Dexmedetomidine for intraoperative sedation in a severe Chronic obstructive pulmonary disease patient for lower limb amputation under regional anesthesia - A novel choice
Keywords:
Conscious sedation, Dexmedetomidine, Regional anaesthesiaAbstract
The effective management of sedation and analgesia in severe chronic obstructive pulmonary disease patients provides a challenge to the anaesthesiologists and critical care practitioners. Choosing the appropriate agent or combination of agents for sedation is crucial in order to alleviate noxious stimuli, stress and anxiety while minimizing the risk of adverse events. We selected epidural anaesthesia and dexmedetomidine to preserve spontaneous breathing and obtained appropriate sedative and analgesic effect without causing respiratory depression and hemodynamic changes in a patient diagnosed to have chronic obstructive pulmonary disease undergoing femoral to tibial bypass with amputation of right foot.References
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2. Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg 2010;110:47-56.
3. Kitamura H, Kitayama M, Tanimo T, Yamaki R, Komatsu H. Successful anesthetic management in a patient with chronic obstructive pulmonary disease(COPD) using dexmedetomidine and combined spinal-epidural anesthesia for low anterior resection of the rectum. Masui 2012;61:840-3.
4. Drouot X, Cabello B, Brochard l. Sleep in the intensive care unit. Sleep Med Rev 2008;12:391-403.
5. Belleville J P, Ward D S, Bloor B C, Maze M. Ventilatory effects of dexmedetomidine in humans . Anesthesiology 1992;77:1125-33.
6. Riker R R , Shehabi Y, Bokesch P, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301:489-99.
7. Elbaradie S, E l Mahalawy F H, Solyman A H. Dexmedetomidine vs. propofol for short term sedation of postoperative mechanically ventilated patients. J Egypt Natl Canc Inst 2004;16:153-8.
8. Grounds R M, Lalor J M, Lumley J, Royston D, Morgan M. Propofol infusion for sedation in the in the icu: a preliminary report. BMJ 1987;294:397-400.
9. Atkenhead A R, Willats S M, Park G. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet 1989,2:704-9.
10. Salonen M, Reid K, Maze M. Synergistic interaction between alpha-2 adrenergic agonists and benzodiazepines in rats. Anesthesiology 1992;76:1004-11.
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Published
2015-02-26
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Sharma, A., Basnet, M., & Pradhan, B. (2015). Dexmedetomidine for intraoperative sedation in a severe Chronic obstructive pulmonary disease patient for lower limb amputation under regional anesthesia - A novel choice. Journal of Society of Anesthesiologists of Nepal, 2(1), 34-36. Retrieved from http://www.jsan.org.np/jsan/index.php/jsan/article/view/34
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