Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia

Background Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. Material/Methods One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. Results Hypotension occurred more frequently in the midazolam group (P<0.001) and bradycardia occurred more frequently in the dexmedetomidine group (P<0.001). Mean Ramsay sedation score was significantly lower in the dexmedetomidine group after arrival in the PACU (P=0.025) and PACU stay was significantly longer in the dexmedetomidine group (P=0.003). Conclusions BIS-guided dexmedetomidine sedation can attenuate intraoperative hypotension, but induces more bradycardia, prolongs PACU stay, and delays recovery from sedation in patients during and after spinal anesthesia as compared with midazolam sedation.

[1]  Jeongmin Kim,et al.  Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose–response study by age group , 2015, BMC Anesthesiology.

[2]  Sang Tae Kim,et al.  The effects of different loading doses of dexmedetomidine on sedation , 2014, Korean journal of anesthesiology.

[3]  Xibing Ding,et al.  Effects of Intravenous and Intrathecal Dexmedetomidine in Spinal Anesthesia: A Meta‐Analysis , 2013, CNS neuroscience & therapeutics.

[4]  Y. Yoon,et al.  Effects of intravenous dexmedetomidine on low‐dose bupivacaine spinal anaesthesia in elderly patients , 2012, Acta anaesthesiologica Scandinavica.

[5]  P. Boscan,et al.  Evaluation of the sedative and cardiovascular effects of intramuscular administration of dexmedetomidine with and without concurrent atropine administration in dogs. , 2011, Journal of the American Veterinary Medical Association.

[6]  F. N. Kaya,et al.  Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia , 2010, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[7]  D. Campagnol,et al.  Evaluation of cardiorespiratory effects of combinations of dexmedetomidine and atropine in cats , 2009, Journal of feline medicine and surgery.

[8]  M. Irwin,et al.  A comparison of dexmedetomidine and midazolam for sedation in third molar surgery * , 2007, Anaesthesia.

[9]  M. Scheinin,et al.  Effects of Low and High Plasma Concentrations of Dexmedetomidine on Myocardial Perfusion and Cardiac Function in Healthy Male Subjects , 2006, Anesthesiology.

[10]  C. Gonano,et al.  Spinal Versus General Anesthesia for Orthopedic Surgery: Anesthesia Drug and Supply Costs , 2006, Anesthesia and analgesia.

[11]  M. Welte,et al.  Bispectral index-guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo-controlled phase II study* , 2002, Critical care medicine.

[12]  D. Davis,et al.  T HE U SE OF M IDAZOLAM FOR P REHOSPITAL R APID - SEQUENCE I NTUBATION M AY B E A SSOCIATED WITH A D OSE - RELATED I NCREASE IN H YPOTENSION , 2001, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[13]  D. H. Mitchell,et al.  Dexmedetomidine: A Novel Sedative-Analgesic Agent , 2001, Proceedings.

[14]  Judith E. Hall,et al.  Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions , 2000, Anesthesia and analgesia.

[15]  M. Imamura,et al.  Mechanism of the negative inotropic effect of midazolam and diazepam in cultured foetal mouse cardiac myocytes. , 1997, European journal of anaesthesiology.

[16]  Spencer S. Liu,et al.  Sympathetic Block During Spinal Anesthesia in Volunteers Using Lidocaine, Tetracaine, and Bupivacaine , 1997, Regional Anesthesia & Pain Medicine.

[17]  T. Higgins,et al.  Propofol versus midazolam for intensive care unit sedation after coronary artery bypass grafting , 1994, Critical care medicine.

[18]  J. Kampine,et al.  Oral Dexmedetomidine Preserves Baroreceptor Function and Decreases Anesthetic Requirements of Halothane‐anesthetized Dogs , 1994, Anesthesiology.

[19]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. , 1992, Anesthesiology.

[20]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. , 1992, Anesthesiology.

[21]  R. Caplan,et al.  Incidence and risk factors for side effects of spinal anesthesia. , 1992, Anesthesiology.

[22]  D. Larach,et al.  Drug Infusion with a PaceportTMSwan-Ganz Catheter during Cardiopulmonary Bypass , 1986 .

[23]  J. Marty,et al.  Effects of Diazepam and Midazolam on Baroreflex Control of Heart Rate and on Sympathetic Activity in Humans , 1986, Anesthesia and analgesia.