The ROLE OF DEXMEDETOMIDINE IN THE PERIOPERATIVE MANAGEMENT OF HEAD AND NECK NEOPLASMS – A RETROSPECTIVE STUDY
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DOI:
https://doi.org/10.25751/rspa.26143Keywords:
Dexmedetomidine, Free Tissue Flaps, Head and Neck Neoplasms, Ventilator WeaningAbstract
The incidence of head and neck neoplasms is increasing worldwide. Extensive surgical resection and reconstruction with a microvascular free flap is often proposed, challenging the maintenance of the airway patency. After the implementation of dexmedetomidine in our anesthetic protocol most patients maintained spontaneous ventilation in the early postoperative period, therefore reducing the need of mechanical ventilation and admission in the Intensive Care Unit (ICU), the incidence of complications and the overall costs. This strategy has proven to be especially valuable during the COVID-19 pandemic since it allowed our team to maintain the surgical management for this cancer patients without burdening the Intensive Care Unit.
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References
. (1) Aupérin A. Epidemiology of head and neck cancers: an update. Curr Opin Oncol. 2020; 32 (3): 178-186.
. (2) P. Pohlenz, J. Klatt, G. Scho¨n, M. Blessmann, L. Li, R. Schmelzle: Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int. J. Oral Maxillofac. Surg. 2012; 41: 739–743.
. (3) Rajan S, Moorthy S, Paul J and Kumar L. Effect of dexmedetomidine on postoperative hemodynamics and outcome of free flap in head and neck reconstructive surgeries. The Open Anesthesiology Journal. 2016, 10: 12-18.
. (4) Courtney R. Jones, MD. Perioperative Uses of Dexmedetomidine. Lippincott Williams & Wilkins. 2013; 51 (2): 81–96.
. (5) Foster J. Complications of sedation and critical illness. Crit Care Nurs Clin North Am. 2005 17(3): 287-296.
. (6) Nseir S, Makris D, Mathieu D, Durocher A, Marquette CH. Intensive Care Unit-acquired infection as a side effect of sedation. Crit Care. 2010;14(2): R30.
. (7) Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis. Intensive Care Med. 2010; 36(6):926-939.
. (8) Kress JP, Pohlman AS, O’Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342 (20): 1471–1477.
. (9) Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group.: Dexmedetomidine vs. midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301: 489-499.
. (10) Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298 (22): 2644-53.
. (11) Shehabi Y, Grant P, Wolfenden H, et al: Prevalence of Delirium with Dexmedetomidine Compared with Morphine Based Therapy after Cardiac Surgery: A Randomized Controlled Trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009; 111: 1075-1084.
. (12) Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J; Dexmedetomidine for Long-Term Sedation Investigators Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012; 21;307(11):1151-60.
. (13) Coyle, M.J., Main, B., Hughes, C., Craven, R., Alexander, R., Porter, G. & Thomas, S. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin. Otolaryngol. 2016; 41: 118–126.
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