Abstract:
BACKGROUND:Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis. METHODS:Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes. RESULTS:We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, P < 0.0001), motor block (at least 58%, P < 0.0001), and analgesia (at least 63%, P < 0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, P < 0.0001) and motor (at least 39%, P < 0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (P < 0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](P = 0.0002)), and hypotension (5.4 [2.7, 11.0] (P < 0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system. CONCLUSIONS:New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Vorobeichik L,Brull R,Abdallah FWdoi
10.1093/bja/aew411subject
Has Abstractpub_date
2017-02-01 00:00:00pages
167-181issue
2eissn
0007-0912issn
1471-6771pii
S0007-0912(17)30077-6journal_volume
118pub_type
杂志文章,meta分析,评审abstract::A series of 443 spinal anaesthetics is described. The procedures included operative vaginal delivery, removal of retained placenta and a miscellaneous group common to most obstetric units. Failure to provide effective relief of pain occurred in 5.2% of patients. There was one potentially serious complication, but with...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/51.6.531
更新日期:1979-06-01 00:00:00
abstract::A new type of intra-arterial oxygen electrode was evaluated. In 14 patients, undergoing one-lung ventilation for thoracic surgery, the electrode was inserted into the radial artery and changes in PaO2 were recorded continuously. Methods of improving PaO2 during one-lung ventilation were demonstrated. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.10.1005
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aeu001
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:The inhibitory effect of anaesthetic agents on hypoxic pulmonary vasoconstriction may depend upon their dose, especially when using a volatile agent. The aim of this randomized open study was to compare the effects of sevoflurane and propofol, as primary anaesthetic agents, on oxygenation during one-lung ven...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem039
更新日期:2007-04-01 00:00:00
abstract::Procaine has been advocated in the treatment of malignant hyperpyrexia, whereas lignocaine has been shown to worsen the condition. Using muscle from patients susceptible to malignant hyperpyrexia in vitro, it has been demonstrated that muscle contracture can occur with procaine on its own, and in one patient the halot...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/47.1.17
更新日期:1975-01-01 00:00:00
abstract::Thirty patients for elective lower segment Caesarean section were randomly divided into two groups. One group received 50 mulitre/kg of Althesin for induction of anaesthesia and the other, 100 mulitre/kg. The two maternal groups were similar. There was no significant difference in the clinical or biochemical status of...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/47.11.1213
更新日期:1975-11-01 00:00:00
abstract::In a random, double-blind crossover trial using an ischaemic limb pain model we have assessed the speed of onset of analgesia after an i.v. bolus of equipotent doses of diamorphine and morphine in 12 healthy male volunteers. Pain and its subsequent relief were assessed by means of a visual analogue scale. Two of the s...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/66.6.656
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Dynamic variables reliably predict fluid responsiveness (FR) in adults, but no data are available regarding their performance in infants. The aim of this prospective study was to assess whether pulse pressure variation (PPV) and stroke volume variation (SVV), in contrast to central venous pressure (CVP) and ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer371
更新日期:2012-01-01 00:00:00
abstract::This report describes the anaesthetic management of a ventricular arrhythmia-prone patient with a prolonged Q-T interval for closed reduction and wiring of a mandibular fracture. The patient was premedicated with propranolol and anaesthetized with isoflurane (inhalation). Documentation of heart rate v. Q-T interval re...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/55.4.361
更新日期:1983-04-01 00:00:00
abstract:BACKGROUND:Hip fracture is a condition with high mortality and morbidity in elderly frail patients. Intraoperative fluid optimization may be associated with benefit in this population. We investigated whether intraoperative fluid management using pulse-contour analysis cardiac monitoring, compared with standard care in...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aeu386
更新日期:2015-03-01 00:00:00
abstract::We present a case of fatal cardiac tamponade that occurred in association with a peripherally inserted central catheter (PICC) inserted from the right antecubital fossa. Migration of the catheter from the right atrium within 24 h of insertion lead to the administration of a potassium-enriched sodium chloride solution ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aem181
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:The pharmacokinetic profile of local anaesthetics is influenced by the mode of administration. We sought to compare the pharmacokinetics of two doses of ropivacaine after fascia iliaca compartment (FIC) block in children. METHODS:In this prospective, double-blind study, children received an FIC block as a p...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/aeh066
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of APE. MET...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aes315
更新日期:2012-12-01 00:00:00
abstract::Six male patients were studied on the morning following upper abdominal surgery for highly selective vagotomy. Nalbuphine hydrochloride was infused i.v. at different rates that increased progressively in each hour over a 4-h period. In the last 15 min of each hour, the plasma nalbuphine concentrations were almost stea...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.11.1356
更新日期:1987-11-01 00:00:00
abstract:BACKGROUND:In regional anaesthesia, there is a risk of direct nerve injury. The purpose of this study was to determine whether the diameter of the applied needle is associated with the magnitude of nerve injury after needle nerve perforation. METHODS:In five anaesthetized pigs, the brachial plexus were exposed bilater...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aep366
更新日期:2010-02-01 00:00:00
abstract::An investigation was carried out into the relationship between the inflation pressures of normally compliant lungs and the airways pressure necessary to produce the insufflation of gas to the stomach. This relationship was examined during manual ventilation with a mask, using a rapid sequence induction technique. In t...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.3.315
更新日期:1987-03-01 00:00:00
abstract::Twelve hydrocephalic patients undergoing hydrodynamic studies and shunt procedures during general anaesthesia were subjected to short term observations of the cerebrovascular effects of isoflurane. Intraventricular pressure (IVP), arterial pressure (AP); cerebral perfusion pressure (CPP = AP-IVP), end-tidal PCO2, Cere...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.10.1208
更新日期:1987-10-01 00:00:00
abstract::Plasma diazepam concentrations were determined following oral, i.m. and i.v. administration to a group of pregnant women with pre-eclampsia and a group of normal pregnant women. Diazepam concentrations were greater following oral as compared with i.m. administration in the control group, who received a single 5-mg dos...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.11.1091
更新日期:1976-11-01 00:00:00
abstract::We have measured plasma concentrations of bupivacaine after ilioinguinal block in children of different sizes. We studied 14 children with weights 10-15 kg and 17 children with weights 15-30 kg. Each child received 0.5% bupivacaine 0.25 ml kg-1 (1.25 mg kg-1) (Carbostesin, Astra, Germany). Venous blood was obtained be...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.3.452
更新日期:1996-03-01 00:00:00
abstract::We have studied the effect of analgesia on maternal temperature (oral and tympanic membrane) progression in 53 women during normal spontaneous labour. Three groups were studied: two received extradural analgesia with a continuous infusion of 0.25% bupivacaine with or without the addition of fentanyl; the third group r...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/67.5.565
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Microalbuminuria, often referred to as the urinary albumin-creatinine ratio (ACR), is thought to be a reflection of increased capillary permeability associated with the systemic inflammatory response syndrome, and has been found to be predictive of outcome in several studies. Therefore, we explored the usefu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/ael211
更新日期:2006-10-01 00:00:00
abstract::We have assessed the role of the cell-cell adhesion molecule, E-cadherin, in the pathogenesis of multiorgan failure in 24 intensive care patients with sepsis and varying degrees of organ dysfunction, compared with 21 healthy subjects. Plasma soluble E-cadherin (sE-cadherin) was measured by enzyme immunoassay. The medi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.5.629
更新日期:1996-05-01 00:00:00
abstract::Patients with Munchausen's syndrome often undergo multiple surgical operations under general anaesthesia. They tend to have multiple exposures to routinely used anaesthetic agents. A patient with Munchausen's syndrome who developed an anaphylactoid reaction to thiopentone is described and the importance of obtaining p...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.11.1472
更新日期:1987-11-01 00:00:00
abstract::Plasma concentrations of amethocaine were measured after topical application of amethocaine cream 2 g (5% w/w) to the dorsum of the right hand of 10 adult volunteers. The cream was applied for 240 min and plasma was assayed for amethocaine and its metabolite p-n-butylaminobenzoic acid at 0, 30, 60, 90, 120 and 240 min...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/67.4.432
更新日期:1991-10-01 00:00:00
abstract::Cardioventilatory coupling (CVC) is the temporal coherence of respiratory and cardiac rhythms. We have suggested that this coherence is the result of triggering of inspiratory onset by a preceding cardiovascular afferent. One implication of this triggering hypothesis is that coupling should only exist under conditions...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/82.4.546
更新日期:1999-04-01 00:00:00
abstract::Pyridostigmine 0.143 mg kg-1 (maximum 10 mg) and atropine 0.0143 mg kg-1 (maximum 1 mg) were administered i.v. to six healthy male volunteers. Peripheral venous blood samples were drawn for measurement of serum cholinesterase activity. Maximum inhibition of the enzyme was found 5 min after injection with a decrease to...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/57.2.204
更新日期:1985-02-01 00:00:00
abstract::The 119 patients who had undergone previous Caesarean section lumbar extradural block was administered to 77 (65%); the other 42 (35%) received analgesia with ketobemidone 0.8-1.0 ml i.m. or nitrous oxide in oxygen intermittently, or both. Controlled i.v. infusion of oxytocin for induction or acceleration of labour wa...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/52.8.827
更新日期:1980-08-01 00:00:00
abstract:BACKGROUND:Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. Quality improvement strategies described by exemplar hospitals of the Global Tracheostomy Collaborative have potential to mitigate such problems. This 3 yr guided implementation programme inves...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1016/j.bja.2020.04.064
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:We measured the effect of two weight adjusted i.v. doses (0.2 mg per 70 kg and 0.4 mg per 70 kg) of the potent opioid buprenorphine on analgesia and respiratory depression in healthy volunteers. The aim of the study was to compare buprenorphine's behaviour with respect to the occurrence of ceiling (or appare...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/ael051
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Interscalene brachial plexus block (ISBPB) is an effective nerve block for shoulder surgery. However, a 100% incidence of phrenic nerve palsy limits the application of ISBPB for patients with limited pulmonary reserve. We examined the incidence of phrenic nerve palsy with a low-volume ISBPB compared with a s...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aen229
更新日期:2008-10-01 00:00:00