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Published on: January 17, 2011
Dexmedetomidine versus fentanyl as adjuvant to propofol: comparative study in children undergoing extracorporeal
Ashgan Raouf Ali1, Mohamed N El Ghoneimy
1Department of Anaesthesiology (ARA), Faculty of Medicine, Cairo University, Cairo, Egypt. ashganraouf@yahoo.com
Insights
Dexmedetomidine combined with propofol reduced propofol use and prolonged pain relief in children undergoing extracorporeal shock wave lithotripsy compared to fentanyl. This combination also showed fewer complications.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Extracorporeal shock wave lithotripsy (ESWL) in children requires effective anesthesia.
- Comparing dexmedetomidine and fentanyl as adjuncts to propofol for pediatric ESWL.
Purpose of the Study:
- To compare the efficacy, tolerability, and safety of dexmedetomidine and fentanyl when combined with propofol for pediatric ESWL.
Main Methods:
- Fifty children (3-8 years, ASA I-II) received either propofol/dexmedetomidine or propofol/fentanyl for ESWL.
- Infusion rates were adjusted to maintain hemodynamics within ±20% of baseline.
- Propofol infusion maintained bispectral index (40-60); drug doses, hemodynamics, complications, and time to analgesia were recorded.
Main Results:
- Propofol requirement was significantly lower with dexmedetomidine vs. fentanyl (P < 0.0001).
- Dexmedetomidine group had lower intraprocedural hypoventilation (P = 0.016) and longer time to first analgesic (P < 0.0001).
- Both combinations were effective, but dexmedetomidine showed reduced propofol consumption and fewer complications.
Conclusions:
- Propofol/dexmedetomidine and propofol/fentanyl are effective for pediatric ESWL.
- Propofol/dexmedetomidine offers advantages including less propofol use, prolonged analgesia, and reduced complications.
Background:
the present study was designed to compare the efficacy, tolerability and safety of dexmedetomidine and fentanyl when combined with propofol during extracorporeal shock wave lithotripsy in children.
Methods:
fifty children aged 3-8 years, the American Society of Anesthesiologists status I and II, scheduled for elective extracorporeal shock wave lithotripsy were randomly allocated to receive a loading dose 0.7 μg kg over 10 min followed by maintenance infusion 0.3 μg kg h of either dexmedetomidine in propofol/dexmedetomidine group or fentanyl in propofol/fentanyl group (n = 25 each). The target drug infusion rates were adjusted to keep the haemodynamics within ± 20% from the baseline values. All patients received propofol infusion to maintain bispectral index values (40-60) throughout the procedure. Induction and maintenance doses of propofol were recorded. Total doses of both studied drugs were calculated. Perioperative haemodynamics, incidence of intraprocedural and postprocedural complications and time to first analgesic requirement were recorded.
Results:
the propofol requirement was significantly lower in the propofol/dexmedetomidine group than that in propofol/fentanyl group during induction and maintenance of anaesthesia (P < 0.0001). Total doses of fentanyl and dexmedetomidine were 0.961 (0.1) μg kg and 0.925 (0.07) μg kg, respectively. Mean arterial pressure and heart rate were significantly decreased compared to the baseline throughout the procedure in both groups and increased significantly relative to both baseline and the other group at 30 min in the propofol/fentanyl group and 60 min in the propofol/dexmedetomidine group in the recovery area (P < 0.05). In propofol/dexmedetomidine group, the incidence of intraprocedural hypoventilation was significantly lower (P = 0.016) and time to first analgesic requirement was significantly longer (P < 0.0001) than that in propofol/fentanyl group.
Conclusion:
both propofol/fentanyl and propofol/dexmedetomidine combinations at mentioned dose regimen were effective and well tolerated for children undergoing extracorporeal shock wave lithotripsy. However, propofol/dexmedetomidine combination was accompanied with less propofol consumption, prolonged analgesia and lower incidence of intraprocedural and postprocedural complications.
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