title: Dexmedetomidine: an alternative for epidural anesthesia in tension-free vaginal-tape surgery.
abstract: OBJECTIVE
  Anesthetic management of tension-free vaginal-tape (TVT) procedures is sometimes difficult to deal with, especially when surgeons request a cough test. Dexmedetomidine has unique sedative and analgesic properties while having minimal respiratory effects, making it suitable for perioperative use in monitored anesthesia care. We aimed to compare dexmedetomidine and epidural anesthesia in TVT patients.
  
  
  METHODS
  Forty-nine women [American Society of Anesthesiologists (ASA 1-3)] with genuine stress incontinence confirmed by preoperative bladder function studies were included in this double-blind, randomized study. The patients were randomly assigned to one of two groups: group D received 0.5 μg/kg dexmedetomidine IV applied as bolus over 10 min and continued with 0.5 μg/kg/h infusion, and local anesthesia (lidocaine 2% with epinephrine) performed by the surgeon. Group E received epidural anesthesia with 15 ml of 0.25% bupivacaine + 100 μg fentanyl. Patients were monitored every 5 min for mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, respiratory rate, sedation, and intraoperative and postoperative pain. Ability to cough was also evaluated by the surgeon.
  
  
  RESULTS
  There was no difference in ability to cough, and this was evaluated by the surgeon as adequate, and there was no difference in scores between groups. Significant decreases in MAP and HR were observed 10 min after the start of surgery in group D compared with group E, and they were significantly decreased until first and second postoperative hours, respectively (p < 0.05). None of the patients had respiratory rate decrease or apnea. Side effects encountered postoperatively were similar.
  
  
  CONCLUSIONS
  Dexmedetomidine can be an alternative to epidural anesthesia in TVT procedure requiring cough test.
authors.affiliation: The Cleveland Clinic, 9500 Euclid Avenue, P-77, Department of Outcomes Research, Anesthesiology Institute, Cleveland, OH 44195, USA. turana@ccf.org
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Sen
authors.forename: Ali
authors.initials: A
authors.lastname: Sizlan
authors.forename: Omer
authors.initials: O
authors.lastname: Yanarateş
authors.forename: Sezai
authors.initials: S
authors.lastname: Ozkan
authors.forename: Onur
authors.initials: O
authors.lastname: Koyuncu
authors.forename: Güner
authors.initials: G
authors.lastname: Dağli
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects; D003371:Cough / Q000503:physiopathology; D000077324:Crystalloid Solutions; D020927:Dexmedetomidine / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000188:drug therapy / Q000453:epidemiology; D007432:Intraoperative Period; D007552:Isotonic Solutions; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy / Q000523:psychology; D010952:Plasma Substitutes; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015656:Respiratory Mechanics / Q000187:drug effects / Q000502:physiology; D053825:Suburethral Slings; D014549:Urinary Incontinence / Q000601:surgery; D014621:Vagina / Q000601:surgery*
chemical_list: D000077324:Crystalloid Solutions; D006993:Hypnotics and Sedatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D020927:Dexmedetomidine