Dexmedetomidine Activation of Dopamine Neurons in the Ventral Tegmental Area Attenuates the Depth of Sedation in Mice

Anesthesiology, Год журнала: 2020, Номер 133(2), С. 377 - 392

Опубликована: Май 12, 2020

Background Dexmedetomidine induces a sedative response that is associated with rapid arousal. To elucidate the underlying mechanisms, authors hypothesized dexmedetomidine increases activity of dopaminergic neurons in ventral tegmental area, and this action contributes to unique properties dexmedetomidine. Methods Only male mice were used. The area dopamine was measured by genetically encoded Ca2+ indicator patch-clamp recording. Dopamine neurotransmitter dynamics medial prefrontal cortex nucleus accumbens sensor. Ventral inhibited or activated chemogenetic approach, depth sedation estimated electroencephalography. Results signals increased after intraperitoneal injection (40 μg/kg; dexmedetomidine, 16.917 [14.882; 21.748], median [25%; 75%], vs. saline, –0.745 [–1.547; 0.359], normalized data, P = 0.001; n 6 mice). transmission 10.812 [9.713; 15.104], –0.498 [–0.664; –0.355], mice) (dexmedetomidine, 8.543 [7.135; 11.828], –0.329 [–1.220; –0.047], Chemogenetic inhibition activation decreased slow waves, respectively, delta wave: two-way repeated measures ANOVA, F[2, 33] 8.016, 0.002; 12 mice; theta 22.800, < 0.0001; Conclusions activates concentrations related forebrain projection areas. This mechanism may explain arousability upon sedation. Editor’s Perspective What We Already Know about Topic Article Tells Us That Is New

Язык: Английский

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Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia

European Journal of Anaesthesiology, Год журнала: 2020, Номер 38(1), С. S9 - S17

Опубликована: Окт. 28, 2020

BACKGROUND Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce. OBJECTIVE To investigate the efficacy and safety reducing POD elderly transthoracic with total intravenous anaesthesia (TIVA). DESIGN A randomised, double-blind, placebo-controlled trial. SETTING Single-centre, tertiary care hospital, November 2016 September 2018. PATIENTS Eligible ( n = 177) were randomly assigned receive (TIVA, 87) or TIVA (DEX-TIVA, 90). INTERVENTIONS Patients receiving DEX-TIVA received loading dose (0.4 μg kg −1 ), over 15 min, followed by continuous infusion at rate 0.1 h until 1 before end physiological saline similar protocol. OUTCOME MEASURES The primary outcome was incidence POD. secondary endpoints emergence agitation, serum interleukin-6 (IL-6) levels haemodynamic profile. RESULTS All randomised included planned intention-to-treat analyses for Delirium occurred (16.7%) 90 cases given dexmedetomidine, 32 (36.8%) 87 P 0.0036). group showed less frequent agitation than (22.1 vs. 48.0%, 0.0058). incremental change surgery-induced IL-6 greater < 0.0001). CONCLUSION Adding peri-operative anaesthetic safely reduces open oesophagectomy. These benefits associated reduction circulating pro-inflammatory cytokine stabilisation TRIAL REGISTRATION Chinese Clinical Trials Register Identifier: ChiCTR-IPR-17010881.

Язык: Английский

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Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Current Neuropharmacology, Год журнала: 2021, Номер 19(9), С. 1519 - 1544

Опубликована: Янв. 19, 2021

Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS), starting with primary pathology inciting trauma and subsequent inflammatory CNS tissue response. Delirium has long been regarded as an almost inevitable consequence moderate to severe TBI, but more recently recognized organ dysfunction syndrome potentially mitigating interventions. The diagnosis delirium is independently associated prolonged hospitalization, increased mortality worse cognitive outcome across critically ill populations. Investigation unique problems management challenges TBI patients needed reduce burden in this population. In narrative review, possible etiologic mechanisms behind post-traumatic are discussed, including structures mediating arousal attention secondary due progressive destruction parenchyma. Other potential contributors include dysregulation neurotransmission intravenous sedatives, seizures, failure, sleep cycle disruption or other risk factors. screening be accomplished presence portends outcomes. There evidence that multi-component care bundles analgesia-prioritized sedation algorithm, regular spontaneous awakening breathing trials, protocolized assessment, early mobility family engagement ICU delirium. aim review summarize approach emphasis on pathogenesis management. Emerging CNS-active drug therapies show promise preclinical studies highlighted.

Язык: Английский

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Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view

European Journal of Pediatrics, Год журнала: 2023, Номер 182(5), С. 2013 - 2026

Опубликована: Март 9, 2023

Язык: Английский

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Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis

˜The œItalian Journal of Pediatrics/Italian journal of pediatrics, Год журнала: 2024, Номер 50(1)

Опубликована: Фев. 8, 2024

Delirium, a form of acute cerebral dysfunction, is common complication postoperative cardiac surgery in children. It strongly associated with adverse outcomes, including prolonged hospitalization, increased mortality, and cognitive dysfunction. This study aimed to identify risk factors incidence delirium after children facilitate early identification provide reference for the implementation effective prevention management. A systematic literature search was conducted PubMed, Web Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, Wanfang studies published English or Chinese from inception each database November 2023. The PRISMA guidelines were followed all phases this review. Risk Bias Assessment Nonrandomized Studies tool used assess methodological quality. total twelve included analysis, four classified as overall low bias, seven moderate one high bias. reported 39 possible predictors delirium, categorized into broad groups: intrinsic parent-related factors, disease-related treatment-related clinical scores laboratory parameters. By conducting qualitative synthesis quantitative meta-analysis, we identified two definite 32 unclear related delirium. Definite age mechanical ventilation duration. Possible developmental delay, cyanotic heart disease, cardiopulmonary bypass time, pain score. With only few high-quality currently available, well-designed more extensive prospective are still needed investigate affecting explore strategies high-risk

Язык: Английский

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