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Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia.
Medicine (Baltimore) 2018; 97(39):e12565M

Abstract

BACKGROUND

Dexmedetomidine is an effective sedative during spinal anesthesia. However, it requires a loading dose, which can result in transient hypertension, hypotension, bradycardia, and/or sinus arrest. In addition, the time required to reach an appropriate depth of sedation may cause anxiety to the patients. Therefore, we examined whether an intravenous bolus of midazolam could replace the loading dose of dexmedetomidine for sedation during surgery in elderly patients who received spinal anesthesia.

METHODS

Patients aged over 60 years who scheduled to undergo total knee arthroplasty under spinal anesthesia were enrolled in this study. The patients were randomized into 2 groups. Patients in dexmedetomidine group (group D) (n = 20) were administered a loading dose of dexmedetomidine (1.0 μg/kg over 10 min) intravenously followed by dexmedetomidine maintenance (0.5 μg/kg/h). Patients in group MD (n = 20) were administered an intravenous midazolam (0.05 mg/kg) followed by dexmedetomidine maintenance (0.5 μg/kg/h) intravenously. Heart rate (HR), mean arterial blood pressure (MBP), peripheral oxygen saturation (SpO2), and patient state index (PSI) were recorded. Ramsay sedation scale (RSS) scores were evaluated at 10 minutes after drug administration and the end of surgery.

RESULTS

A total of 40 subjects were enrolled in the present study. At baseline, there was no between-group difference in HR. Ten minutes after drug administration, group D had lower HR than group MD (62.1 ± 9.4 versus 69.6 ± 13.4, P = .047). PSI was significantly lower in group MD at 10 minutes after drug administration (82.8 ± 13.0 versus 72.0 ± 16.0, P = .024); there was no between-group difference at 30 and 60 minutes, and lower values in group D at the end of surgery (70.2 ± 22.6 versus 79.7 ± 10.9, P = .011). The RSS score showed statistically significantly deeper sedation in group MD 10 minutes after drug administration, but no difference at the end of surgery.

CONCLUSIONS

An intravenous bolus of midazolam is a viable alternative to dexmedetomidine loading for sedation during surgery in elderly patients who received spinal anesthesia. This is especially effective for patients who are at high risk for bradycardia or who want a faster sedation.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University.Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University.Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30278560

Citation

Park, Sung Wook, et al. "Replacement of Dexmedetomidine Loading With Midazolam for Sedation in Elderly Patients With Spinal Anesthesia." Medicine, vol. 97, no. 39, 2018, pp. e12565.
Park SW, Choi JH, Kim HT, et al. Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia. Medicine (Baltimore). 2018;97(39):e12565.
Park, S. W., Choi, J. H., Kim, H. T., & Cho, Y. H. (2018). Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia. Medicine, 97(39), pp. e12565. doi:10.1097/MD.0000000000012565.
Park SW, et al. Replacement of Dexmedetomidine Loading With Midazolam for Sedation in Elderly Patients With Spinal Anesthesia. Medicine (Baltimore). 2018;97(39):e12565. PubMed PMID: 30278560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia. AU - Park,Sung Wook, AU - Choi,Jeong-Hyun, AU - Kim,Hyung-Tak, AU - Cho,Yong Hyun, PY - 2018/10/4/entrez PY - 2018/10/4/pubmed PY - 2018/10/12/medline SP - e12565 EP - e12565 JF - Medicine JO - Medicine (Baltimore) VL - 97 IS - 39 N2 - BACKGROUND: Dexmedetomidine is an effective sedative during spinal anesthesia. However, it requires a loading dose, which can result in transient hypertension, hypotension, bradycardia, and/or sinus arrest. In addition, the time required to reach an appropriate depth of sedation may cause anxiety to the patients. Therefore, we examined whether an intravenous bolus of midazolam could replace the loading dose of dexmedetomidine for sedation during surgery in elderly patients who received spinal anesthesia. METHODS: Patients aged over 60 years who scheduled to undergo total knee arthroplasty under spinal anesthesia were enrolled in this study. The patients were randomized into 2 groups. Patients in dexmedetomidine group (group D) (n = 20) were administered a loading dose of dexmedetomidine (1.0 μg/kg over 10 min) intravenously followed by dexmedetomidine maintenance (0.5 μg/kg/h). Patients in group MD (n = 20) were administered an intravenous midazolam (0.05 mg/kg) followed by dexmedetomidine maintenance (0.5 μg/kg/h) intravenously. Heart rate (HR), mean arterial blood pressure (MBP), peripheral oxygen saturation (SpO2), and patient state index (PSI) were recorded. Ramsay sedation scale (RSS) scores were evaluated at 10 minutes after drug administration and the end of surgery. RESULTS: A total of 40 subjects were enrolled in the present study. At baseline, there was no between-group difference in HR. Ten minutes after drug administration, group D had lower HR than group MD (62.1 ± 9.4 versus 69.6 ± 13.4, P = .047). PSI was significantly lower in group MD at 10 minutes after drug administration (82.8 ± 13.0 versus 72.0 ± 16.0, P = .024); there was no between-group difference at 30 and 60 minutes, and lower values in group D at the end of surgery (70.2 ± 22.6 versus 79.7 ± 10.9, P = .011). The RSS score showed statistically significantly deeper sedation in group MD 10 minutes after drug administration, but no difference at the end of surgery. CONCLUSIONS: An intravenous bolus of midazolam is a viable alternative to dexmedetomidine loading for sedation during surgery in elderly patients who received spinal anesthesia. This is especially effective for patients who are at high risk for bradycardia or who want a faster sedation. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/30278560/Replacement_of_dexmedetomidine_loading_with_midazolam_for_sedation_in_elderly_patients_with_spinal_anesthesia_ L2 - http://Insights.ovid.com/pubmed?pmid=30278560 DB - PRIME DP - Unbound Medicine ER -