title: [Feasibility and Safety of Dexmedetomidine Sedation in Transarterial Embolization for Hepatocellular Carcinoma with Hepatitis C-Related Cirrhosis].
abstract: BACKGROUND
  Dexmedetomidine (Precedex®)is an agonist of a2-adrenergic receptors in certain parts of the brain. It was approved for "procedural sedation in the non-intubation in under local anesthesia" in June 2013 in Japan. However, because of metabolism delay, dexmedetomidine has to be administered carefully to patients with liver dysfunction.
  
  
  OBJECTIVE
  To evaluate the feasibility and safety of sedation using dexmedetomidine in percutaneous arterial chemoembolization for hepatocellular carcinoma with liver dysfunction.
  
  
  METHODS
  Thirty consecutive cases of percutaneous arterial chemoembolization for hepatocellular carcinoma with hepatitis C-related cirrhosis(male, 23; female, 7; age, 74±5.9; weight, 62.7±12.3 kg; Child-Pugh A, 23; Child-Pugh B, 7)were analyzed retrospectively. Dexmedetomidine was administered at 3 mg/kg/h for 15 minutes as the initial loading dose and at 0.4 mg/kg/h as the maintenance dose. The sedation level was evaluated using the Ramsay sedation scale.
  
  
  RESULTS
  In 30 of 30 cases, percutaneous arterial chemoembolization therapy could be performed with dexme- detomidine sedation. In 27 of 30 cases, the procedure was completed with the maintenance dose of 0.4 mg/kg/h. In 3 of 30 cases, the maintenance dose was increased to 0.6 mg/kg/h because of patient body motion. The mean administration time of dexmedetomidine was 82±30 minutes. The level of sedation measured with the Ramsay sedation scale at the end of the procedure was 3 points in 29 cases and 5 points in one case. Adverse events occurred in 3 of 30 cases. Intravenous drip leakage occurred in one case, vertigo occurred in one case, and vomiting occurred in one case. There were no adverse events requiring treatment.
  
  
  CONCLUSIONS
  Sedation with dexmedetomidine in percutaneous arterial chemoembolization for hepatocellular carcinoma with liver dysfunction was feasible and safe.
authors.affiliation: Dept. of Radiology, Kansai Medical University.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komemushi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Sano
authors.forename: Shuji
authors.initials: S
authors.lastname: Kariya
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nakatani
authors.forename: Rie Yagi
authors.initials: RY
authors.lastname: Yoshida
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kono
authors.forename: Koshi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Keita
authors.initials: K
authors.lastname: Utsunomiya
authors.forename: Yoko
authors.initials: Y
authors.lastname: Harima
authors.forename: Noboru
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000628:therapy*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000209:etiology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine