Anesth Pain Med.  2018 Jul;13(3):264-270. 10.17085/apm.2018.13.3.264.

The effects of loading dose administration rate of dexmedetomidine on sedation and dexmedetomidine requirement in elderly patients undergoing spinal anesthesia

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea. uamyfriends@hanmail.net

Abstract

BACKGROUND
This study evaluated the effect of decrease in loading dose administration rate of dexmedetomidine (DMT) on sedation and DMT requirement in elderly patients.
METHODS
Fifty-eight patients over 65 years old with ASA I-II who were planned to receive DMT sedation during spinal anesthesia were randomly assigned to two groups. Group S (n = 29) received a 0.5 µg/kg DMT loading dose over 20 minutes, while group C (n = 29) received the DMT loading dose over 10 minutes. Then, both groups received a continuous infusion of 0.4 µg/kg/h. The sedative status was recorded before and at 5, 10, 15, 20, 25, and 30 minutes after administration of DMT and at the end of the anesthesia according to the Ramsay sedation scale (RSS). Also, the time to reach RSS-3 (patients asleep, responsive to commands) and the dose of DMT until reaching RSS-3 were recorded.
RESULTS
The time to reach RSS-3 was similar between the two groups (group S = 16.0 ± 4.3 minutes vs. group C = 15.5 ± 4.2 minutes, P = 0.673). However, the DMT required to reach RSS-3 in group S was significantly lower than that in group C (23.3 ± 7.1 vs. 32.5 ± 6.0 µg, P < 0.001). There was no difference in RSS between the two groups from the administration of DMT to the end of the anesthesia (P = 0.927).
CONCLUSIONS
Decreasing the administration rate of the DMT loading dose did not delay the onset of RSS-3 sedation and reduced the DMT requirement in elderly patients.

Keyword

Adrenergic alpha-2 receptor agonists; Aged; Dexmedetomidine; Hypnotics and sedatives; Spinal anesthesia
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