Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia

Ko, Ki Ho; Jun, In Jung; Lee, Sang Seok; Lim, Yun Hee; Yoo, Byunghoon; Kim, Kye Min

doi:10.4097/kjae.2015.68.6.575

Cited by 27 publications

(21 citation statements)

References 17 publications

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“…In addition to pain relief, dexmedetomidine continuous infusion in SAPB was associated with better sedation during the early postoperative period (12 hrs). Intravenous continuous infusion injection of dexmedetomidine is used effectively to produce adequate levels of sedation during different types of surgical procedures 22–24. Dexmedetomidine has also extra benefits in perioperative care such as anxiolysis, control of postoperative shivering, and PONV 20…”

Section: Discussionmentioning

confidence: 99%

<p>Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study</p>

Abdallah¹,

Bakeer²,

Youssef³

et al. 2019

JPR

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Purpose: The study aimed to evaluate the analgesic efficiency of dexmedetomidine (DEX) when added to levobupivacaine in continuous ultrasound-guided serratus anterior plane block (SAPB) performed at the end of major thoracic surgery. Methods: This randomized, double-blind trial included 50 adults undergoing thoracic surgery. Continuous SAPB was performed at the end of surgery. Patients were randomized into two groups. Group L (n=25) received levobupivacaine only while Group DL (n=25) received a mixture of levobupivacaine and DEX. All patients received intravenous (IV) paracetamol every 8 hrs. Morphine IV was given according to VAS score of pain as a 5 mg loading dose. The primary outcome measure was postoperative pain intensity. Secondary outcome measures were postoperative morphine consumption and adverse effects. Results: Analgesia was satisfactory in the two groups up to 24 hrs. VAS score was significantly lower in group DL compared to group L between 6 and 24 hrs postoperatively. Total morphine consumption was significantly lower in group DL compared to group L ( p <0.001). Up to 12 hrs postoperatively, sedation score was significantly lower in group DL compared to group L. Afterwards, all patients were fully alert. All values of mean arterial pressure and heart rate were within the clinically accepted ranges. There were no recorded cases of hypotension or bradycardia in the whole studied group. Conclusions: Continuous SAPB with levobupivacaine plus DEX seems to be a promising analgesic alternative following thoracotomy. Combined with IV paracetamol, this approach provided adequate analgesia and proper sedation. Trial registration: ISRCTN registry; study ID: ISRCTN35517318

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Section: Discussionmentioning

confidence: 99%

<p>Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study</p>

Abdallah¹,

Bakeer²,

Youssef³

et al. 2019

JPR

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“…In another study, excessive sedation occurred in 46 and 60% of elderly patients (aged >60 years) receiving 0.5 and 1 µg/kg dexmedetomidine, respectively, [ 110 ]. In a study by Ko et al [ 111 ], loading doses of 0.1–1.0 µg/kg over 10 min were well tolerated in 47 elderly subjects (aged >65 years). Hypotension was observed more frequently in patients receiving loading doses of ≥0.7 µg/kg.…”

Section: Special Populationsmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

et al. 2017

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Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α2-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.

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“…However, the dose effect varied among these studies, which may be partly due to differences in population age, the invasiveness of the procedures, and the methods of anesthesia. In two dexmedetomidine dose–response studies conducted in elderly patients under spinal anesthesia,22, 23 the ED 50 of single‐dose dexmedetomidine required to obtain adequate sedation was 0.25 and 0.29 μg/kg, respectively. These ED 50 values were both lower than those in our study, which is probably because spinal anesthesia itself can reduce the requirement for sedative hypnotics as a result of decreased afferent input 24.…”

Section: Discussionmentioning

confidence: 99%

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

Wang

Zhang

2018

Acta Anaesthesiol Scand

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BackgroundThe median effective dose (ED 50) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED 50 of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB.MethodsForty‐two patients aged 65–85 years were included and stratified into two groups according to age: young‐old group (aged 65–74 years) and middle‐old group (aged 75–85 years). After the PNB was performed, a pre‐calculated dose of dexmedetomidine was administered for 10 min. The Observer's Assessment of Alertness/Sedation scale, bispectral index score, blood pressure and heart rate were recorded. ED 50 values of dexmedetomidine for adequate sedation were estimated by the up‐and‐down method of Dixon and probit regression.ResultsThe ED 50 of single‐dose dexmedetomidine adjuvant to PNB was 0.57 μg/kg (95% confidence interval [CI], 0.47–0.65) in the young‐old group and 0.38 μg/kg (95% CI, 0.28–0.46) in the middle‐old group. The ED 50 of dexmedetomidine differed significantly between the two groups (P < 0.001). In addition, no significant adverse hemodynamic or hypoxemic effects were noted.ConclusionWe determined the ED 50 for sedation using intravenous dexmedetomidine adjuvant to PNB in elderly patients. The ED 50 of dexmedetomidine in the middle‐old group decreased by 33% compared with that in the young‐old group with a mean age difference of 11 years between the two groups.

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Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia

Cited by 27 publications

References 17 publications

<p>Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study</p>

<p>Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study</p>

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

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