This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.

In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.

Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.

Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.

The usefulness of ultra-fast track cardiac anaesthesia may give great benefits to patients; however, its usefulness has not been completely evaluated in infants and toddlers, who are generally considered the most difficult group for ultra-fast track cardiac anaesthesia.

A total of 130 children were allocated randomly into to a ultra-fast track cardiac anaesthesia group (Group D) or a conventional anaesthesia group (Group C) (each n = 65). In Group D, dexmedetomidine was administrated at a dosage of 1 µg/kg/hour after induction. The patient- controlled intravenous analgesia was dexmedetomidine and sufentanil. In Group C, patients were infused with of the same volume of normal saline, and sufentanil alone for patient-controlled intravenous analgesia. The dosages of sufentanil, extubation time, haemodynamic parameters, postoperative hospitalisation conditions, pain and sedation scores, blood gas analysis, and inotropic scores were all recorded.

The dosage of sufentanil (1.49 ± 0.05 vs. 3.81 ± 0.04 µg, p < 0.001) and extubation time (2.63 ± 0.52 vs. 436.60 ± 22.19 minutes, p < 0.001) in Group D were all significantly lower than those in Group C. Moreover, cardiac intensive care unit stay time, total hospital stay, hospitalisation costs, postoperative lactate levels, and inotropic scores were also significantly lower in Group D.

Using of ultra-fast track cardiac anaesthesia in infants and toddlers is effective, it not only reduce the perioperative requirement for opioids and shorten the extubation time but also decreases the inotrope requirement and provide a better postoperative condition for young children.

Intranasal dexmedetomidine is an attractive option for procedural sedation in pediatrics due to ease of administration and its relatively short half-life. This study sought to compare the safety and efficacy of intranasal dexmedetomidine to a historical cohort of pediatric patients sedated using chloral hydrate in a pediatric echo lab.

Chart review was performed to compare patients sedated between September, 2017 and October, 2019 using chloral hydrate and intranasal dexmedetomidine. Vital signs, time to sedation, duration of sedation, need for second dose of medication, rate of failed sedation, and impact on vital signs were compared between groups. Subgroup analysis was performed for those with complex and cyanotic heart disease.

Chloral hydrate was used in 356 patients and intranasal dexmedetomidine in 376. Patient age, complexity of heart disease, and duration of sedation were similar. Rates of failed sedation were very low and similar. Average heart rate and minimum heart rate were lower for those receiving intranasal dexmedetomidine than chloral hydrate. Impact on vital signs was similar for those with complex and cyanotic heart disease. No adverse events occurred in either group.

Sedation with intranasal dexmedetomidine is comparable to chloral hydrate in regards to safety and efficacy for children requiring echocardiography. Consistent with the mechanism of action, patients receiving intranasal dexmedetomidine have a lower heart rate without morbidity.

Microelectrode recordings (MERs) are used during deep brain stimulation surgery (DBS) to optimize patient outcomes and provide a unique method of collecting data regarding neurological conditions. However, MERs can be affected by anesthetics such as dexmedetomidine. Little is known about the effects of dexmedetomidine (DEX) on the globus pallidus interna (GPi), a common target for DBS. The primary aim of this study is to investigate the hypothesis that DEX is associated with alterations in GPi MERs.

We conducted a retrospective analysis comparing MERs from patients with Parkinson’s disease (PD) and dystonia who underwent insertion of DBS of the GPi under DEX sedation with those who went through the same procedure without DEX (No DEX).

Firing rates for GPi neurons in the DEX group were lower (57.44 ± 2.04; mean ± SEM, n = 163 cells) than the No DEX group (69.53 ± 2.06, n = 112 cells, P < 0.0001). Overall, DEX was associated with a greater proportion of GPi cells classified as firing in bursty pattern compared to our No DEX group. (29.41%, n = 153 vs 14.81%, n = 108, P = 0.008). This effect was present for both PD and dystonia patients who underwent the procedure. High doses of DEX were associated with lower firing rates than low doses.

Our results suggest that DEX is associated with a decrease in GPi firing rates and are associated with an increase in burstiness. Furthermore, these effects are similar between dystonia and PD patients. Lastly, the effects of DEX may differ between high doses and low doses.

This retrospective case series examined the outcomes of surgeon-performed intubation using the anterior commissure rigid laryngoscope and bougie in adults with a difficult airway, including awake patients.

This study comprised a series of adult patients who underwent surgeon-performed intubation over a 10-year period. They were identified by a records search for the Current Procedural Terminology (‘CPT’) code 31500 – ‘intubation by surgeon’.

Forty-nine intubations performed in the operating theatre were reviewed. Intubation performed by the surgeon using the rigid anterior commissure laryngoscope was successful in 47 of the cases (96 per cent). Over half of the patients had experienced failed intubation attempts with other methods by other providers prior to the surgeon performing direct laryngoscopy. Twenty intubations were performed without paralytics and with the patient awake.

In properly selected adults who need an urgent, secure airway in the operating theatre, surgeon-performed anterior commissure laryngoscopic intubation using a bougie should be considered a safe, reliable procedure. In most cases, this procedure can be performed in selected patients whilst awake, with sedation.

Intra-operative bleeding diminishes visualisation during functional endoscopic sinus surgery and can cause unfavourable outcomes. Dexmedetomidine is a potent alpha-2 agonist, with sympatholytic effects. This systematic review aimed to assess whether dexmedetomidine decreases intra-operative bleeding and improves operative field quality.

All randomised, controlled trials that assessed the ability of dexmedetomidine to provide good operative fields for functional endoscopic sinus surgery were identified from Medline and Embase. The outcomes of interest were: operative field quality, intra-operative bleeding, operative time and adverse events.

Five studies (254 patients) met the inclusion criteria. When compared to saline, dexmedetomidine improved the quality of the operative field. The operative time was similar between groups. When compared to other drugs, dexmedetomidine was as effective as esmolol and remifentanil. There were no adverse incidents.

Dexmedetomidine is beneficial in providing good visibility during functional endoscopic sinus surgery. Controlled hypotensive anaesthesia with this medicine decreases intra-operative bleeding and enhances surgical field quality.

To evaluate the peri-operative usefulness of dexmedetomidine in obstructive sleep apnoea surgery.

In a clinical audit, patients were divided into a study group (dexmedetomidine used; n = 125; 82.9 per cent males, 17.1 per cent females; mean age 48.1 years) and a control group (dexmedetomidine not used; n = 143; 85.5 per cent males, 14.5 per cent females; mean age 47.4 years). The selected outcome measures were mean arterial pressure, use of anti-hypertensives and use of opioids.

Mean arterial pressure was stable (i.e. below 100 mmHg) in 93.3 per cent of the study group and 72.0 per cent of the control group (relative risk 1.30, 95 per cent confidence interval 1.14–1.47). The use of glyceryl trinitrate and hydralazine was significantly less in the study group, compared with controls (p = 0.005 and <0.001, respectively). Study group patients underwent more procedures than control patients (p < 0.001) and were more likely to require morphine. No difference was noted in the median dose of opioids.

Dexmedetomidine improves haemodynamic stability in patients undergoing surgery for obstructive sleep apnoea. It is reliable and reduces the need for polypharmacy. Its opioid-sparing action has been established in the literature; however, this was not demonstrated in our study.

Analgesia and sedation are usually required during extracorporeal shock wave lithotripsy. In the present study, the recovery time and effectiveness of sedation and analgesia of dexmedetomidine was compared with a midazolam/fentanyl combination in outpatient extracorporeal shock wave lithotripsy.

Forty-nine patients scheduled for outpatient extracorporeal shock wave lithotripsy were randomly assigned to two groups: a dex group (n = 25; dexmedetomidine 1 μg kg−1 loading dose followed by dexmedetomidine 0.2 μg kg−1 h−1) and a control group (n = 24; midazolam 0.05 mg kg−1 and fentanyl 1 μg kg−1). Recovery time, rescue analgesics (fentanyl 25 μg) and sedatives (midazolam 1 mg), and patients’ satisfaction rates were recorded.

The two groups were similar regarding patient characteristics and procedure-related details (P > 0.05). Recovery time was significantly prolonged in the dex group when compared with the control group (116.4 ± 39.3 vs. 50.8 ± 19.8 min, respectively, P < 0.001). The percentage of patients requiring rescue doses of fentanyl and the applied doses were significantly higher in the dex group than in the control group (96% vs. 67%, P = 0.01; and 69.0 ± 31.7 vs. 38.8 ± 42.9 μg, respectively, P = 0.007). More patients in the dex group received rescue midazolam (96% vs. 58%, P = 0.002). More patients in the control group were highly satisfied with their sedation/analgesia (83% vs. 56%, P = 0.038).

Dexmedetomidine was associated with a longer recovery time than a midazolam/fentanyl combination when used for sedation and analgesia during outpatient extracorporeal shock wave lithotripsy in this study. The incidence of rescue sedative and analgesic need was also significantly higher when dexmedetomidine was used.

To determine whether intraoperative systemic dexmedetomidine improves postoperative pain and interacts with epidural neostigmine to produce analgesic effects.

Sixty patients undergoing gynaecological surgery were randomly divided into four groups to receive epidural neostigmine and/or systemic dexmedetomidine: control (Group C), epidural neostigmine (Group N), systemic dexmedetomidine (Group D) and co-administered neostigmine and dexmedetomidine (Group ND). Epidural neostigmine (0.3 mg) was administered with 10 mL of 0.75% ropivacaine before the induction of general anaesthesia. Systemic dexmedetomidine (loading dose of 1 μg kg−1 over 10 min followed by 0.4 μg kg−1 h−1) was infused after the induction of general anaesthesia and continued until the end of surgery. The pain status of patients was assessed using the visual analogue scale at 2, 4, 6, 24 and 72 h postoperatively.

Intraoperative systemic dexmedetomidine alone did not reduce postoperative pain scores. However, co-administered neostigmine and dexmedetomidine significantly decreased scores at 24 and 72 h (Group C: 3.0 [1.0–5.8] and 2.0 [0.3–3.0]; Group N: 1.5 [0.3–3.4] and 0 [0–1.3]; Group D: 3.5 [0–5.0] and 0 [0–1.4]; and Group ND: 0 [0–1.0]* and 0 [0–0]†; median [interquartile range] *P = 0.0031, †P = 0.0045 compared with Group C).

The intraoperative systemic infusion of dexmedetomidine alone at doses causing sedation does not result in postoperative analgesic effects. However, the co-administration of systemic dexmedetomidine and epidural neostigmine at higher doses may be a useful method to improve postoperative pain although side-effects have to be evaluated.

The anaesthetic method for intracranial neurosurgery must provide haemodynamic stability on emergence and allow early evaluation of the neurological status. In this study, we examined the effects of the α-2 agonist dexmedetomidine given at the end of the procedure to prevent hyperdynamic responses during extubation and to allow a comfortable and high-quality recovery.

Forty ASA I–III patients, aged between 18 and 75 yr, having elective intracranial surgery, were divided into two random groups. Standard procedures and drugs were used for monitoring, induction and maintenance. Isoflurane was reduced by 50% 5 min before the end of the surgery, and in Group I dexmedetomidine 0.5 μg kg−1 and in Group II 20 mL of 0.9% NaCl were administrated intravenously over 60 s. Systolic, diastolic and mean arterial pressures, and heart rate were recorded before intravenous administration and also at 1, 3 and 5 min after administration, 1 min before extubation, during extubation, 1, 3, 5, 10, 15, 20 and 30 min after extubation. Duration of extubation and recovery were noted, and the quality of extubation was evaluated on a 5-point scale.

Mean arterial pressure and heart rate were significantly higher in Group II than in Group I (P < 0.01). There were no statistically significant differences between groups regarding the duration of extubation and recovery (P > 0.05). Extubation quality score of all the patients were 1 in Group I; and in Group II, the quality scores were 1 for 35%, 2 for 45% and 3 for 20% of the patients (P < 0.001). None of the patients in Group I and Group II showed respiratory depression, nausea or vomiting.

Without interfering in recovery time, dexmedetomidine 0.5 μg kg−1 administered 5 min before the end of surgery stabilizes haemodynamics, allows easy extubation, provides a more comfortable recovery and early neurological examination following intracranial operations.

There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol.

In all, 52 patients, ASA I–II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 μg kg−1 fentanyl (in 10 mL normal saline) and Group D received 1 μg kg−1 dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg−1 propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion.

More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001).

Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Controlled hypotension is frequently used for obtaining better exposure during tympanoplasty. The aim of this study was to compare dexmedetomidine, a selective, short-acting, central α2-adrenergic agonist with remifentanil, an ultra-short-acting opioid with properties similar to other μ-specific agonists, regarding their effects in achieving controlled hypotension and improving surgical field exposure and surgeon’s satisfaction during tympanoplasty.

In this prospective, double-blind pilot study, 24 consecutive patients scheduled for elective tympanoplasty were randomly assigned to receive either dexmedetomidine 1 μg kg−1 over 10 min at anaesthesia induction followed by 0.4–0.8 μg kg−1 h−1 infusion during maintenance or remifentanil 1 μg kg−1 over 1 min at anaesthesia induction followed by 0.2–0.4 μg kg−1 min−1 infusion during maintenance. Mean arterial pressure and heart rate were recorded before induction, at incision, 30, 60, 90 and 120 min after incision and 10 min after stopping the infusion. Surgical field exposure condition and satisfaction scores were assessed by the surgeon, blinded to the study drugs.

Mean arterial pressure and heart rate were significantly lower in the remifentanil group compared with the dexmedetomidine group at all times (P = 0.03 and 0.036, respectively). Surgical field exposure condition (3 ± 0.01 vs. 2.3 ± 0.7; P = 0.039) and surgeons’ satisfaction (3 ± 0.01 vs. 2.25 ± 0.87; P = 0.039) scores were significant after remifentanil compared with dexmedetomidine.

Infusion of dexmedetomidine, at the doses used in this study, was less effective than remifentanil in achieving controlled hypotension, good surgical field exposure condition and surgeons’ satisfaction during tympanoplasty.