***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: PURPOSE To investigate whether dexmedetomidine infusion could reduce opioid consumption and opioid-related side effects after uterine artery embolization ( UAE ) . MATERIAL S AND METHODS Fifty patients undergoing UAE for symptomatic leiomyomas or adenomyosis were r and omized into two groups . In 25 patients , dexmedetomidine infusion was started at 0.2 μg/kg/h at 30 minutes before the procedure , followed by 0.4 μg/kg/h for 6 hours after the procedure . In another 25 patients ( control group ) , volume-matched normal saline solution was administered . Both groups received fentanyl-based intravenous patient-controlled analgesia ( PCA ; fentanyl 10 μg/h with a bolus dose of 20 μg ) during the 24 hours after the procedure . Nonspherical polyvinyl alcohol particles were used . Pain scores , fentanyl consumption , need for additional analgesics , and side effects were assessed for 24 hours after UAE . RESULTS Compared with the control group , patients in the dexmedetomidine group required 28 % less PCA fentanyl during the 24 hours after UAE ( P = .006 ) . Numeric rating scale scores for pain ( 5.0±2.4 vs 7.0±2.2 ; P = .026 ) and the need for additional analgesics ( two of 25 vs 17 of 25 ; P<.001 ) were lower in the dexmedetomidine group than in the control group during the first 1 hour after UAE . The incidence and severity of nausea and vomiting during the 24 hours after UAE were lower in the dexmedetomidine group than in the control group ( P < .05 ) . CONCLUSIONS The addition of dexmedetomidine infusion to fentanyl PCA provides better analgesia , fentanyl-sparing effect , and less nausea and vomiting , without significant hemodynamic instability Thirty-four patients scheduled for elective inpatient surgery were r and omized equally to receive either dexmedetomidine ( initial loading dose of 1-&mgr;g/kg over 10 min followed by 0.4 & mgr;g · kg−1 · h−1 for 4 h ) or morphine sulfate ( 0.08 mg/kg ) 30 min before the end of surgery . We determined heart rate ( HR ) , mean arterial blood pressure ( MAP ) , respiratory rate ( RR ) , sedation and analgesia ( visual analog scale ) , and use of additional morphine  in the postanesthesia care unit ( PACU ) and up to 24 h after surgery . Groups were similar for patient demographics , ASA physical status , surgical procedure , baseline hemodynamics , and intraoperative use of drugs and fluids . Dexmedetomidine-treated patients had slower HR in the PACU ( by an average of 16 bpm ) , whereas MAP , RR , and level of sedation were similar between groups . During Phase I recovery , dexmedetomidine-treated patients required significantly less morphine  to achieve equivalent analgesia ( PACU dexmedetomidine group , 4.5 ± 6.8 mg ; morphine group , 9.2 ± 5.2 mg ) . Sixty minutes into recovery only 6 of 17 dexmedetomidine patients required morphine in contrast to 15 of 17 in the morphine group . The administration of dexmedetomidine before the completion of major inpatient surgical procedures significantly reduced , by 66 % , the early postoperative need for morphine and was associated with a slower HR in the PACU Abstract Smoking is one of the most common addictions in the world . Nicotine inhalation could increase the risk of cardiorespiratory diseases . However , the solution that improved postoperative analgesia for highly nicotine-dependent patients undergoing thoracic surgery has not been specifically addressed . This CONSORT- prospect i ve , r and omized , double-blinded , controlled trial investigated the efficacy of combination of dexmedetomidine and sufentanil for highly nicotine ( Fagerstrom test of nicotine dependence ≥6)-dependent patients after thoracic surgery . One hundred seventy-four male patients who underwent thoracic surgery were screened between February 2014 and November 2014 , and a total of forty-nine were excluded . One hundred thirty-two highly nicotine-dependent male patients who underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia were divided into 3 groups after surgery in this double-blind , r and omized study : sufentanil ( 0.02 & mgr;g/kg/h , Group S ) , sufentanil plus dexmedetomidine ( 0.02 & mgr;g/kg/h each , Group D1 ) , or sufentanil ( 0.02 & mgr;g/kg/h ) plus dexmedetomidine ( 0.04 & mgr;g/kg/h ) ( Group D2 ) . The patient-controlled analgesia ( PCA ) program was programmed to deliver a bolus dose of 2 ml , with background infusion of 2 ml/h and a lockout of 5 min , 4-hour limit of 40 ml , as our retrospective study . The primary outcome measure was the cumulative amount of self-administered sufentanil ; the secondary outcome measures were pain intensity ( numerical rating scale , NRS ) , level of sedation ( LOS ) , Bruggrmann comfort scale ( BCS ) , functional activity score ( FAS ) , and concerning adverse effects . The amount of self-administered sufentanil were lower in group D2 compared with S and D1 groups during the 72 hours after surgery ( P < 0.05 ) , whereas the total dosage and dosage per body weight of sufentanil were significantly lower in D1 group than that of S group only at 4 , 8 , and 16 hours after surgery ( P < 0.05 ) . Compared with S group , the NRS scores at rest at 1 , 4 , and 8 hours after surgery and with coughing at 4 , 8 , 16 , and 24 hours after surgery were significantly lower in D2 group ( P < 0.05 ) . However , compared with D1 group , the NRS scores both at rest and with coughing at 4 and 8 hours after surgery were significantly lower in D2 group ( P < 0.05 ) . The NRS scores both at rest and with coughing show that there were no significant differences between D1 group and S group at each time point after surgery ( P > 0.05 ) . LOS of group D2 was higher than S and D1 groups at 1 hour after surgery ( P < 0.05 ) , BCS of group D2 was higher than S and D1 groups at 4 , 8 , and 16 hours after surgery ( P < 0.05 ) , and FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after surgery ( P < 0.05 ) . The number of rescue analgesia during 72 hours after surgery in D2 group was lower than S and D1 groups ( P < 0.05 ) . There were no significant differences among the 3 groups in terms of baseline clinical characteristics and postoperative adverse effects except for itching ( P > 0.05).Among the tested patient-controlled analgesia options , the addition of dexmedetomidine ( 0.04 & mgr;g/kg/h ) and sufentanil ( 0.02 & mgr;g/kg/h ) showed better analgesic effect and greater patient satisfaction without other clinical ly relevant side effects for highly nicotine-dependent patients during the initial 72 hours after thoracic surgery . Trial Registration : chictr.org ( ChiCTR-TRC-14004191 ) BACKGROUND Perioperative use of dexmedetomidine is associated with reduction in postoperative analgesic requirements . This study examined whether dexmedetomidine added to i.v . patient-controlled analgesia ( PCA ) morphine could improve analgesia while reducing opioid-related side-effects . METHODS In this double-blinded , r and omized , controlled study , 100 women undergoing abdominal total hysterectomy were allocated to receive either morphine 1 mg ml(-1 ) alone ( Group M ) or morphine 1 mg ml(-1 ) plus dexmedetomidine 5 microg ml(-1 ) ( Group D ) for postoperative i.v . PCA , which was programmed to deliver 1 ml per dem and with a 5 min lockout interval and no background infusion . Cumulative PCA requirements , pain intensities , cardiovascular and respiratory variables , and PCA-related adverse events were recorded for 24 h after operation . RESULTS Compared with Group M , patients in Group D required 29 % less morphine during the 0 - 24 h postoperative period and reported significantly lower pain levels from the second postoperative hour onwards and throughout the study . Whereas levels of sedation were similar between the groups at each observational time point , decreases in heart rate and mean blood pressure from presurgery baseline at 1 , 2 , and 4 h after operation were significantly greater in Group D ( by a range of 5 - 7 beats min(-1 ) and 10 - 13 % , respectively ) . The 4 - 24 h incidence of nausea was significantly lower in Group D ( 34 % vs 56.3 % , P<0.05 ) . There was no bradycardia , hypotension , oversedation , or respiratory depression . CONCLUSIONS The addition of dexmedetomidine to i.v . PCA morphine result ed in superior analgesia , significant morphine sparing , less morphine-induced nausea , and was devoid of additional sedation and untoward haemodynamic changes Introduction Only limited information exists on the pharmacokinetics of prolonged ( > 24 hours ) and high-dose dexmedetomidine infusions in critically ill patients . The aim of this study was to characterize the pharmacokinetics of long dexmedetomidine infusions and to assess the dose linearity of high doses . Additionally , we wanted to quantify for the first time in humans the concentrations of H-3 , a practically inactive metabolite of dexmedetomidine . Methods Thirteen intensive care patients with mean age of 57 years and Simplified Acute Physiology Score ( SAPS ) II score of 45 were included in the study .  Dexmedetomidine infusion was commenced by using a constant infusion rate for the first 12 hours . After the first 12 hours , the infusion rate of dexmedetomidine was titrated between 0.1 and 2.5 μg/kg/h by using predefined dose levels to maintain sedation in the range of 0 to -3 on the Richmond Agitation-Sedation Scale . Dexmedetomidine was continued as long as required to a maximum of 14 days . Plasma dexmedetomidine and H-3 metabolite concentrations were measured , and pharmacokinetic variables were calculated with st and ard noncompartmental methods . Safety and tolerability were assessed by adverse events , cardiovascular signs , and laboratory tests . Results The following geometric mean values ( coefficient of variation ) were calculated : length of infusion , 92 hours ( 117 % ) ; dexmedetomidine clearance , 39.7 L/h ( 41 % ) ; elimination half-life , 3.7 hours ( 38 % ) ; and volume of distribution during the elimination phase , 223 L ( 35 % ) . Altogether , 116 steady-state concentrations were found in 12 subjects . The geometric mean value for clearance at steady state was 53.1 L/h ( 55 % ) . A statistically significant linear relation ( r2 = 0.95 ; P < 0.001 ) was found between the areas under the dexmedetomidine plasma concentration-time curves and cumulative doses  of dexmedetomidine . The elimination half-life of H-3 was 9.1 hours ( 37 % ) . The ratio of AUC0-∞ of H-3 metabolite to that of dexmedetomidine  was 1.47 ( 105 % ) , ranging from 0.29 to 4.4 . The ratio was not statistically significantly related to the total dose of dexmedetomidine  or the duration of the infusion . Conclusions The results suggest linear pharmacokinetics of dexmedetomidine up to the dose of 2.5 μg/kg/h . Despite the high dose and prolonged infusions , safety findings were as expected for dexmedetomidine and the patient population .Trial Registration Clinical Trials.gov : Abstract Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms , and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy . This CONSORT- prospect i ve , r and omized , double-blinded , controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia ( PCA ) for 72 hours after abdominal hysterectomy . Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil ( Group C ; 0.02 & mgr;g/kg/h ) , sufentanil plus dexmedetomidine ( Group D1 ; 0.02 & mgr;g/kg/h , each ) , or sufentanil ( 0.02 & mgr;g/kg/h 
    Output:
    
DEX had no effect on the incidence of hypotension or bradycardia , which was also confirmed by the TSA .
The GRADE level of evidence was high for postoperative nausea , moderate for pain intensity at rest at 24 hours postoperatively , morphine-equivalent requirement during 0 - 24 hours postoperatively , and postoperative vomiting , pruritus , and bradycardia , and low for postoperative hypotension .
LIMITATIONS The risk of introducing potentially significant heterogeneity exists , and this study did not evaluate the effects of DEX combined with opioids on long-term outcomes including chronic pain and patients ' satisfaction after hospital discharge .
Postoperative PCA strategies with opioid-DEX combinations decreased postoperative pain , opioid requirement , and opioid-related adverse events .
DEX is a useful adjuvant to opioid-based PCA .