title: Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia.
abstract: BACKGROUND Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. MATERIAL AND METHODS One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. RESULTS Hypotension occurred more frequently in the midazolam group (P<0.001) and bradycardia occurred more frequently in the dexmedetomidine group (P<0.001). Mean Ramsay sedation score was significantly lower in the dexmedetomidine group after arrival in the PACU (P=0.025) and PACU stay was significantly longer in the dexmedetomidine group (P=0.003). CONCLUSIONS BIS-guided dexmedetomidine sedation can attenuate intraoperative hypotension, but induces more bradycardia, prolongs PACU stay, and delays recovery from sedation in patients during and after spinal anesthesia as compared with midazolam sedation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Youn Yi
authors.initials: YY
authors.lastname: Jo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Dongchul
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Wol Seon
authors.initials: WS
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Noo Ree
authors.initials: NR
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam