Anesth Pain Med.  2020 Jul;15(3):297-304. 10.17085/apm.20007.

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea

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.

Keyword

Dexmedetomidine; Elderly; Midazolam; Sedation; Spinal anesthesia

Figure

  • Fig. 1. Consolidated standards of reporting trials (CONSORT) flow chart of the study. A total of 72 patients (American Society of Anesthesiologists physical status classification I–II, aged over 65 years) were randomly allocated into three groups. Group DD: initial dose of 0.5 μg/kg dexmedetomidine + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group MD: initial dose of 0.02 mg/kg midazolam + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group D: continuous infusion of 0.5 μg/kg/h dexmedetomidine without initial dose.

  • Fig. 2. Trends of heart rate (A) and mean blood pressure (B). Graphs’ values are presented as mean ± SD. Group DD: initial dose of 0.5 μg/kg dexmedetomidine + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group MD: initial dose of 0.02 mg/kg midazolam + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group D: continuous infusion of 0.5 μg/kg/h dexmedetomidine without initial dose. T0: start sedation, T10, 20, 30, 60: 10, 20, 30, 60 min after sedation. There were no significant differences among the groups at any time point.

  • Fig. 3. Trends of Bispectral index. Graphs’ values are presented as mean ± SD. Group DD: initial dose of 0.5 μg/kg dexmedetomidine + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group MD: initial dose of 0.02 mg/kg midazolam + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group D: continuous infusion of 0.5 μg/kg/h dexmedetomidine without initial dose. T0: start sedation, T10, 20, 30, 60: 10, 20, 30, and 60 min after sedation. Bispectral index in Group D was significantly higher than in the other two groups at T10 and T30. *P < 0.05.

  • Fig. 4. Trends of oxygen saturation (SpO2) (A), end-tidal carbon dioxide (ETCO2) (B), and respiratory rate (C). Graphs’ values are presented as mean ± SD. Group DD: initial dose of 0.5 μg/kg dexmedetomidine + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group MD: initial dose of 0.02 mg/kg midazolam + continuous infusion of 0.5 μg/kg/h dexmedetomidine. Group D: continuous infusion of 0.5 μg/kg/h dexmedetomidine without initial dose. T0: start sedation, T10, 20, 30, 60: 10, 20, 30, and 60 min after sedation. There were no significant differences among the groups at any time point.


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