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Category: Volume 08 Issue 09 September 2020
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Title: Dexmedetomidine for Sedation during Total Abdominal Hysterectomy under Spinal Anesthesia

Authors: Dr Rajat Shuvra Das, Dr Mohammad Shaddam Hoshian Mondol, Dr Arman Ali, Dr Ishrat Jahahan Shathi

 DOI: https://dx.doi.org/10.18535/jmscr/v8i9.31

Abstract

Background: Intravenous Dexmedetomidine is associated with stable cardiovascular profile and less associated with fear, anxiety and agitation. Spinal anesthesia offers many advantages over general anesthesia, like providing analgesia and muscle relaxation in a conscious and compliant patient and an uneventful postoperative recovery.

Objective: To evaluate the efficacy of dexmedetomidine in attenuation of haemodynamic stability and sedation during total abdominal hysterectomy under spinal anesthesia.

Materials and Methods: This prospective study work was conducted during 8th June 2017 to 7th December 2017, in Dhaka Medical College Hospital, Dhaka, Bangladesh. Total 60 patients were recruited as study population under two groups of group D of dexmedetomidine and M of midazolam who classified by American Society of Anesthesiologists (ASA- I, II). Random sampling methods was followed. Subarachnoid anaesthesia was performed in all patients with 0.5% hyperbaric bupivacaine intrathecally, at L3-L4 interspinous spaces, with 25G Quinke’s spinal needle. The patients of group D) was administrated with an intravenous loading dose of 0.5 µg.kg-dexmedetomidine and group M 0.04 µg.kg- midazolam via a syringe infusion. Changes of BP, pulse and any complication was recorded. Collected data were analyzed by SPSS software, version 22.0.

Results: According to the study, majority of the patients 66.6% (n=40) were between 50-60 years, mean age was 53.3±11.5 years. The difference was not statistically significant (p>0.05) between two groups. The baseline mean heart rate was found 90.2±7.3 and 93.1±8.2 beat/min in group Mand D.  At 5 minute after, mean heart rate was 92.9±7. and 93.7±9.4 beat/min. At 30 minute after mean heart rate was 100.4±9.1 and 93.5±9.1. At 45 minute, mean heart rate was 103.0±8.9 and 87.7±17.7. At 60 minutes,104.5±7.7 and 92.7±8.2. At after 30 minute, 45 minute and 60-minute difference was statistically significant (p<0.05) between two groups. On evaluation of systolic blood pressure, baseline, mean systolic BP was found 89.6±6.3 mmHg and 84.3±5.0 mmHg. At 10 minute after, was 95.3±7.1 and 85.5±5.1 mmHg. At 45 minute, was 94.6±15.6 and 84.3±5.0. At 10, 15, 30 and 45 minute after difference was statistically significant (p<0.05) between two groups. After 30 minute, mean sedation was found 4.13±0.32 and 3.89±0.5. After 60 minute, mean sedation was found 4.38±0.57 score in group D, but in group M score is reduced and found 3.52±0.27. Mean difference was statistically significant (p<0.05) between two groups.

Conclusion: In this study, intraoperative Ramsay sedation scores were significantly higher in dexmedetomidine group. When compared with intravenous (IV) midazolam, administration of IV dexmedetomidine during spinal anesthesia provides a longer duration of postoperative analgesia, with satisfactory arousable sedation and minimal side effects.

Keywords: Dexmedetomidine, spinal anaesthesia, statistically significant, baseline.

References

  1. Kolarkar P, Badwaik G, Kalbande G, Watve A, Bhalerao A, Giri A. Does intravenous low dose dexmedetomidine supplementation has beneficial effects on spinal anaesthesia?. International Journal of Contemporary Medical Research 2016; 3(6): 1547-1550.
  2. Kabsool A. General Versus Spinal Anesthesia with Difference Form of Sedation for Patient Undergoing Elective Hysterectomy. MedCrave Group LLC 2016: 4-26.
  3. Base-Smith V. Anesthetic Management: Hysterectomy. Perspectives 2016; 1(2): 2-7.
  4. JG, Rosenberg  PH.  Forster Clinically useful adjuvants in Regional anaesthesia. Curropin Anaesthesiol. 2003; 16: 477-86.
  5. Shah P, Dubey K, Sahare K and Agrawal A. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: A comparative study. J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun; 32(2): 245–249.
  6. Patel V, Patel H. A comparison between dexmedetomidine and midazolam infusion on characteristic of spinal anesthesia. International Journal of Medical Science and Public Health 2016; 5(5): 906-909.
  7. Hayashi Y, Maze M. Alpha 2 adrenoceptor agonists and anaesthesia. Br J Anaesth. 1993; 71:108–18.
  8. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, Bulbul M, Baraka AS. Effects of low dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anesthesiol Scand. 2006; 50: 222-7.
  9. Liang Y, Gu M, Wang S, Chu H. A comparison of dexmedetomidine and midazolam for sedation in gynecologic surgery under epidural anesthesia. J CurrSurg 2011; 1(1):12–8.
  10. Kumari R, Kumar A, Kumar S, Singh R. Intravenous dexmedetomidine as an adjunct to subarachnoid block: A simple effective method of better perioperative efficacy. J Anaesthesiol Clin Pharmacol 2017; 33:203-8.
  11. Bajwa S, Kulshrestha A. Dexmedetomidine: An adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013; 3:475‑83.
  12. The American Society of Health-System Pharmacists. Retrieved March 1, 2017.
  13. Barends C, Absalom A, Minnen B, Vissink A, Visser A. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety. PLoS ONE, 2017; 12(1):1-12.
  14. Midazolam- Product Information. Alphapharm Pty Limited. Downloaded from: www.alphapharm.com.au. Accessed on March 2017.
  15. Barends CRM, Absalom A,vanMinnen B, VissinkA,VisserA. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety. PLoS 2017; 12(1): e0169525.
  16. Magalhães E, Ladeira LCA, Govêia CS, Espíndola BV. Intravenous Dexmedetomidine for Sedation does not interfere with Sensory and Motor Block Duration during Spinal Anesthesia. Rev Bras Anestesiol 2006; 56: 1: 1 – 7.
  17. Swati Bisht, Sudha Prasad. “Intravenous Dexmedetomidine Prolongs Bupivacaine Spinal Anesthesia”.  Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 07, February 17; Page: 1745-1752.
  18. Tarkan M, Zekeriya E, Namigar T. Spinal Anaesthesia and Perioperative Anxiety. Turk J AnaesthReanim 2014; 42: 190-5.
  19. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol E, Ozcan B. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anesth/J Can Anesth (2010) 57:39–45.
  20. Yazbek-Karam VG, Aouad MA. Perioperative uses of dexmedetomidine. M.E.J. Anesth. 2006; 18: 1043-1058.
  21. Gertler R, Brown H, Mitchell D, Silvius E. Dexmedetomidine: a novel sedative- analgesic agent. BaylUniv Med Cent Proc. 2001; 14:13–21.
  22. Mannion S. Sedation, spinal anesthesia and older patients. J Postgrad Med 2007; 53:155.
  23. Bajwa S, Kulshrestha A. Dexmedetomidine: An adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013; 3:475‑83
  24. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anesth 2010;57(1):39–45.
  25. Celik M, Koltka N, Cevik B, Baba H. Intraoperative sedation during epidural anesthesia: dexmedetomidine vs midazolam. Internet J Anesthesiol2008; 17:2
  26. Senses E, Apan A, Kose EA, Oz G, Rezaki H. The effects of midazolam and dexmedetomidine infusion on peri-operative anxiety in regional anesthesia. Middle East J Anesthesiol 2013; 22(1):35–40.
  27. Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al-Barazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anesthesiol 2009;20(2): 225–31.
  28. Elcicek K, Tekin M, Kati I. The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine aesthesia. J Anesth 2010;24(4):544–8.
  29. Lugo VW, Gomez IA, Cisneros-Corral R, Martinez-Gallegos N. Intravenous dexmedetomidine versus intravenous clonidine to prolong bupivacaine spinal anaesthesia. A double blind study. Anaestesiaen Mexico 2007; 19:143–6.
  30. Harsoor SS, Rani DD, Yalamuru B, Sudheesh K, Nethra S. Effect of supplementation of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine. Indian J Anaesth 2013;57 (3):265–9.

Corresponding Author

Dr Rajat Shuvra Das

Specialist, Department of Anaesthesia, BRB Hospitals Ltd. Panthapath, Dhaka, Bangladesh