Anesthetic Efficacy of Dexmedetomidine versus Midazolam When Combined with Remifentanil for Percutaneous Transluminal Angioplasty in Patients with Peripheral Artery Disease

Abstract

Anesthesia for percutaneous transluminal angioplasty (PTA) involves a high-risk population having a broad spectrum of pain character and intensity. This study delved the anesthetic efficacy of dexmedetomidine versus midazolam, when used with remifentanil. Seventy patients scheduled for femoropopliteal PTA were randomized into two groups receiving either intermittent midazolam boluses (0.03–0.05 mg/kg) (MR group) or dexmedetomidine 0.2–0.7 μg/kg/h after a loading dose of 1.0 μg/kg for 10 min (DR group), both with remifentanil. The primary endpoint was the patients’ satisfaction (1–5, 5; extremely satisfied). Secondary endpoints included postprocedural pain scores (0–10, 10; worst imaginable pain) and adverse events. The satisfaction level of patients was significantly greater in the DR group compared with the MR group (4.0 [3.0, 5.0] versus 4.0 [2.0, 5.0] p = 0.021). The number of patients having a postprocedural pain score of at least 3 was significantly greater in the MR group compared with the DR group (10 [29%] versus 2 [6%], p = 0.013). The number of patients with hypotensive episodes was higher in the DR group (5 [14.7%] versus 0, p = 0.025), which could all be restored with ephedrine. The use of dexmedetomidine in conjunction with remifentanil may be a safe option that provides excellent patient satisfaction while potentially attenuating postprocedural pain.

The efficacy of intramuscular ephedrine in preventing hemodynamic perturbations in patients with spinal anesthesia and dexmedetomidine sedation

“…Of particular relevance to spinal anesthesia, both intrathecal and intravenous administration of dexmedetomidine extend the duration of sensory and motor blockades, deepen sedation, delay the time required for postoperative rescue analgesics, and reduce consumption of morphine during the postoperative 24 hours 18 , 23 . Indeed, cumulating evidence shows that dexmedetomidine is superior in terms of satisfaction for both patient and interventionists compared with midazolam 16 , 24 - 26 . In addition, patients sedated with dexmedetomidine exhibited lower pain values and lower analgesic requirements postoperatively 26 , 27 .…”

“…After confirmation of appropriate block height, dexmedetomidine infusion was initiated based on previous studies [16]. In both groups, dexmedetomidine 1.0 μg/kg was administered for 10 minutes followed by continuous infusion of 0.2-0.7 μg/kg/h until the end of surgery.…”

Nalbuphine versus dexmedetomidine for treatment of combined spinal-epidural post-anesthetic shivering in pregnant women undergoing cesarean section

“…Park et al. 27 found that dexmedetomidine (0.2–0.7 μg/kg/hours) combined with remifentanil could reduce postoperative pain. Yu et al.…”

“…Notably, dexmedetomidine is adopted to relieve pain by combination with other agonists. Park et al 27 found that dexmedetomidine (0.2-0.7 lg/kg/hours) combined with remifentanil could reduce postoperative pain. Yu et al 9 suggested that dexmedetomidine 0.05 lg/kg/hour is a better choice for antishivering, which is consistent with our study.…”

Monitored Anesthesia Care for Cardiovascular Interventions

“…Combination of opioids such as remifentanil with benzodiazepines or propofol may improve sedation experience, however, it can increase a risk of respiratory depression 65). Addition of dexmedetomidine can confer both sedation and analgesia while sparing the dose of opioids and preserving the respiratory function 66)…”