Anesth Pain Med.  2016 Jul;11(3):255-259. 10.17085/apm.2016.11.3.255.

A loading dose of 1 µg/kg and maintenance dose of 0.5 µg/kg/h of dexmedetomidine for sedation under spinal anesthesia may induce excessive sedation and airway obstruction

• Yeom JH
• Oh MK
• Ahn DW
• Park SI

• KMID: 2344927
• DOI: http://doi.org/10.17085/apm.2016.11.3.255

Abstract

BACKGROUND
For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical.
METHODS
Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 µg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 µg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients' vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection.
RESULTS
The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60-80 at 30 and 50 min.
CONCLUSIONS
A loading dose of DEX 1 µg/kg for 10 min, and a maintenance dose of DEX 0.5 µg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.

Keyword

Bispectral index monitor; Dexmedetomidine; Ideal body weight; Spinal anesthesia

MeSH Terms

Airway Obstruction*
Anesthesia, Spinal*
Body Weight
Capillaries
Consciousness Monitors
Cough
Dexmedetomidine*
Humans
Ideal Body Weight
Incidence
Oxygen
Vital Signs
Dexmedetomidine
Oxygen

Reference

1. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000; 93:382–94. DOI: 10.1097/00000542-200008000-00016. PMID: 10910487.

2. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000; 90:699–705. DOI: 10.1097/00000539-200003000-00035. PMID: 10702460.

3. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000; 4:302–8. DOI: 10.1186/cc712. PMID: 11056756.

4. Park JW, Han JU, Shinn HK, Jung JK, Cha YD, Kang SA, et al. The effect of intravenous dexmedetomidine on the duration of brachial plexus block. Anesth Pain Med. 2012; 7:307–11.

5. Cho K, Lee JH, Kim MH, Lee W, Lim SH, Lee KM, et al. Effect of perioperative infusion of lidocaine vs. dexmedetomidine on reduced consumption of postoperative analgesics after laparoscopic cholecystectomy. Anesth Pain Med. 2014; 9:185–92.

6. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002; 95:461–6. DOI: 10.1097/00000539-200208000-00042.

7. Kunisawa T, Hanada S, Kurosawa A, Suzuki A, Takahata O, Iwasaki H. Dexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient. J Anesth. 2010; 24:938–41. DOI: 10.1007/s00540-010-1025-z. PMID: 21110048.

8. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000; 321:1493. DOI: 10.1136/bmj.321.7275.1493. PMID: 11118174. PMCID: PMC27550.

9. Svircevic V, van Dijk D, Nierich AP, Passier MP, Kalkman CJ, van der Heijden GJ, et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011; 114:271–82. DOI: 10.1097/ALN.0b013e318201d300.

10. Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 2014; 311:2508–17. DOI: 10.1001/jama.2014.6499. PMID: 25058085. PMCID: PMC4344128.

11. Maheshwari D, Ismail S. Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. J Anaesthesiol Clin Pharmacol. 2015; 31:196–200. DOI: 10.4103/0970-9185.155148. PMID: 25948900. PMCID: PMC4411833.

12. Carvalho B, Cohen SE, Lipman SS, Fuller A, Mathusamy AD, Macario A. Patient preferences for anesthesia outcomes associated with cesarean delivery. Anesth Analg. 2005; 101:1182–7. DOI: 10.1213/01.ane.0000167774.36833.99. PMID: 16192541.

13. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences (Riyadh). 2007; 12:145–8.

14. Thorp JM, Kennedy BW, Millar K, Fitch W. Personality traits as predictors of anxiety prior to caesarean section under regional anaesthesia. Anaesthesia. 1993; 48:946–50. DOI: 10.1111/j.1365-2044.1993.tb07470.x. PMID: 8250187.

15. Shevde K, Panagopoulos G. A survey of 800 patients’ knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg. 1991; 73:190–8. DOI: 10.1213/00000539-199108000-00013. PMID: 1854034.

16. Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol. Anesth Analg. 2009; 109:1811–5. DOI: 10.1213/ANE.0b013e3181c04e58. PMID: 19923507.

17. Vernon JM, Lang E, Sebel PS, Manberg P. Prediction of movement using bispectral electroencephalographic analysis during propofol/alfentanil or isoflurane/alfentanil anesthesia. Anesth Analg. 1995; 80:780–5. DOI: 10.1213/00000539-199504000-00023. PMID: 7893035.

18. Sandler NA, Hodges J, Sabino M. Assessment of recovery in patients undergoing intravenous conscious sedation using bispectral analysis. J Oral Maxillofac Surg. 2001; 59:603–11. DOI: 10.1053/joms.2001.23366. PMID: 11381378.

19. Liu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg. 1997; 84:185–9. DOI: 10.1213/00000539-199701000-00033. PMID: 8989022.

20. Sleigh JW, Andrzejowski J, Steyn-Ross A, Steyn-Ross M. The bispectral index: a measure of depth of sleep? Anesth Analg. 1999; 88:659–61. DOI: 10.1213/00000539-199903000-00035. PMID: 10072023.

21. Pollock JE, Neal JM, Liu SS, Burkhead D, Polissar N. Sedation during spinal anesthesia. Anesthesiology. 2000; 93:728–34. DOI: 10.1097/00000542-200009000-00022. PMID: 10969306.

22. Gentili M, Huu PC, Enel D, Hollande J, Bonnet F. Sedation depends on the level of sensory block induced by spinal anaesthesia. Br J Anaesth. 1998; 81:970–1. DOI: 10.1093/bja/81.6.970. PMID: 10211030.

23. Tverskoy M, Shagal M, Finger J, Kissin I. Subarachnoid bupivacaine blockade decreases midazolam and thiopental hypnotic requirements. J Clin Anesth. 1994; 6:487–90. DOI: 10.1016/0952-8180(94)90089-2.

24. Tverskoy M, Fleyshman G, Bachrak L, Ben-Shlomo I. Effect of bupivacaine-induced spinal block on the hypnotic requirement of propofol. Anaesthesia. 1996; 51:652–3. DOI: 10.1111/j.1365-2044.1996.tb04647.x. PMID: 8758157.

25. Mason KP, Zurakowski D, Zgleszewski S, Prescilla R, Fontaine PJ, Dinardo JA. Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth. 2010; 20:516–23. DOI: 10.1111/j.1460-9592.2010.03299.x. PMID: 20412458.

26. Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: A wonder drug? Indian J Anaesth. 2011; 55:323–4. DOI: 10.4103/0019-5049.84824. PMID: 22013245. PMCID: PMC3190503.

27. Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology. 2000; 93:1345–9. DOI: 10.1097/00000542-200011000-00030. PMID: 11046225.