, Kaya FN, Ozcan B. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth. 2006; 53: 646–52.

  • Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000; 90: 699–705.

  • Tanskanen PE, Kyttä JV, Randell TT, Aantaa RE. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: A double-blind, randomized and placebo-controlled study. Br J Anaesth. 2006; 97: 658–65.

  • Orser BA, Pennefather PS, MacDonald JF. Multiple mechanisms of Ketamine blockade of N-methyl-D-aspartate receptors. Anesthesiology. 1997; 86(4): 903–17.

  • Lilburn JK, Dundee JW, Nair SG, Fee JF, Johnston HM. Ketamine sequelae. Evaluation of the ability of various premedicants to attenuate its psychic actions. Anaesthesia. 1978; 33(4): 307–11.

  • Mattila MAK, Larni HM, Nummi SE, Pekkola PO. Effect of Diazepam on emergence from Ketamine Anaesthesia: a double blind study. Anaestheitist. 1979; 28: 20–23.

  • Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000; 90: 834–9.

  • Taniyama K, Oda H, Okawa K, Himeno K, Shikanai K, Shibutani T. Psychosedation with dexmedetomidine hydrochloride during minor oral surgery. Anesth Prog. 2009; 56: 75–80.

  • Devangi A Parikh, Sagar N Kolli, et al. A prospective randomized double blind study comparing dexmedetomidine vs. combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care.Journal of Anaesthesiology and Clinical Pharmacology.2013; 29(2): 173-178.

  • Alhashemi JA. Dexmedetomidine vs. Midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth 2006; 96: 722-6.

  • Karaaslan K, Yilmaz F, Gulcu N,et al. Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study. Curr Ther Res Clin Exp 2007; 68: 69-81.

  • Gerlach AT, Dasta JF. Dexmedetomidine: An updated review. Ann Pharmacother 2007; 41: 245-52.

  • Cheung CW, Ying CL, Chiu WK, et al. A comparison of Dexmedetomidine and Midazolam for sedation in third molar surgery. Anaesthesia 2007; 62: 1132-8.

  • Na HS, Song IA, Park HS, et al. Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery. Korean J Anesthesiol 2011; 61: 453-9

  • Walker J, Maccallum M, Fischer C, Kopcha R, Saylors R, McCall J. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res. 2006; 27(2): 206–10.

  • Reetu Verma, Rajni Gupta, VK Bhatia, et al.Dexmedetomidine and propofol for monitored anesthesia care in the middle ear surgery.Indian Journal of Autology. 2014; 20(2): 70-74.

  • Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002; 95: 461–6.

  • Taghinia AH, Shapiro FE, Slavin SA. Dexmedetomidine in aesthetic facial surgery: Improving anesthetic safety and efficacy. Plast Reconstr Surg. 2008; 121(1): 269–76.

  • Scheinin B, Lindgren L, Randell T, Scheinin, Scheinin M. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anesth. 1992; 68: 126–31.

  • Suzuki M, Tsueda K, Lansing PS, et al. Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery. Anesth Analg 1999; 89: 98–103.

  • Warncke T, Stubhaug A, Jorum E. Ketamine. An NMDA receptor antagonist, suppresses spatial and temporal properties of burn-induced secondary hyperalgesia in man: a double-blind, cross-over comparison with morphine and placebo. Pain 1997; 72: 99-106.

  • White PF, Way WL, Trevor AJ. Ketamine-its Pharmacology and Therapeutic uses. Anesthesiology 1982; 56: 119-36

  • Joseph D. Tobias et al.Saudi J Anaesth. 2011; 5(4): 395–410.

  • Miner JR, Burton JH. Clinical practice advisory: Emergency department procedural sedation with propofol. Ann Emerg Med. 2007; 50: 182–7 187.e1

  • Arellano RJ, Pole ML, Rafuse SE, et al. Omission of nitrous oxide from a propofol-based anesthetic does not affect the recovery of women undergoing outpatient gynecologic surgery.Anesthesiology 2000; 93: 332–9

  • Jevtovic-Todorovic V, Todorovic SM, Mennerick S, et al. Nitrou s oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin. Nat Med 1998; 4: 460–3.

  • Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: A novel sedative-analgesic agent. Proc (Bayl Univ Med Cent) 2001; 14: 13–21

  • Abdellatif AA, Elkabarity RH, Hamdy TA. Dexmedetomidine vs. midazolam sedation in middle ear surgery under local anesthesia: Effect on surgical field and patient satisfaction. Egypt J Anaesth. 2012; 28: 117–23.

  • Ghali A, Mahfouz AK, Ihanamäki T, et al. Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia. Saudi J Anaesth. 2011; 5: 36–41

  • Takimoto K, Ueda T, Shimamoto F, Kojima Y, Fujinaga Y, Kashiwa A, et al. Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer. Dig Endosc. 2011; 23: 176–81.


Abstract Views: 256

PDF Views: 0




  • Hysteroscopic Procedure as Day Care Cases under Tiva with Dexmedetomidine Vs Ketamine

Abstract Views: 256  |  PDF Views: 0

Authors

Jayashree Sen
Professor, Department of Anaesthesia, (DMIMS), Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital Sawangi,Wardha, Maharashtra 442001, India
Bitan Sen
2Post Doctoral (Dr NB Critical Care Medicine), Senior Resident., India

Abstract


Background: Day care surgery under total intravenous anaesthesia where the patient is discharged the same day has made hysteroscopy, a form of minimally invasive surgery, the most frequently performed gynaecological procedure. Aim and objective: Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having dose dependent sedation, analgesic properties and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties have been chosen to compare their efficacy, evaluate the requirement of rescue sedative and/or analgesic, haemodynamic changes and any complication per-operatively for day care hysteroscopic procedures. Methods: 25 patients in each group in the range of age 20 to 55yrs, weight 40-60kg, height 145-155cm, ASA I and II were administered dexmedetomidine (D) 100μg IV or Ketamine (K) 75mg IV both over 10 mins, at the onset of the procedure. Maintenance of anaesthetia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide. Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value <0.0001. The requirement of rescue sedative propofol, midazolam and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p value <0.01, statistically highly significant. Group K had suffered more per-operative complications. Conclusion: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice.


Keywords


Dexmedetomidine, Gynaecological day care, Hysteroscopy, Ketamine.

References