Comparison of several dosing schedules of intravenous dexmedetomidine in elderly patients under spinal anesthesia

Yeom, Jong Hoon; Ahn, Dae-woong; Kim, Kyoung Hun

doi:10.17085/apm.2017.12.4.320

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Yeom et al [ 13 ] investigated the appropriate dose of DEX by comparing three groups: a initial dose of 1.0 μg/kg (based on actual body weight), 1.0 μg/kg (based on ideal body weight), or 0.8 μg/kg (based on ideal body weight) followed by continuous infusion of 0.5 μg/kg/h (based on each corresponding body weight criterion). They observed that an appropriate level of sedation was maintained in the 0.8 μg/kg (based on ideal body weight) group, and although the incidence of airway obstruction and bradycardia did not significantly differ between the three groups, a total of eight patients developed bradycardia.…”

Section: Discussionmentioning

confidence: 99%

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

et al. 2020

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Background: The purpose of this study was to investigate the degree of sedation and the incidence of adverse effects resulting from various methods of administering the initial dose followed by continuous infusion of dexmedetomidine (DEX) for sedation in elderly patients undergoing spinal anesthesia.Methods: In total, 72 patients aged over 65 years who were to be administered spinal anesthesia were randomly allocated into three groups. The initial doses were injected to the groups as follows: group DD, DEX 0.5 μg/kg for 10 min; group MD, midazolam 0.02 mg/kg; and group D, no initial dose. This was followed immediately by infusing a maintenance dose of DEX 0.5 μg/kg/h to all groups.Results: The Bispectral index (BIS) in the D group was significantly higher than in the other two groups. There were no significant differences in the Ramsay sedation scale (RSS) among the groups. The RSS 3 level was reached in 10 min from the start of sedation in MD and DD groups and in 20 min from the start of sedation in D group. Neither bradycardia nor hypotension was observed in any of the groups.Conclusions: Patients in all three groups reached the RSS 3 sedating-effect level. However, the group that received continuous infusion only without the initial dose showed higher BIS than the other two groups and reached the RSS 3 later. No adverse events were observed in any of the groups.

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Section: Discussionmentioning

confidence: 99%

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

et al. 2020

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“…The potential complications of deep sedation include hypoventilation, apnea, airway obstruction, aspiration, and hemodynamic instability [9]. For elderly patients, safer sedation strategies with lesser respiratory depression and stable hemodynamics are required [10].…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary aspiration during balanced sedation with dexmedetomidine and midazolam - A case report -

2019

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An ideal sedative should have a fast onset and offset of drug efficacy, be predictable and titratable, and have no serious side effects. Additionally, low price burden is preferable.Dexmedetomidine is a selective α2-adrenergic receptor agonist and is known to be a safe sedative that causes little respiratory depression [1]. It is characterized by "conscious sedation" and a clean and easy arousal from sedation, similar to being awakened by natural sleep [2]. Despite its expanded use within variable populations for procedural sedation, life-threatening pulmonary aspiration associated with dexmedetomidine has rarely been reported in cases of procedural sedation [3]. However, dexmedetomidine has some disadvantages, such as slower onset, frequent in-procedural awakenings, hemodynamic instability, and longer stay in postoperative care units [4,5]. Recently, "balanced sedation" has been introduced as an alternative strategy to increased doses of dexmedetomidine. Some sedatives or opioids such as ketamine, midazolam, or other opioids (e.g., remifentanil infusion) can be co-administered. However, the coadministration of other drugs can not guarantee the complete safety [6,7].We describe a case of fatal pulmonary aspiration that developed in balanced sedation with dexmedetomidine and a small amount of midazolam during spinal anesthesia in an elderly patient. CASE REPORTThe patient was an 84-year-old male (155 cm in height and 52 kg in weight) with a history of hypertension and kyphoscoliosis. He was transferred to our trauma center because of periprosthetic fracture of the left hip. He had undergone hip hemiarthroplasty 4 years ago and again fractured at the same position. He had cane-assisted ambulation prior to surgery and was relatively healthy for his age. Following routine preoperative examinations, including laboratory investigations,

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Comparison of several dosing schedules of intravenous dexmedetomidine in elderly patients under spinal anesthesia

Cited by 2 publications

References 16 publications

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

Fatal pulmonary aspiration during balanced sedation with dexmedetomidine and midazolam - A case report -

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