Korean J Anesthesiol. 2016 Oct;69(5):446-452. doi: 10.4097/kjae.2016.69.5.446. Epub 2016 Sep 08.

Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia.

Korean journal of anesthesiology

Douk-Keun Yoon, Jong-Seouk Ban, Sang-Gon Lee, Ji-Hyang Lee, Eunju Kim, Jihyun An

PMID: 27703624 PMCID: PMC5047979 DOI: 10.4097/kjae.2016.69.5.446

Abstract

BACKGROUND: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation.

METHODS: Ninety patients classified as American Society of Anesthesiologists physical status I-II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused.

RESULTS: At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55-80 and the Ramsay Sedation Scale score was within the optimal range of 3-5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively).

CONCLUSIONS: Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.

Keywords: Dexmedetomidine; Midazolam; Spinal anesthesia

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