Background: Postoperative delirium is a significant problem that deteriorates the cognitive state of patients after cardiac surgery, which can be a short- or long-term complication.Objectives: This study was conducted to evaluate the efficacy of dexmedetomidine, commenced simultaneously with anesthesia induction and continued throughout the surgical operation, on postoperative delirium after cardiac surgery with cardiopulmonary bypass. Methods: This randomized, double-blind, case-control trial was conducted on sixty-one patients undergoing cardiac surgery. The patients were randomly divided into dexmedetomidine (case) and normal saline (control) groups. The primary outcome was the incidence of delirium, as screened by the Confusion Assessment Method for the ICU (CAM-ICU). Results: There was no distinction in CAM-ICU outcomes between the two groups at 6 and 24 hours postoperatively. However, the difference in non-positive CAM-ICU results was statistically significant at 24 hours for +1 and -1 Richmond Agitation-Sedation Scale scores. Conclusions: Starting dexmedetomidine before cardiopulmonary bypass did not significantly affect the delirium rate based on CAM-ICU assessments. Further research examining larger groups is necessary to clarify the efficacy of perioperative dexmedetomidine on postoperative delirium.

Introduction: Pain is a persistent concern and a common symptom in critically ill patients. It is an increasingly unpleasant experience in patients discharged from the intensive care units (ICUs).  Objective: This study aims to evaluate the correlation of pain intensity with the acute physiology and chronic health evaluation (APACHE II) score, the Ramsay Sedation scale (RSS) score, and some ventilation parameters in patients under mechanical ventilation admitted to the ICU.  Materials and Methods: This cross-sectional study was conducted on 40 intubated patients under mechanical ventilation at the trauma ICU of a hospital in Sabzevar, Iran, from November 2020 to May 2021. The samples were selected using a convenience sampling method. Data were collected using the critical-care pain observation tool (CPOT), APACHE II, RSS, and a form surveying demographic and ventilation parameters. Data analysis was performed using descriptive statistics, Spearman’s correlation test, and Mann-Whitney U test. The significance level was set at 0.05. Results: Among participants, 87.5% were male (n=35) and 12.5% female (n=5). Their mean age was 42.80±17.12 years, ranged 18-83 years. The CPOT score at rest (r=0.78) and during suctioning (r=0.72) was significantly correlated with the APACHE II score (P=0.001). It also had a significant association with the RSS score at rest and during suctioning and position change (P=0.001), surgical diagnosis (P=0.002 at rest, P=0.001 during suctioning), and using sedatives (P=0.001 at rest, P=0.001 during procedure). However, no significant correlation was observed between the CPOT score and ventilation parameters. Pain intensity was significantly different among patients with and without a history of addiction (r=0.68, P=0.015 at rest; P=0.002 during suctioning). Conclusion: Given the correlation of the pain intensity with the APACHE II and RSS scores in patients under mechanical ventilation, these factors should be considered by healthcare planners to promote the quality of care and effective management of pain in these patients admitted to ICUs.

Background: Intravenous (IV) Sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. Sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious Sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of Sedation and hemodynamic stability. Objective: To compare efficacy of dexmedetomidine for intraoperative Sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia. Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr.  Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and Sedation using observer’s assessment of alertness/Sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test.   Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p>0.05). According to Sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep. Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing Sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.