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Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial.

Abstract

Context

Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain.

Aims

To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia.

Settings and Design

This prospective randomized control trial was conducted in a tertiary care institution.

Subjects and Methods

Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S1 level, and sedation score were noted.

Statistical Analysis Used

To test the statistical significance of duration of sensory blockade, Mann-Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test.

Results

The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S1 dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039).

Conclusion

Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability.

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  • Authors+Show Affiliations

    ,

    Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

    ,

    Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

    ,

    Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

    ,

    Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

    Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31198255

    Citation

    Sivachalam, Swetha N., et al. "Comparison of Prolongation of Spinal Anesthesia Produced By Intravenous Dexmedetomidine and Midazolam: a Randomized Control Trial." Anesthesia, Essays and Researches, vol. 13, no. 2, 2019, pp. 330-333.
    Sivachalam SN, Puthenveettil N, Rajan S, et al. Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial. Anesth Essays Res. 2019;13(2):330-333.
    Sivachalam, S. N., Puthenveettil, N., Rajan, S., Paul, J., & Kumar, L. (2019). Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial. Anesthesia, Essays and Researches, 13(2), pp. 330-333. doi:10.4103/aer.AER_38_19.
    Sivachalam SN, et al. Comparison of Prolongation of Spinal Anesthesia Produced By Intravenous Dexmedetomidine and Midazolam: a Randomized Control Trial. Anesth Essays Res. 2019;13(2):330-333. PubMed PMID: 31198255.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial. AU - Sivachalam,Swetha N, AU - Puthenveettil,Nitu, AU - Rajan,Sunil, AU - Paul,Jerry, AU - Kumar,Lakshmi, PY - 2019/6/15/entrez PY - 2019/6/15/pubmed PY - 2019/6/15/medline KW - Adjuvants KW - dexmedetomidine KW - midazolam KW - spinal anesthesia SP - 330 EP - 333 JF - Anesthesia, essays and researches JO - Anesth Essays Res VL - 13 IS - 2 N2 - Context: Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain. Aims: To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia. Settings and Design: This prospective randomized control trial was conducted in a tertiary care institution. Subjects and Methods: Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S1 level, and sedation score were noted. Statistical Analysis Used: To test the statistical significance of duration of sensory blockade, Mann-Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test. Results: The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S1 dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039). Conclusion: Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability. SN - 0259-1162 UR - https://www.unboundmedicine.com/medline/citation/31198255/Comparison_of_Prolongation_of_Spinal_Anesthesia_Produced_by_Intravenous_Dexmedetomidine_and_Midazolam:_A_Randomized_Control_Trial L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31198255/ DB - PRIME DP - Unbound Medicine ER -