Effects of Various Methods of Dexmedetomidine Administration for Sedation in Elderly Patients Undergoing Spinal Anesthesia: a Randomized Controlled Study

Overview

Journal Anesth Pain Med (Seoul)

Specialty Anesthesiology

Date 2020 Dec 17

PMID 33329828

Citations 1

Authors

Jeong Jeong

So Hee Jin

Dong Yeon Kim

Sooyoung Cho

Heeseung Lee

Jong In Han

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to investigate the degree of sedation and the incidence of adverse effects resulting from various methods of administering the initial dose followed by continuous infusion of dexmedetomidine (DEX) for sedation in elderly patients undergoing spinal anesthesia.

Methods: In total, 72 patients aged over 65 years who were to be administered spinal anesthesia were randomly allocated into three groups. The initial doses were injected to the groups as follows: group DD, DEX 0.5 μg/kg for 10 min; group MD, midazolam 0.02 mg/kg; and group D, no initial dose. This was followed immediately by infusing a maintenance dose of DEX 0.5 μg/kg/h to all groups.

Results: The Bispectral index (BIS) in the D group was significantly higher than in the other two groups. There were no significant differences in the Ramsay sedation scale (RSS) among the groups. The RSS 3 level was reached in 10 min from the start of sedation in MD and DD groups and in 20 min from the start of sedation in D group. Neither bradycardia nor hypotension was observed in any of the groups.

Conclusions: Patients in all three groups reached the RSS 3 sedating-effect level. However, the group that received continuous infusion only without the initial dose showed higher BIS than the other two groups and reached the RSS 3 later. No adverse events were observed in any of the groups.

Citing Articles

Spinal anesthesia in elective lumbar spinal surgery.

Hernandez N, Begashaw B, Riesenburger R, Kryzanski J, Liu P Anesth Pain Med (Seoul). 2023; 18(4):349-356.

PMID: 37919919 PMC: 10635856. DOI: 10.17085/apm.23031.

References

Ebert T, Hall J, BARNEY J, Uhrich T, Colinco M . The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000; 93(2):382-94. DOI: 10.1097/00000542-200008000-00016. View

Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H, Viinamaki O . Effects of dexmedetomidine, a selective alpha 2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989; 46(1):33-42. DOI: 10.1038/clpt.1989.103. View

Priebe H . The aged cardiovascular risk patient. Br J Anaesth. 2000; 85(5):763-78. DOI: 10.1093/bja/85.5.763. View

Arain S, Ebert T . The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002; 95(2):461-6, table of contents. DOI: 10.1097/00000539-200208000-00042. View

Riker R, Shehabi Y, Bokesch P, Ceraso D, Wisemandle W, Koura F . Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301(5):489-99. DOI: 10.1001/jama.2009.56. View

Weinbroum A, Szold O, Ogorek D, Flaishon R . The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature. Eur J Anaesthesiol. 2001; 18(12):789-97. DOI: 10.1046/j.1365-2346.2001.00922.x. View

Paris A, Tonner P . Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2006; 18(4):412-8. DOI: 10.1097/01.aco.0000174958.05383.d5. View

Bell J, Laasch H, Wilbraham L, England R, Morris J, Martin D . Bispectral index monitoring for conscious sedation in intervention: better, safer, faster. Clin Radiol. 2004; 59(12):1106-13. DOI: 10.1016/j.crad.2004.04.008. View

Sebel P, Lang E, Rampil I, White P, Cork R, Jopling M . A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg. 1997; 84(4):891-9. DOI: 10.1097/00000539-199704000-00035. View

10.

Yoon D, Ban J, Lee S, Lee J, Kim E, An J . Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia. Korean J Anesthesiol. 2016; 69(5):446-452. PMC: 5047979. DOI: 10.4097/kjae.2016.69.5.446. View

11.

Dawson R, von Fintel N, Nairn S . Sedation assessment using the Ramsay scale. Emerg Nurse. 2010; 18(3):18-20. DOI: 10.7748/en2010.06.18.3.18.c7825. View

12.

Yano H, Iishi H, Tatsuta M, Sakai N, Narahara H, Omori M . Oxygen desaturation during sedation for colonoscopy in elderly patients. Hepatogastroenterology. 1999; 45(24):2138-41. View

13.

Jakob S, Ruokonen E, Grounds R, Sarapohja T, Garratt C, Pocock S . Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012; 307(11):1151-60. DOI: 10.1001/jama.2012.304. View

14.

Liu J, Singh H, White P . Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg. 1997; 84(1):185-9. DOI: 10.1097/00000539-199701000-00033. View

15.

Fraser G, Devlin J, Worby C, Alhazzani W, Barr J, Dasta J . Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials. Crit Care Med. 2013; 41(9 Suppl 1):S30-8. DOI: 10.1097/CCM.0b013e3182a16898. View

16.

Alexander C, Gross J . Sedative doses of midazolam depress hypoxic ventilatory responses in humans. Anesth Analg. 1988; 67(4):377-82. View

17.

Lakatta E . Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation. 2003; 107(3):490-7. DOI: 10.1161/01.cir.0000048894.99865.02. View