Ann Surg Treat Res.  2014 Nov;87(5):245-252. 10.4174/astr.2014.87.5.245.

The comparison of monitored anesthesia care with dexmedetomidine and spinal anesthesia during varicose vein surgery

• Moon EJ
• Kang KW
• Chung JY
• Kang JM
• Park JH
• Joh JH
• Park HC
• Yi JW

• KMID: 2266883
• DOI: http://doi.org/10.4174/astr.2014.87.5.245

Abstract

PURPOSE
The purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery.
METHODS
Forty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 microg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 microg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups.
RESULTS
Systolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery.
CONCLUSION
We believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition.

Keyword

Dexmedetomidine; Monitored anesthesia care; Sedation; Spinal anesthesia

MeSH Terms

Anesthesia*
Anesthesia, Spinal*
Blood Pressure
Dexmedetomidine*
Heart Rate
Humans
Ketamine
Midazolam
Varicose Veins*
Vital Signs
Walking
Dexmedetomidine
Ketamine
Midazolam

Figure

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  Fig. 1 Changes in hemodynamic variables. MAC, monitored anesthetic care with dexmedetomidine; SA, spinal anesthesia; T1, baseline; T2, 5 minutes after loading of dexmedetomidine in the MAC group, or 5 minutes after performing intrathecal local anesthetic injection in the SA group; T3, 5 minutes after T2; T4, 5 minutes after T3 (5 minutes after maintenance infusion of dexmedetomine in the MAC group); T5, 5 minutes after T4 (5 minutes after injection of midazolam in the SA group); T6, 5 minutes after injection of first dose of ketamine in the MAC group, or 5 minutes after T5 in the SA group; T7, 5 minutes after T6; T8, at the end of surgery. *P < 0.05, the MAC group vs. the SA group.

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