Study objective: To determine the median effective concentration (EC50) of remifentanil during targeted-controlled infusion for smooth tracheal extubation during emergence from total intravenous anesthesia in elderly patients.Design: Prospective, Dixon up-and-down method.Setting: Postoperative emergence.Patients: Twenty-four American Society of Anesthesiologists grade I-II female elderly patients undergoing elective jaw cyst surgery.Interventions: The EC50 of remifentanil for smooth emergence was calculated by the Dixon up-and-down method.Measurements: The EC50 and 95% confidence intervals were analyzed by probit analysis using logistic regression. Vital signs (mean arterial pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide partial pressure), postanesthesia recovery score, visual analogue pain scale, and adverse effects were monitored. Mean arterial pressure and heart rate were compared between patients with smooth extubation vs those with failed smooth extubation.Main results: The Dixon up-and-down method showed that the EC50 of remifentanil for smooth tracheal extubation during emergency from anesthesia was 0.94 ng/mL in female elderly patients. The probit analysis showed that the EC50 of remifentanil was 0.99 ng/mL (95% confidence interval, 0.52-1.51 ng/mL). Heart rate and mean arterial pressure were significantly lower in patients with smooth extubation as compared with those with failed smooth extubation at 0 minute (at extubation) as well as 1 and 5 minutes after extubation (P< .05).Conclusions: Target infusion of remifentanil at 0.94 ng/mL could effectively inhibit tracheal extubation related cough response and cardiovascular responses in 50% of the female elderly patients without delaying recovery from anesthesia, which could ensure smooth tracheal extubation during emergence from anesthesia. (C) 2016 Elsevier Inc. All rights reserved.

The aim of the study was to determine whether or not dexmedetomidine- (DEX-) based intravenous infusion in dental implantation can provide better sedation and postoperative analgesia via suppressing postoperative inflammation and oxidative stress. Sixty patients were randomly assigned to receive either DEX (group D) or midazolam (group M). Recorded variables were vital sign (SBP/HR/RPP/SpO 2 /RR), visual analogue scale (VAS) pain scores, and observer’s assessment of alertness/sedation scale (OAAS) scores. The plasma levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF- α ), antioxidant superoxide dismutase (SOD), and the lipid peroxidation product malondialdehyde (MDA) were detected at baseline and after 2, 4, and 24 h of drug administration. The VAS pain scores and OAAS scores were significantly lower for patients in group D compared to group M. The plasma levels of TNF- α , IL-6, and MDA were significantly lower in group D patients than those in group M at 2 h and 4 h. In group M, SOD levels decreased as compared to group D at 2 h and 4 h. The plasma levels of TNF- α , IL-6, and MDA were positively correlated with VAS pain scores while SOD negatively correlated with VAS pain scores. Therefore, DEX appears to provide better sedation during office-based artificial tooth implantation. DEX offers better postoperative analgesia via anti-inflammatory and antioxidation pathway.

Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). Recorded variables were patient preoperative anxiety scores, vital signs, visual analogue scale (VAS) pain scores, Observer's Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, surgeon and patient degree of satisfaction, and the duration of analgesia after surgery. The OAAS scores were significantly lower for patients administered D/F compared to those who received M/F. The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3h) than in those who received M/F (4.1h; P=0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P=0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.