A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patients undergoing bariatric surgery

Abstract

Background:Morbidly obese patients with obstructive sleep apnea are extremely sensitive to sedative premedication. Intranasal dexmedetomidine is painless and quick acting. Intranasal dexmedetomidine can be used for premedication as it produces adequate sedation and also obtund hemodynamic response to laryngoscopy and tracheal intubation.Materials and Methods:Forty morbidly obese patients with BMI > 35 were chosen and divided into two groups. Group DEX received intranasal dexmedetomidine 1 mcg/kg (ideal body weight) while other group (AZ) received oral alprazolam 0.5 mg. Sedation scale, heart rate and the mean arterial pressure was assessed in both the groups at 0 hour, 45 minutes, during laryngoscopy and tracheal intubation.Results:The demographic profile, baseline heart rate, means arterial pressure, oxygen saturation and sedation scale was comparable between the two groups. The sedation scores, after 45 min, were statistically significant between the two groups i.e., 2.40 ± 1.09 in the AZ group as compared to 3.20 ± 1.79 in DEX group P value 0.034. The heart rate, mean arterial pressure and oxygen saturation were statistically similar between the two groups, after 45 min. The heart rate was significantly lower in the DEX group as compared to the AZ group. There was no statistical difference in the mean arterial pressure between the two groups either during laryngoscopy or tracheal intubation.Conclusion:Intranasal dexmedetomidine is a better premedication agent in morbidly obese patients than oral alprazolam.

Perioperative care of the obese patient

“…If intravenous midazolam is used, obese patients should be closely monitored, with supplementary oxygen immediately available. Ketamine plus clonidine or dexmedetomidine are other options, with minimal adverse respiratory effects.…”

Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment

“…DEX is a fast-acting alpha-2 adrenergic receptor agonist [ 1 2 3 4 7 8 ] with few adverse effects due to its short half-life [ 8 ]. Respiratory failure, which is a risk factor of most sedatives, occurs more often in obese patients.…”

“…Respiratory failure, which is a risk factor of most sedatives, occurs more often in obese patients. Jayaraman et al [ 4 ] reported that there was no incidence of respiratory failure following sedation of obese patients using DEX. Use of sevoflurane in pediatric patients undergoing general anesthesia is associated with a high risk of emergence delirium; although it has been reported that the incidence of emergence delirium is lower when DEX is used [ 8 ].…”

“…Rates of absorption and bioavailability are similar to those of drugs administered intravenously, which makes DEX superior to oral sedatives. DEX may be administered easily and painlessly in pediatric patients who do not possess behavioral control [ 4 5 6 ]. Use of a disposable Mucosal Atomizer Device (LMA MAD Nasal™, Wolfe Tory Medical Inc., USA) to enable aerosol delivery of DEX into the nasal cavity ( Fig.…”

Obezite Hastalarında Anestezi Yönetimi

“…Yapılan bir çalışmada OUAS hastalarında sedasyon amaçlı selektif alfa-2 adrenoreseptör agonisti deksmedetomidin kullanımınının solunum depresyonu yapmadığı bildirilmiştir 24 .…”