Dexmedetomidine In Burn Patients: A Literature Review
Analgesic and Sedative Effects of Dexmedetomidine in Burn Patients:
A Literature Review
It is a well-documented fact that patients with severe burn injuries experience continuous blood loss in the treatment process. With major burn injuries, patients may experience acute anemia, which occurs primarily from the surgical administration of the burn wound, anemia of critical illness, and iatrogenic blood loss. Burn patients may experience repeated painful techniques like dressing changes, which require general anesthesia or analgosedation depending on location, size, and origin of the wound defect. Institutional preferences largely determine the choice of drugs and techniques for analgosedation in burn patients. The researchers and clinicians have demonstrated the need for more profound and better sedation, as well as for prevention of hypertension when utilizing dexmedetomidine as an adjunct during burn procedures. Dexmedetomidine, a selective a2-adrenergic agonist, is used in anesthetic practice because of its combined analgesic, sedative, hypnotic and …show more content…
anxiolytic impact. Dexmedetomidine decreases the dose requirements of opioids and anesthetic agents and weakens the hemodynamic responses to tracheal intubation and surgical stimuli (Asmussen et al., 2013).
Anesthesia providers must have a thorough understanding of maintaining proper sedation. Analgesia can be exceptionally challenging and frequently requires high doses of analgesics and anxiolytics since resistance immediately develops. Anesthesia providers must be aware of common complications that can occur with overdosage, such as, hypotension, bradycardia, atrial fibrillation, and heart blocks. The anesthesia provider must develop the skill to decrease the risk of morbidity and mortality. This paper will present a critical assessment of the article submitted by Asmussen et al. (2013), “A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients.” Clinical applications of the research will be discussed, and recommendations for best care will be addressed.
Critical Assessment
Type of Research
The research reported by Asmussen et al. (2013), retrieved from the ScienceDirect Database is a systematic review and meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients. Meta-analyses and systematic reviews are usually referred to as Level I evidence hierarchy. A web-based literature search was performed in Medline (Pubmed) using search words related to each subject in combination with established search algorithms for: ‘‘dexmedetomidine, burn, burns’’. Literature was introduced and discussed by four writers, taking the accessible proof published before October 01, 2012 into the record. The study included four prospective randomized clinical trials including 266 patients/interventions with burn injury. Each literature was evaluated for methodological quality of studies using the recommendations of the ‘‘Oxford Centre for Evidence Based Medicine’’ (OCEBM). The statistical analysis was performed using the statistical program Comprehensive Meta-Analysis Software (CMA).
Validity of Article
All the literature was retrieved from the U.S. National Library of Medicine, which is well known and is the world's biggest medical library operated by the United States federal government. The library collects materials from the global network of researchers, experts, clinical trials, caregivers and people interested in health. It is a well-respected, renowned database for performing valid research reviews.
Asmussen et al. (2013) conducted a thorough literature review and synthesis of data in agreement with the methodological quality of studies recommended by OCEBM. OCEBM is committed to the practice, teaching and distribution of high-quality of evidence-based medicine to improve health care in everyday clinical practice. The trials and studies were examined for quality, and authors conducted an appropriate statistical analysis. Furthermore, the authors declare no competing interests. The review of Asmussen et al. (2013), is a meta-analysis of primary research articles representing a Level II on the evidence hierarchy.
Clinical Application and Anesthesia Techniques
The study by Asmussen et al. (2013), focused on analgesic and sedative effects of dexmedetomidine in burn patients. The findings were comprehensive and are appropriate to everyday practice in anesthesia. Despite the fact that there were just a small number of clinical trials accessible, meta-analysis demonstrates evidence for deeper and better sedation and also for prevention of hypertension when utilizing dexmedetomidine as an adjunct during burn procedures.
Dexmedetomidine provides sedation, anxiolysis, and analgesia with much less respiratory depression as compared to other sedatives. Dexmedetomidine is hemodynamically settling, has a short elimination half-life of roughly two hours after a fast appropriation period of around six minutes, and is mainly renal eliminated. The most beneficial impacts of dexmedetomidine appear in the perioperative stage. It reduced the prerequisite of opioids perioperatively in the recovery room. Utilization of the mix of ketamine, tramadol and dexmedetomidine were observed to be an acceptable treatment alternative for the anticipation of the procedural pain endured by adult patients during dressing changes. The study shows that dexmedetomidine prevented hypoxia and respiratory depression compared to propofol (Asmussen et al., 2013).
The study has permitted me to comprehend convincing circumstances quantitatively during burn and wound excision. Understanding when the hemodynamic and hematologic changes happen during the surgery will allow me to anticipate when to adjust sedative administration as needed. I will be able to select drugs that provide analgesia, sedation, and a balanced hemodynamic state, as well as implement all possible monitoring techniques that facilitate early intervention and patient care.
Additional research needed to establish the best care guidelines
The four randomized clinical trials used in the systematic review contained only 266 patients so results could not be generalized to the overall population.
However, none of the studies showed the confidence interval in their statistical analysis, which is crucial to assess the study quality. The authors suggest that additional prospective, randomized, controlled multicenter trials with a sufficient number of patients is needed to further clarify the potentially helpful effects of dexmedetomidine for administration in the care of burn patients. Furthermore, the study must be standardized for administration and dosages. The perioperative period should be focused on the assessment of sedation, analgesia, and hemodynamics changes. The half-life of the medications utilized must be taken into account and reiteration of doses should be considered to examine the drug profile of dexmedetomidine in burn
patients.
Conclusion
Many challenges must be anticipated during the care of the burn patient. Burn patients often need repeated painful surgical procedures, and a significant loss of blood volume and body temperature are common in these cases. It is imperative for the anesthesia provider to understand fully the dynamic complexities of severely burned patients. Anesthesia providers must have a better understanding of sedation of patients and prevention of hypertension during dressing changes. The analgesic requirements in burn patients are different as opposed to the general population because of higher sensitivity and adapting pain levels caused by the high frequency of surgical procedures. It is essential for anesthesia providers to be aware of alterations in drug metabolism and distribution and the need to be accurate in the titration of anesthetic drugs.
A Literature Review
It is a well-documented fact that patients with severe burn injuries experience continuous blood loss in the treatment process. With major burn injuries, patients may experience acute anemia, which occurs primarily from the surgical administration of the burn wound, anemia of critical illness, and iatrogenic blood loss. Burn patients may experience repeated painful techniques like dressing changes, which require general anesthesia or analgosedation depending on location, size, and origin of the wound defect. Institutional preferences largely determine the choice of drugs and techniques for analgosedation in burn patients. The researchers and clinicians have demonstrated the need for more profound and better sedation, as well as for prevention of hypertension when utilizing dexmedetomidine as an adjunct during burn procedures. Dexmedetomidine, a selective a2-adrenergic agonist, is used in anesthetic practice because of its combined analgesic, sedative, hypnotic and …show more content…
anxiolytic impact. Dexmedetomidine decreases the dose requirements of opioids and anesthetic agents and weakens the hemodynamic responses to tracheal intubation and surgical stimuli (Asmussen et al., 2013).
Anesthesia providers must have a thorough understanding of maintaining proper sedation. Analgesia can be exceptionally challenging and frequently requires high doses of analgesics and anxiolytics since resistance immediately develops. Anesthesia providers must be aware of common complications that can occur with overdosage, such as, hypotension, bradycardia, atrial fibrillation, and heart blocks. The anesthesia provider must develop the skill to decrease the risk of morbidity and mortality. This paper will present a critical assessment of the article submitted by Asmussen et al. (2013), “A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients.” Clinical applications of the research will be discussed, and recommendations for best care will be addressed.
Critical Assessment
Type of Research
The research reported by Asmussen et al. (2013), retrieved from the ScienceDirect Database is a systematic review and meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients. Meta-analyses and systematic reviews are usually referred to as Level I evidence hierarchy. A web-based literature search was performed in Medline (Pubmed) using search words related to each subject in combination with established search algorithms for: ‘‘dexmedetomidine, burn, burns’’. Literature was introduced and discussed by four writers, taking the accessible proof published before October 01, 2012 into the record. The study included four prospective randomized clinical trials including 266 patients/interventions with burn injury. Each literature was evaluated for methodological quality of studies using the recommendations of the ‘‘Oxford Centre for Evidence Based Medicine’’ (OCEBM). The statistical analysis was performed using the statistical program Comprehensive Meta-Analysis Software (CMA).
Validity of Article
All the literature was retrieved from the U.S. National Library of Medicine, which is well known and is the world's biggest medical library operated by the United States federal government. The library collects materials from the global network of researchers, experts, clinical trials, caregivers and people interested in health. It is a well-respected, renowned database for performing valid research reviews.
Asmussen et al. (2013) conducted a thorough literature review and synthesis of data in agreement with the methodological quality of studies recommended by OCEBM. OCEBM is committed to the practice, teaching and distribution of high-quality of evidence-based medicine to improve health care in everyday clinical practice. The trials and studies were examined for quality, and authors conducted an appropriate statistical analysis. Furthermore, the authors declare no competing interests. The review of Asmussen et al. (2013), is a meta-analysis of primary research articles representing a Level II on the evidence hierarchy.
Clinical Application and Anesthesia Techniques
The study by Asmussen et al. (2013), focused on analgesic and sedative effects of dexmedetomidine in burn patients. The findings were comprehensive and are appropriate to everyday practice in anesthesia. Despite the fact that there were just a small number of clinical trials accessible, meta-analysis demonstrates evidence for deeper and better sedation and also for prevention of hypertension when utilizing dexmedetomidine as an adjunct during burn procedures.
Dexmedetomidine provides sedation, anxiolysis, and analgesia with much less respiratory depression as compared to other sedatives. Dexmedetomidine is hemodynamically settling, has a short elimination half-life of roughly two hours after a fast appropriation period of around six minutes, and is mainly renal eliminated. The most beneficial impacts of dexmedetomidine appear in the perioperative stage. It reduced the prerequisite of opioids perioperatively in the recovery room. Utilization of the mix of ketamine, tramadol and dexmedetomidine were observed to be an acceptable treatment alternative for the anticipation of the procedural pain endured by adult patients during dressing changes. The study shows that dexmedetomidine prevented hypoxia and respiratory depression compared to propofol (Asmussen et al., 2013).
The study has permitted me to comprehend convincing circumstances quantitatively during burn and wound excision. Understanding when the hemodynamic and hematologic changes happen during the surgery will allow me to anticipate when to adjust sedative administration as needed. I will be able to select drugs that provide analgesia, sedation, and a balanced hemodynamic state, as well as implement all possible monitoring techniques that facilitate early intervention and patient care.
Additional research needed to establish the best care guidelines
The four randomized clinical trials used in the systematic review contained only 266 patients so results could not be generalized to the overall population.
However, none of the studies showed the confidence interval in their statistical analysis, which is crucial to assess the study quality. The authors suggest that additional prospective, randomized, controlled multicenter trials with a sufficient number of patients is needed to further clarify the potentially helpful effects of dexmedetomidine for administration in the care of burn patients. Furthermore, the study must be standardized for administration and dosages. The perioperative period should be focused on the assessment of sedation, analgesia, and hemodynamics changes. The half-life of the medications utilized must be taken into account and reiteration of doses should be considered to examine the drug profile of dexmedetomidine in burn
patients.
Conclusion
Many challenges must be anticipated during the care of the burn patient. Burn patients often need repeated painful surgical procedures, and a significant loss of blood volume and body temperature are common in these cases. It is imperative for the anesthesia provider to understand fully the dynamic complexities of severely burned patients. Anesthesia providers must have a better understanding of sedation of patients and prevention of hypertension during dressing changes. The analgesic requirements in burn patients are different as opposed to the general population because of higher sensitivity and adapting pain levels caused by the high frequency of surgical procedures. It is essential for anesthesia providers to be aware of alterations in drug metabolism and distribution and the need to be accurate in the titration of anesthetic drugs.