Anesth Pain Med.  2023 Apr;18(2):159-168. 10.17085/apm.22257.

Comparison of the effect of dexmedetomidine and midazolam under spinal anesthesia for cesarean delivery: a randomized controlled trial, single center study in South Korea

• Kang H
• Lim T
• Lee Hj
• Kim TW
• Kim W
• Chang HW

• KMID: 2543657
• DOI: http://doi.org/10.17085/apm.22257

Abstract

Background
Cesarean section under spinal anesthesia may cause anxiety and hypotension. Administration of sedative drugs after delivery can diminish these side-effects, but may increase hemodynamic instability. We evaluated the effect of the administration of 0.7 μg/kg dexmedetomidine and compared it with that of 0.03 mg/kg midazolam for usefulness of sedation of the parturient after delivery during cesarean section.
Methods
After obtaining written consent and the ethics board approval, 60 parturients aged 20–43 years who underwent elective cesarean delivery under spinal anesthesia were recruited. A total of 0.5% hyperbaric bupivacaine (8–10 mg) and intrathecal fentanyl (10 μg) was given to induce anesthesia. Parturients were then randomly allocated to receive either midazolam (0.03 mg/kg; group M) or dexmedetomidine 0.7 (μg/kg; group D) after delivery. The primary outcome measure was patient satisfaction score. Secondary outcomes included vital signs; vasopressor dosage; incidence of shivering, nausea, and vomiting; incidence of bradycardia; time to sensory and motor recovery; postoperative nausea and vomiting score; and postoperative pain visual analog scale at 6, 24, and 48 h.
Results
Satisfaction scores for sedation were similar between the two groups. The systolic blood pressure, heart rate, oximetry saturation, and tympanic temperature were comparable between the two groups. The predicted mean systolic blood pressure of group D was 106.3 mmHg and that of group M was 107.5 mmHg. Both groups showed comparable adverse intraoperative and postoperative outcomes.
Conclusions
Dexmedetomidine and midazolam showed similar hemodynamic effects and patient satisfaction in parturients under spinal anesthesia.

Keyword

Cesarean delivery; Dexmedetomidine; Midazolam; Spinal anesthesia

Figure

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  Fig. 1. Flow diagram based on CONSORT statement. CONSORT: Consolidated Standards for Reporting of Trials.

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  Fig. 2. Changes in the systolic blood pressure (A), heart rate (B), SPO2 (C), and body temperature (D). The graphs show the mean value and standard deviation of each variable for each time point during spinal anesthesia and at the PACU. All data were collected baseline, 5 min after induction of anesthesia, at the time of baby out, 10 min and 30 min after the drug administration at the end of surgery, and 10 min and 30 min at the PACU. SPO2: oxygen saturation, PACU: postanesthetic care unit. Group D (●): parturients who received 0.7 μg/kg dexmedetomidine, Group M (□): parturients who received 0.03 mg/kg midazolam. All data are comparable at each time point between group D and group M.

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  Fig. 3. The change in Ramsay sedation score in the two groups. Group D (●): parturients who received 0.7 μg/kg dexmedetomidine, Group M (□): parturients who received 0.03 mg/kg midazolam. There is no difference between the sedation scores of group D and group M. T1: 10 min after drug administration, T2: 20 min after drug administration, T3: 30 min after drug administration, and T4: end of surgery.

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