Advantages of the combined use of dexmedetomidine and magnesium sulphate in alcohol withdrawal delirium

Abstract

Annotation. The search for effective sedation schedule in management of alcohol withdrawal delirium, which would ensure both an adequate sedation level and sufficient safety profile, is an urgent problem of modern anesthesiology and intensive care medicine. In this respect, the aim of our study is to research the use of dexmedetomidine combined with magnesium preparations, which seems to be promising. The study was conducted on 80 patients with alcoholic delirium randomized into 4 groups, in which the following parameters were evaluated: delirium duration, plasma magnesium, hemodynamics parameters, presence of respiratory disorders, as well as the levels of urea, creatinine, transaminase, cortisol and serotonin in plasma. The control group patients underwent standard sedation therapy. In experimental group 1, standard sedation with benzodiazepines was supplemented magnesium sulfate. In group 2, we maintained infusion of dexmedetomidine. In group 3, we combined intravenous magnesium sulfas with dexmedetomidine infusion. Statistical processing was performed using: Mann-Whitney U-test, Wilcoxon T-test, and Kruskal-Wallace H-test. Duration of delirium proved to be significantly shorter in all study groups as compared to the controls, p <0.05. The best sedation therapy results were recorded in group 3, p <0.05. On the first day of treatment, all patients were found to have elevated MAP and heart rate, while significant improvement in hemodynamic parameters was observed on the third day, p <0.05. Cases of hypotension were detected in groups 1 and 2. On the third day of treatment, the patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol and serotonin as compared to the controls, p<0.05, while serotonin level was higher in experimental group 3 as compared to the control patients, p<0.05. The use of combination of magnesium with dexmedetomidine infusion proved to be beneficial and effective in treatment of patients with alcohol withdrawal delirium improving the quality of patients’ care and shortening delirium duration.