Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients.
OBJECTIVE
Sedation in dialysis dependent end-stage renal disease patients requires caution as a result of performing high doses of sedatives and its complications. Multidrug sedation regimens might be superior and advantage on lesser drug consumption and by the way adverse events which occur easily in end-stage renal disease patients. We evaluated the effects of dexmedetomidine premedication on propofol consumption, sedation levels with Observer's Assessment of Alertness and Sedation scores and the bispectral index and the hemodynamic changes, potential side effects in geriatric patients with end-stage renal disease who underwent hip fracture surgery under spinal anesthesia.


METHODS
In this randomized, controlled, double-blind study 60 elderly patients (age≥65 years) with end-stage renal disease and hip fracture scheduled for anterograde femoral intramedullary nailing were assigned to groups that received either intravenous saline infusion (Group C) or dexmedetomidine 0.5μg/kg/10min infusion for premedication (Group D). All the patients received propofol infusion after the induction of the spinal anesthesia.


RESULTS
Total propofol consumption, propofol dose required for targeted sedation levels according to Observer's Assessment of Alertness and Sedation scores and bispectral index levels, recovery times were significantly lower in Group D (p<0.001). The time to reach to Observer's Assessment of Alertness and Sedation score 4 and to achieve bispectral index≤80 was significantly lower in Group C compared with Group D (p<0.001). Adverse events were similar in both groups.


CONCLUSIONS
Dexmedetomidine premedication lowers intraoperative propofol consumption to maintain targeted level of sedation. Therefore low dose dexmedetomidine premedication in addition to propofol infusion might be an alternative in geriatric patients with end-stage renal disease for sedation.
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey. Electronic address: pergenoglu@yahoo.com.
Pinar
P
Ergenoglu
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Sule
S
Akin
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Cagla
C
Bali
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Hatice Evren
HE
Eker
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Oya
O
Yalcin Cok
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Anis
A
Aribogan
D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008297:Male; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage*
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
Dexmedetomidina; Dexmedetomidine; Doença renal em estágio terminal; End stage renal disease; Geriatric patient; Paciente geriátrico; Propofol