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The timing of administration of intravenous dexmedetomidine during lower limb surgery: a randomized controlled trial.
BMC Anesthesiol 2016; 16(1):116BA

Abstract

BACKGROUND

Dexmedetomidine, a selective alpha-2 agonist, has sedative, analgesic, and anxiolytic effects without respiratory depression. Dexmedetomidine can cause a biphasic cardiovascular response, and induce transient hypertension. Hypotension is a common complication of spinal anesthesia. Decreasing anxiety of patients before procedure is important for high quality of procedure. This study aimed to compare the incidence of hypotension and patients' anxiety and comfort levels when dexmedetomidine was intravenously administered before and after spinal anesthesia.

METHODS

Seventy-four patients with American Society of Anesthesiologists physical status classification I or II were randomly allocated into two groups. Spinal anesthesia was performed using 12 mg of 0.5% heavy bupivacaine. In Group A, 1 μg/kg of dexmedetomidine was intravenously administered for 10 min, followed by the maintenance infusion of dexmedetomidine 0.2 μg/kg/hr after 5 min of intrathecal bupivacaine injection. Patients in Group B received same dose of dexmedetomidine by intravenous administration before 5 min of intrathecal bupivacaine injection. Perioperative vital signs, anxiety (using the Spielberger's State-Trait Anxiety Inventory) and comfort (using the numerical rating scale) were evaluated.

RESULTS

The incidence of hypotension was significantly lower in Group A (16.1%) than in Group B (48.4%) during infusion of dexmedetomidine (p = 0.01). The need for treatment of hypotension is higher in Group B than Group A (p = 0.02). The incidence of bradycardia and desaturation did not significantly differ between the two groups. There were no statistically significant differences regarding the patients' anxiety and comfort.

CONCLUSIONS

Hypotension is more frequently occurred, and the treatment of hypotension is more needed in Group B. The intravenously administration of dexmedetomidine before spinal anesthesia has no advantages in hemodynamic status and patients' comfort compared to that after spinal anesthesia during lower limb surgery.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT02155010 . Retrospectively registered on May 22, 2014.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea. tedy3333@naver.com.Department of Anesthesiology and Pain Medicine, Cheju Halla General Hospital, 65, Doryeong-ro, Jeju-si, Jeju-do, 63127, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Korea.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27871236

Citation

Kang, Eunsu, et al. "The Timing of Administration of Intravenous Dexmedetomidine During Lower Limb Surgery: a Randomized Controlled Trial." BMC Anesthesiology, vol. 16, no. 1, 2016, p. 116.
Kang E, Lee KH, Jeon SY, et al. The timing of administration of intravenous dexmedetomidine during lower limb surgery: a randomized controlled trial. BMC Anesthesiol. 2016;16(1):116.
Kang, E., Lee, K. H., Jeon, S. Y., Lee, K. W., Ko, M. J., Kim, H., ... Jung, J. W. (2016). The timing of administration of intravenous dexmedetomidine during lower limb surgery: a randomized controlled trial. BMC Anesthesiology, 16(1), p. 116.
Kang E, et al. The Timing of Administration of Intravenous Dexmedetomidine During Lower Limb Surgery: a Randomized Controlled Trial. BMC Anesthesiol. 2016 11 21;16(1):116. PubMed PMID: 27871236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The timing of administration of intravenous dexmedetomidine during lower limb surgery: a randomized controlled trial. AU - Kang,Eunsu, AU - Lee,Ki Hwa, AU - Jeon,Sang Yoon, AU - Lee,Kyu Won, AU - Ko,Myoung Jin, AU - Kim,Hyojoong, AU - Kim,Yong Han, AU - Jung,Jae-Wook, Y1 - 2016/11/21/ PY - 2016/06/29/received PY - 2016/11/13/accepted PY - 2016/11/23/entrez PY - 2016/11/23/pubmed PY - 2017/8/5/medline KW - Dexmedetomidine KW - Hypotension KW - Spinal anesthesia SP - 116 EP - 116 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 16 IS - 1 N2 - BACKGROUND: Dexmedetomidine, a selective alpha-2 agonist, has sedative, analgesic, and anxiolytic effects without respiratory depression. Dexmedetomidine can cause a biphasic cardiovascular response, and induce transient hypertension. Hypotension is a common complication of spinal anesthesia. Decreasing anxiety of patients before procedure is important for high quality of procedure. This study aimed to compare the incidence of hypotension and patients' anxiety and comfort levels when dexmedetomidine was intravenously administered before and after spinal anesthesia. METHODS: Seventy-four patients with American Society of Anesthesiologists physical status classification I or II were randomly allocated into two groups. Spinal anesthesia was performed using 12 mg of 0.5% heavy bupivacaine. In Group A, 1 μg/kg of dexmedetomidine was intravenously administered for 10 min, followed by the maintenance infusion of dexmedetomidine 0.2 μg/kg/hr after 5 min of intrathecal bupivacaine injection. Patients in Group B received same dose of dexmedetomidine by intravenous administration before 5 min of intrathecal bupivacaine injection. Perioperative vital signs, anxiety (using the Spielberger's State-Trait Anxiety Inventory) and comfort (using the numerical rating scale) were evaluated. RESULTS: The incidence of hypotension was significantly lower in Group A (16.1%) than in Group B (48.4%) during infusion of dexmedetomidine (p = 0.01). The need for treatment of hypotension is higher in Group B than Group A (p = 0.02). The incidence of bradycardia and desaturation did not significantly differ between the two groups. There were no statistically significant differences regarding the patients' anxiety and comfort. CONCLUSIONS: Hypotension is more frequently occurred, and the treatment of hypotension is more needed in Group B. The intravenously administration of dexmedetomidine before spinal anesthesia has no advantages in hemodynamic status and patients' comfort compared to that after spinal anesthesia during lower limb surgery. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02155010 . Retrospectively registered on May 22, 2014. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/27871236/The_timing_of_administration_of_intravenous_dexmedetomidine_during_lower_limb_surgery:_a_randomized_controlled_trial_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0282-2 DB - PRIME DP - Unbound Medicine ER -