Title: Dexmedetomidine for Sedation during Total Abdominal Hysterectomy under Spinal Anesthesia
Authors: Dr Rajat Shuvra Das, Dr Mohammad Shaddam Hoshian Mondol, Dr Arman Ali, Dr Ishrat Jahahan Shathi
DOI: https://dx.doi.org/10.18535/jmscr/v8i9.31
Abstract
Background: Intravenous Dexmedetomidine is associated with stable cardiovascular profile and less associated with fear, anxiety and agitation. Spinal anesthesia offers many advantages over general anesthesia, like providing analgesia and muscle relaxation in a conscious and compliant patient and an uneventful postoperative recovery.
Objective: To evaluate the efficacy of dexmedetomidine in attenuation of haemodynamic stability and sedation during total abdominal hysterectomy under spinal anesthesia.
Materials and Methods: This prospective study work was conducted during 8th June 2017 to 7th December 2017, in Dhaka Medical College Hospital, Dhaka, Bangladesh. Total 60 patients were recruited as study population under two groups of group D of dexmedetomidine and M of midazolam who classified by American Society of Anesthesiologists (ASA- I, II). Random sampling methods was followed. Subarachnoid anaesthesia was performed in all patients with 0.5% hyperbaric bupivacaine intrathecally, at L3-L4 interspinous spaces, with 25G Quinke’s spinal needle. The patients of group D) was administrated with an intravenous loading dose of 0.5 µg.kg-dexmedetomidine and group M 0.04 µg.kg- midazolam via a syringe infusion. Changes of BP, pulse and any complication was recorded. Collected data were analyzed by SPSS software, version 22.0.
Results: According to the study, majority of the patients 66.6% (n=40) were between 50-60 years, mean age was 53.3±11.5 years. The difference was not statistically significant (p>0.05) between two groups. The baseline mean heart rate was found 90.2±7.3 and 93.1±8.2 beat/min in group Mand D. At 5 minute after, mean heart rate was 92.9±7. and 93.7±9.4 beat/min. At 30 minute after mean heart rate was 100.4±9.1 and 93.5±9.1. At 45 minute, mean heart rate was 103.0±8.9 and 87.7±17.7. At 60 minutes,104.5±7.7 and 92.7±8.2. At after 30 minute, 45 minute and 60-minute difference was statistically significant (p<0.05) between two groups. On evaluation of systolic blood pressure, baseline, mean systolic BP was found 89.6±6.3 mmHg and 84.3±5.0 mmHg. At 10 minute after, was 95.3±7.1 and 85.5±5.1 mmHg. At 45 minute, was 94.6±15.6 and 84.3±5.0. At 10, 15, 30 and 45 minute after difference was statistically significant (p<0.05) between two groups. After 30 minute, mean sedation was found 4.13±0.32 and 3.89±0.5. After 60 minute, mean sedation was found 4.38±0.57 score in group D, but in group M score is reduced and found 3.52±0.27. Mean difference was statistically significant (p<0.05) between two groups.
Conclusion: In this study, intraoperative Ramsay sedation scores were significantly higher in dexmedetomidine group. When compared with intravenous (IV) midazolam, administration of IV dexmedetomidine during spinal anesthesia provides a longer duration of postoperative analgesia, with satisfactory arousable sedation and minimal side effects.
Keywords: Dexmedetomidine, spinal anaesthesia, statistically significant, baseline.
