Anesth Pain Med.  2019 Jan;14(1):19-28. 10.17085/apm.2019.14.1.19.

Fluid loading during spinal anesthesia can reduce bradycardia after intravenous dexmedetomidine infusion

• Lee W
• Han Y
• Lim SH
• Moon SH
• Cho K
• Kim MH

• KMID: 2434194
• DOI: http://doi.org/10.17085/apm.2019.14.1.19

Abstract

BACKGROUND
Dexmedetomidine has been widely used during spinal anesthesia to provide sedation. However, dexmedetomidine frequently causes significant bradycardia. This study was designed to evaluate whether fluid loading could reduce the incidence of bradycardia after intravenous dexmedetomidine infusion in patients under spinal anesthesia.
METHODS
A total of 99 patients, 18 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, who were scheduled for elective total knee replacement or internal fixation of lower leg fracture under spinal anesthesia were enrolled. The patients were randomly assigned into one of the three groups, and fluid was loaded as follows: group LOW - 4 ml/kg, group MID - 8 ml/kg, and group HI - 12 ml/kg. After fluid loading and spinal anesthesia, dexmedetomidine was infused as follows: 1 μg/kg of loading dose for 10 minutes, thereafter continuous infusion at 0.4 μg/kg/h.
RESULTS
The heart rate of group HI was significantly higher than that of group LOW (P = 0.049). The dosage of atropine administration was significantly lower in group HI than in group LOW (P = 0.003). The change in thoracic fluid contents was significantly higher in group HI than in group LOW (P = 0.018).
CONCLUSIONS
Fluid loading during spinal anesthesia can reduce the incidence and extent of bradycardia after intravenous dexmedetomidine infusion.

Keyword

Bradycardia; Dexmedetomidine; Fluid therapy; Heart rate; Spinal anesthesia

MeSH Terms

Anesthesia, Spinal*
Arthroplasty, Replacement, Knee
Atropine
Bradycardia*
Dexmedetomidine*
Fluid Therapy
Heart Rate
Humans
Incidence
Leg
Atropine
Dexmedetomidine

Figure

• 

  Fig. 1 Consolidated Standards of Reporting Trials (CONSORT) flow chart. ASA: American Society of Anesthesiologists physical status.

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  Fig. 2 Schematic timetable of experiment. PACU: post anesthetic care unit.

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  Fig. 3 The heart rate (A), mean blood pressure (B), oxygen saturation (C), change in thoracic fluid contents from initial value (TFCd) (D), and Ramsay sedation scale (E) over time. Group LOW: fluid loading 4 ml/kg, Group MID: fluid loading 8 ml/kg, Group HI: fluid loading 12 ml/kg. Dex: dexmedetomidine, PACU: post anesthetic care unit. *P < 0.05 when compared with group LOW, †P < 0.05 when compared with group MID.

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