Remifentanil and dexmedetomidine are well known to suppress airway reflexes during airway procedures. Smooth tracheal extubation is important after otologic surgery. The purpose of this study is to compare the effectiveness of dexmedetomidine or remifentanil infusion for producing smooth tracheal extubation in deeply anesthetized patients after otologic surgery. Seventy-four ASA I-II adult patients (18-60 years old) scheduled for elective otologic surgery were randomly assigned to one of three groups: sevoflurane-remifentanil (Group SR, n = 25), sevoflurane-dexmedetomidine (0.5 μg/kg) (Group SD5, n = 24), or sevoflurane-dexmedetomidine (0.7 μg/kg) (Group SD7, n = 25). Remifentanil or dexmedetomidine were administered for 10 min at the end of surgery. The primary outcome was the rate of smooth extubation. Respiratory pattern, airway obstruction, hemodynamic and respiratory profiles, time to awake, rescue analgesics in the post-anesthesia care unit (PACU), and postoperative nausea and vomiting (PONV) were also recorded. The rate of smooth tracheal extubation as defined 1 min post-extubation was the same for Groups SR and SD7 (P > 0.05), but the rate of smooth extubation was lower for Group SD5 than for the other two groups (p < 0.05). During extubation, the respiratory rate was lower in Group SR than in both dexmedetomidine groups (p < 0.05). The hemodynamic profiles at extubation were similar between groups (p > 0.05), but the mean arterial pressure and heart rate were higher in Group SR at 10 and 15 min after extubation (p < 0.05). The incidence of airway obstruction and time to awake were comparable for all groups (p > 0.05). The need for rescue analgesic in the PACU was more common in Group SR than in both dexmedetomidine groups (P < 0.01). Compared to Group SR, both dexmedetomidine groups had less PONV on postoperative day 1 (p < 0.05). Combined with 1 MAC sevoflurane, dexmedetomidine 0.7 ug/kg and remifentanil provided similar rates for smooth tracheal extubation in spontaneously breathing, anesthetized adults. Dexmedetomidine exhibited opioid-sparing effects postoperatively and was associated with less PONV than remifentanil.

Dexmedetomidine as an adjunct with opioids has been confirmed to spare opioids usage and improve analgesia for postoperative pain treatment. Furthermore, dexmedetomidine can attenuate the airway reflex. The aim of this study is to assess the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia after partial laryngectomy. A total of 60 adult male patients were recruited and randomly allocated to receive sufentanil 1.0 μg ml−1 (Group S) or sufentanil 1.0 μg ml−1 plus dexmedetomidine 4 μg ml−1 (Group SD) for postoperative analgesia. The IV patient controlled analgesia (PCA) device was programmed to deliver 1.5 ml per demand with a 10 min lockout interval and 1.5 ml per hour background infusion. Cumulative consumption of sufentanil and pain intensity during 24 hour (h) after surgery were recorded. Coughing episodes per day, sleep quality, hemodynamic and respiratory profiles were measured. Compared with Group S, patients in Group SD required less sufentanil during the 0–24 h postoperative period (p < 0.0001) and reported significant lower pain intensity from the second postoperative hour to the end of the study (P < 0.0001). Daily coughing episodes, sleep disturbance was lower and patients’ satisfaction was higher in Group SD (P < 0.05). Decrease in heart rate and mean blood pressure from baseline at 1 h, 2 h, 3 h, 12 h, and 24 h after operation were significantly greater in Group SD (P = 0.00). The incidence of PCA related adverse events were comparable between the two groups. Dexmedetomidine/sufentanil combination for postoperatjve analgesia in partial laryngectomized patients resulted in significant sufentanil sparing, better analgesia, reduced frequency coughing episodes, and better sleep quality. Chinese Clinical Registry (ChiCTR): ChiCTR-TRC-14004618 , date of registration: 08 May 2014.

Purpose: To examine whether nighttime dexmedetomidine infusion improved sleep quality in patients after laryngectomy. Patients and Methods: Thirty-five post-laryngectomy patients admitted to the intensive care unit (ICU) were randomly assigned to a 9-h (from 2100 h on surgery day to 0600 h the morning after laryngectomy) dexmedetomidine (0.3 μg/kg/h continuous infusion) or placebo group. Polysomnography results were monitored during the dexmedetomidine infusion period. The percentage of stage 2 non-rapid eye movement (stage N2) sleep was the primary outcome measure. Results: Thirty-five patients (18 placebo group; 17 dexmedetomidine group) had complete polysomnogram recordings. The percentage of stage N3 sleep was significantly increased in the dexmedetomidine infusion group (from median 0% (0 to 0) in placebo group to 0% (interquartile range, 0 to 4) in dexmedetomidine group (difference, − 2.32%; 95% CI, − 4.19 to − 0.443; P = 0.0167)). Infusion had no effect on total sleep time, stage N1 or N2 sleep percentages, or sleep efficiency. It decreased muscle tensity and snore non-rapid eye movement. Subjective sleep quality improved. Hypotension incidence increased in the dexmedetomidine group, but significant intervention was not required. Conclusion: Dexmedetomidine infusion improved overall patient sleep quality in the ICU after laryngectomy.