Yonsei Med J.  2016 Jul;57(4):998-1005. 10.3349/ymj.2016.57.4.998.

Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia

• Wu X
• Hang LH
• Wang H
• Shao DH
• Xu YG
• Cui W
• Chen Z

• KMID: 2374135
• DOI: http://doi.org/10.3349/ymj.2016.57.4.998

Abstract

PURPOSE
Intranasal dexmedetomidine is an effective sedative for premedication and is regularly used to reduce preoperative tension and anxiety in children. This study aimed to assess the effect of intranasally adjunctive dexmedetomidine on perioperative sedative and analgesic requirements in adults.
MATERIALS AND METHODS
Patients were randomly divided into four groups to receive preoperative administration of saline, intranasal dexmedetomidine 1 µg/kg and 2 µg/kg, and intravenous dexmedetomidine 1 µg/kg, respectively. Propofol and remifentanil were target-controlled infused to maintain intraoperative bispectral index at 45-55 and blood pressure at baseline value±20%. Sufentanil was administered to maintain postoperative visual analogue scale ≤3. Perioperative anesthetics requirements were compared using nonparametric tests.
RESULTS
Intranasal dexmedetomidine significantly attenuated propofol requirements for anesthesia induction and maintenance in a dose-dependent manner. Patients given intranasal dexmedetomidine 2 µg/kg required less remifentanil for anesthesia maintenance. The first postoperative request for sufentanil analgesia was delayed in patients given intranasal dexmedetomidine 2 µg/kg. The anesthetics-sparing effect of intranasal dexmedetomidine was significantly weaker than intravenous dexmedetomidine at the same dose of 1 µg/kg. The incidences of adverse events, including hemodynamic instability and delayed recovery, were comparable with and without intranasal dexmedetomidine.
CONCLUSION
Intranasal administration of dexmedetomidine can reduce perioperative anesthetic requirements, and a dose of dexmedetomidine 2 µg/kg produces a better effect in adults. The anesthetics-sparing effect of intranasal dexmedetomidine 1 µg/kg is less than that with the same intravenous dose of dexmedetomidine.

Keyword

Dexmedetomidine; administration, intranasal; anesthetics, intravenous

MeSH Terms

*Administration, Intranasal
Adult
*Anesthesia, General
Child
Dexmedetomidine/*administration & dosage/adverse effects/*pharmacology
Double-Blind Method
Female
Humans
Hypnotics and Sedatives/*administration & dosage/adverse effects/*pharmacology
Male
Middle Aged
Pain Measurement
*Perioperative Care
Premedication
Dexmedetomidine
Hypnotics and Sedatives

Figure

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  Fig. 1 Study design. DEX, dexmedetomidine; IN1, intranasal dexmedetomidine 1 µg/kg; IN2, intranasal dexmedetomidine 2 µg/kg; IV, intravenous dexmedetomidine 1 µg/kg.

• 

  Fig. 2 Trial consort diagram. DEX, dexmedetomidine.

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  Fig. 3 Kaplan-Meier curves analyzing delay to first postoperative sufentanil rescue. DEX, dexmedetomidine.

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