Dexmedetomidine, an alpha-2 adrenergic agonist is a relatively new drug and an upcoming agent which can be used for procedural sedation. It has sedative, anxiolytic and analgesic properties without respiratory depression. Percutaneous RF ablation is an alternative treatment for hepatocellular carcinomas (HCCs) but it requires a deep patient sedation. The aim of our study was to investigate the effect of dexmedetomidine on perioperative sedation, hemodynamic, ventilation, pain level, patient satisfaction, and interventional physician comfort during HCCs ablation procedures. Patients undergoing RF ablation procedures for HCCs were enrolled. Mean arterial pressure (PAM), Heart Rate (HR), Peripheral Oxygen Saturation (SpO2), Respiratory Rate (RR) and electrocardiogramm were recorded before, during and after the procedures every 5 minu- tes. A dose of 1 mcg/Kg dexmedetomidine was administered i.v. in about 10 minutes. The RF ablation started 15-20 min after the end of the infusion but previous the administration of a bolus of fentanyl 1-1,5 mcg/kg and a cutaneous local anaesthesia. Preoperative anxiety level, Ramsay sedation scale (RSS) before and after the end of the procedure and any adverse reactions were re- corded. After and the end of the procedure, the level of patient pain, patient satisfaction and physician comfort were also recorded. We enrolled 12 patients: 5 females and 7 males, classified in ASA physical status II-III. Mean age was 65 years. PAM and HR were stable during the procedures; in two cases we had a severe bradycardia requiring atropine administration. At the end of the procedure, all patients reported no pain and were very satisfied. Dexmedetomidine can be used as an alternative to conventional drugs in procedural sedation; it has a better safety profile because of the stability of haemodynamic and respiratory pattern. In association with fentanyl analgesia and local anaesthesia, it provides good analge- sia and high patient’s satisfaction score. During RF ablation on HCCs it allows a better comfort for the interventional physician

Dexmedetomidine for sedation: our experience with ultrasound guided percutaneous hepatocellular carcinomas (HCCs) radiofrequency (RF) ablation

F. Bruno;V. Palmieri;F. Puntillo
2019

Abstract

Dexmedetomidine, an alpha-2 adrenergic agonist is a relatively new drug and an upcoming agent which can be used for procedural sedation. It has sedative, anxiolytic and analgesic properties without respiratory depression. Percutaneous RF ablation is an alternative treatment for hepatocellular carcinomas (HCCs) but it requires a deep patient sedation. The aim of our study was to investigate the effect of dexmedetomidine on perioperative sedation, hemodynamic, ventilation, pain level, patient satisfaction, and interventional physician comfort during HCCs ablation procedures. Patients undergoing RF ablation procedures for HCCs were enrolled. Mean arterial pressure (PAM), Heart Rate (HR), Peripheral Oxygen Saturation (SpO2), Respiratory Rate (RR) and electrocardiogramm were recorded before, during and after the procedures every 5 minu- tes. A dose of 1 mcg/Kg dexmedetomidine was administered i.v. in about 10 minutes. The RF ablation started 15-20 min after the end of the infusion but previous the administration of a bolus of fentanyl 1-1,5 mcg/kg and a cutaneous local anaesthesia. Preoperative anxiety level, Ramsay sedation scale (RSS) before and after the end of the procedure and any adverse reactions were re- corded. After and the end of the procedure, the level of patient pain, patient satisfaction and physician comfort were also recorded. We enrolled 12 patients: 5 females and 7 males, classified in ASA physical status II-III. Mean age was 65 years. PAM and HR were stable during the procedures; in two cases we had a severe bradycardia requiring atropine administration. At the end of the procedure, all patients reported no pain and were very satisfied. Dexmedetomidine can be used as an alternative to conventional drugs in procedural sedation; it has a better safety profile because of the stability of haemodynamic and respiratory pattern. In association with fentanyl analgesia and local anaesthesia, it provides good analge- sia and high patient’s satisfaction score. During RF ablation on HCCs it allows a better comfort for the interventional physician
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11586/283236
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