Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose–response study by age group

Authors: Jeongmin Kim, Won Oak Kim, Hye-Bin Kim, Hae Keum Kil

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

Dexmedetomidine (DMT), a highly selective α2-adrenoceptor agonist, has been used safely as a sedative in patients under regional anesthesia. The purpose of this study was to determine the 50% effective dose (ED50) of single-dose DMT to induce adequate light sedation in elderly patients in comparison with younger patients undergoing transurethral resection of the prostate (TURP) with spinal anesthesia.

Methods

Forty-two male patients were recruited. The young age group (Group Y) included patients 45 to 64 years old and the old age group (Group O) included patients 65 to 78 years old. After the spinal anesthesia was performed, a pre-calculated dose of DMT was administered for 10 min. The Observer’s Assessment of Alertness/Sedation (OAA/S) scale, bispectral index score (BIS) were assessed then at 2-min intervals for 20 min. A modified Dixon’s up-and-down method was used to determine the ED50 of the drug for light sedation (OAA/S score 3/4). In the recovery room, regression times of the motor and sensory blocks were recorded.

Results

The ED50 of DMT was 0.25 (95% C.I. 0.15-0.35) μg/kg in Group O and 0.35 (95% C.I. 0.35-0.45) μg/kg in Group Y (p = 0.002). The ED95 was 33% lower in Group O compare with Group Y (0.38 (95% C.I. 0.29-0.39) μg/kg vs. 0.57 (95% C.I. 0.49-0.59) μg/kg). The regression time of sensory block was longer in Group O than in Group Y (109.0 ± 40.2 min vs. 80.0 ± 31.6 min) (p = 0.014).

Conclusion

The single-dose of DMT for light sedation was lower by 21% in Group O compare with Group Y underwent TURP with spinal anesthesia.

Trial registration

ClinicalTrials.gov identifier: NCT01665586. Registered July 31, 2012.
Literature
1.
Alaali HH, Irwin MG: Anaesthesia for urological surgery.Anaesth Intensive Care Med 2012,13(7):343–7. 10.1016/j.mpaic.2012.04.010CrossRef
2.
3.
Brown CH, Azman AS, Gottschalk A, Mears SC, Sieber FE: Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.Anesth Analg 2014,118(5):977–80. 10.1213/ANE.0000000000000157CrossRefPubMedPubMedCentral
4.
Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB, et al.: Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.Mayo Clin Proc 2010,85(1):18–26. 10.4065/mcp.2009.0469CrossRefPubMedPubMedCentral
5.
Song J, Kim WM, Lee SH, Yoon MH: Dexmedetomidine for sedation of patients undergoing elective surgery under regional anesthesia.Korean J Anesthesiol 2013,65(3):203–8. 10.4097/kjae.2013.65.3.203CrossRefPubMedPubMedCentral
6.
Senses E, Apan A, Kose EA, Oz G, Rezaki H: The effects of midazolam and dexmedetomidine infusion on peri-operative anxiety in regional anesthesia.Middle East J Anesthesiol 2013,22(1):35–40.PubMed
7.
Hong JY, Kim WO, Yoon Y, Choi Y, Kim SH, Kil HK: Effects of intravenous dexmedetomidine on low-dose bupivacaine spinal anaesthesia in elderly patients.Acta Anaesthesiol Scand 2012,56(3):382–7. 10.1111/j.1399-6576.2011.02614.xCrossRefPubMed
8.
Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, et al.: Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiol 2004,101(5):1066–76. 10.1097/00000542-200411000-00005CrossRef
9.
Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD: The effects of increasing plasma concentrations of dexmedetomidine in humans.Anesthesiol 2000,93(2):382–94. 10.1097/00000542-200008000-00016CrossRef
10.
Cooper L, Candiotti K, Gallagher C, Grenier E, Arheart KL, Barron ME: A randomized, controlled trial on dexmedetomidine for providing adequate sedation and hemodynamic control for awake, diagnostic transesophageal echocardiography.J Cardiothorac Vasc Anesth 2011,25(2):233–7. 10.1053/j.jvca.2010.06.006CrossRefPubMed
11.
Park SH, Shin YD, Yu HJ, Bae JH, Yim KH: Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia.Korean J Anesthesiol 2014,66(5):371–6. 10.4097/kjae.2014.66.5.371CrossRefPubMedPubMedCentral
12.
Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, et al.: Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia.Can J Anaesth 2010,57(1):39–45. 10.1007/s12630-009-9231-6CrossRefPubMed
13.
Abdallah FW, Abrishami A, Brull R: The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis.Anesth Analg 2013,117(1):271–8. 10.1213/ANE.0b013e318290c566CrossRefPubMed
14.
Ok HG, Baek SH, Baik SW, Kim HK, Shin SW, Kim KH: Optimal dose of dexmedetomidine for sedation during spinal anesthesia.Korean J Anesthesiol 2013,64(5):426–31. 10.4097/kjae.2013.64.5.426CrossRefPubMedPubMedCentral
15.
Jung SH, Lee SK, Lim KJ, Park EY, Kang MH, Lee JM, et al.: The effects of single-dose intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia.J Anesth 2013,27(3):380–4. 10.1007/s00540-012-1541-0CrossRefPubMed
16.
Bromage PR: A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia.Acta Anaesthesiol Scand Suppl 1965, 16:55–69.CrossRefPubMed
17.
Stylianou M, Flournoy N: Dose finding using the biased coin up-and-down design and isotonic regression.Biometrics 2002,58(1):171–7. 10.1111/j.0006-341X.2002.00171.xCrossRefPubMed
18.
Pollock JE, Neal JM, Liu SS, Burkhead D, Polissar N: Sedation during spinal anesthesia.Anesthesiol 2000,93(3):728–34. 10.1097/00000542-200009000-00022CrossRef
19.
Dixon WJ: Staircase bioassay: the up-and-down method.Neurosci Biobehav Rev 1991,15(1):47–50. 10.1016/S0149-7634(05)80090-9CrossRefPubMed
20.
Korea Pharmaceutical Information C: Precedex® (dexmedetomidine hydrochloride) injection: prescribing information. 2014.
21.
Hoy SM, Keating GM: Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation.Drugs 2011,71(11):1481–501. 10.2165/11207190-000000000-00000CrossRefPubMed
22.
Iirola T, Ihmsen H, Laitio R, Kentala E, Aantaa R, Kurvinen JP, et al.: Population pharmacokinetics of dexmedetomidine during long-term sedation in intensive care patients.Br J Anaesth 2012,108(3):460–8. 10.1093/bja/aer441CrossRefPubMed
23.
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(6):970–1. 10.1093/bja/81.6.970CrossRefPubMed
24.
Tverskoy M, Shagal M, Finger J, Kissin I: Subarachnoid bupivacaine blockade decreases midazolam and thiopental hypnotic requirements.J Clin Anesth 1994,6(6):487–90. 10.1016/0952-8180(94)90089-2CrossRefPubMed
25.
Tverskoy M, Fleyshman G, Bachrak L, Ben-Shlomo I: Effect of bupivacaine-induced spinal block on the hypnotic requirement of propofol.Anaesth 1996,51(7):652–3. 10.1111/j.1365-2044.1996.tb07847.xCrossRef
26.
Morley AP, Chung DC, Wong AS, Short TG: The sedative and electroencephalographic effects of regional anaesthesia.Anaesth 2000,55(9):864–9. 10.1046/j.1365-2044.2000.01473.xCrossRef
27.
Marucci M, Diele C, Bruno F, Fiore T: Subarachnoid anaesthesia in caesarean delivery: effects on alertness.Minerva Anestesiol 2003,69(11):809–19. 819–824PubMed
28.
Veering BT, Burm AG, Vletter AA, van den Hoeven RA, Spierdijk J: The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration.Anesthesiol 1991,74(2):250–7. 10.1097/00000542-199102000-00010CrossRef
29.
Veering BT, Burm AG, Spierdijk J: Spinal anaesthesia with hyperbaric bupivacaine. Effects of age on neural blockade and pharmacokinetics.Br J Anaesth 1988,60(2):187–94. 10.1093/bja/60.2.187CrossRefPubMed
30.
Racle JP, Benkhadra A, Poy JY, Gleizal B: Spinal analgesia with hyperbaric bupivacaine: influence of age.Br J Anaesth 1988,60(5):508–14. 10.1093/bja/60.5.508CrossRefPubMed
31.
Veering BT, Burm AG, van Kleef JW, Hennis PJ, Spierdijk J: Spinal anesthesia with glucose-free bupivacaine: effects of age on neural blockade and pharmacokinetics.Anesth Analg 1987,66(10):965–70.CrossRefPubMed
32.
Yamashita K, Terao Y, Inadomi C, Takada M, Fukusaki M, Sumikawa K: Age-dependent relationship between bispectral index and sedation level.J Clin Anesth 2008,20(7):492–5. 10.1016/j.jclinane.2008.05.004CrossRefPubMed
33.
Lysakowski C, Elia N, Czarnetzki C, Dumont L, Haller G, Combescure C, et al.: Bispectral and spectral entropy indices at propofol-induced loss of consciousness in young and elderly patients.Br J Anaesth 2009,103(3):387–93. 10.1093/bja/aep162CrossRefPubMed
34.
Chisholm CJ, Zurica J, Mironov D, Sciacca RR, Ornstein E, Heyer EJ: Comparison of electrophysiologic monitors with clinical assessment of level of sedation.Mayo Clin Proc 2006,81(1):46–52. 10.4065/81.1.46CrossRefPubMedPubMedCentral
35.
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(6):1811–5. 10.1213/ANE.0b013e3181c04e58CrossRefPubMed
Metadata
Title
Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose–response study by age group
Authors
Jeongmin Kim
Won Oak Kim
Hye-Bin Kim
Hae Keum Kil
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-15-17

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Research article

Ringer’s lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial

Research article

Perceived barriers to computerised quality documentation during anaesthesia: a survey of anaesthesia staff

Research article

Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes

Research article

Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement

Research article

Knowledge, attitudes and use of labour analgesia among women at a low-income country antenatal clinic

Research article

Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana