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Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study

Title
Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study
Authors
Chun, Eun HeeHan, Myeong JaeBaik, Hee JungPark, Hahck SooChung, Rack KyungHan, Jong InLee, Hun JungKim, Jong Hak
Ewha Authors
김종학정락경한종인백희정박학수천은희
SCOPUS Author ID
김종학scopus; 정락경scopus; 한종인scopus; 백희정scopus; 박학수scopus; 천은희scopus
Issue Date
2016
Journal Title
BMC ANESTHESIOLOGY
ISSN
1471-2253JCR Link
Citation
vol. 16
Keywords
DexmedetomidineFentanylKetamineMidazolamMonitored anesthesia care
Publisher
BIOMED CENTRAL LTD
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Background: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient sedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was to compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF) combination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC). Methods: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF. All patients received 1 mu g. kg(-1) dexmedetomidine over 10 min followed by 0.2-1.0 mu g. kg(-1)h(-1) in order to maintain 3 or 4 of modified Observer's Assessment of Analgesia and Sedation score checked every 3 min. At the start of dexmedetomidine infusion, patients in group DK or DMF received 0.5 mg. kg(-1) ketamine or 0.05 mg.kg(-1) midazolam+ 0.5 mu g. kg(-1) fentanyl intravenously, respectively. When required, rescue sedatives (0.5 mg. kg(-1) of ketamine or 0.05 mg. kg(-1) of midazolam) and analgesics (0.5 mg. kg(-1) of ketamine or 0.5 mu g. kg(-1) of fentanyl) were given to the patients in DK or DMF group, respectively. The primary outcome of this study was the recovery parameters (time to spontaneous eye opening and the length of the recovery room stay). The secondary outcomes were parameters indicating quality of sedation/analgesia, cardiorespiratory variables, and satisfaction scores. Results: There were no significant differences in the onset time, time to spontaneous eye opening, recovery room stay, the incidences of inadequate analgesia, hypotension and bradycardia between the two groups. Despite lower infusion rate of dexmedetomidine, more patients in the DMF group had bispectral index (BIS) < 60 than in the DK group and vice versa for need of rescue sedatives. The satisfaction scores of patients, surgeon, and anesthesiologist in the DMF group were significantly better than the DK group. Conclusions: The DK and DMF groups showed comparable recovery time, onset time, cardiorespiratory variables, and analgesia. However, the DMF group showed a better sedation quality and satisfaction scores despite the lower infusion rate of dexmedetomidine, and a higher incidence of BIS < 60 than the DK group.
DOI
10.1186/s12871-016-0211-4
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의학전문대학원 > 의학과 > Journal papers
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