Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T12:20:07.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Dexmedetomidine causes prolonged recovery when compared with midazolam/fentanyl combination in outpatient shock wave lithotripsy

Published online by Cambridge University Press:  01 December 2008

P. Zeyneloglu ,
A. Pirat ,
S. Candan ,
S. Kuyumcu ,
I. Tekin  and
G. Arslan
P. Zeyneloglu
Affiliation:
Baskent University Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
A. Pirat*
Affiliation:
Baskent University Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
S. Candan
Affiliation:
Baskent University Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
S. Kuyumcu
Affiliation:
Baskent University Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
I. Tekin
Affiliation:
Baskent University Faculty of Medicine, Department of Urology, Ankara, Turkey
G. Arslan
Affiliation:
Baskent University Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
*
Correspondence to: Arash Pirat, Anesteziyoloji Anabilim Dalı, Başkent Üniversitesi Hastanesi, 10. Sok. No. 45 Bahçelievler, 06490 Ankara, Turkey. E-mail: arashp@baskent-ank.edu.tr; Tel: +90 312 212 68 68/1069; Fax: +90 312 223 73 33
Get access

Summary

Background and objectives

Analgesia and sedation are usually required during extracorporeal shock wave lithotripsy. In the present study, the recovery time and effectiveness of sedation and analgesia of dexmedetomidine was compared with a midazolam/fentanyl combination in outpatient extracorporeal shock wave lithotripsy.

Methods

Forty-nine patients scheduled for outpatient extracorporeal shock wave lithotripsy were randomly assigned to two groups: a dex group (n = 25; dexmedetomidine 1 μg kg−1 loading dose followed by dexmedetomidine 0.2 μg kg−1 h−1) and a control group (n = 24; midazolam 0.05 mg kg−1 and fentanyl 1 μg kg−1). Recovery time, rescue analgesics (fentanyl 25 μg) and sedatives (midazolam 1 mg), and patients’ satisfaction rates were recorded.

Results

The two groups were similar regarding patient characteristics and procedure-related details (P > 0.05). Recovery time was significantly prolonged in the dex group when compared with the control group (116.4 ± 39.3 vs. 50.8 ± 19.8 min, respectively, P < 0.001). The percentage of patients requiring rescue doses of fentanyl and the applied doses were significantly higher in the dex group than in the control group (96% vs. 67%, P = 0.01; and 69.0 ± 31.7 vs. 38.8 ± 42.9 μg, respectively, P = 0.007). More patients in the dex group received rescue midazolam (96% vs. 58%, P = 0.002). More patients in the control group were highly satisfied with their sedation/analgesia (83% vs. 56%, P = 0.038).

Conclusion

Dexmedetomidine was associated with a longer recovery time than a midazolam/fentanyl combination when used for sedation and analgesia during outpatient extracorporeal shock wave lithotripsy in this study. The incidence of rescue sedative and analgesic need was also significantly higher when dexmedetomidine was used.

Keywords

DEXMEDETOMIDINEANAESTHESIA RECOVERY PERIODLITHOTRIPSYSEDATIONAMBULATORY CARE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 12 , December 2008 , pp. 961 - 967
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Medina, HJ, Galvin, EM, Dirckx, M et al. Remifentanil as a single drug for extracorporeal shock wave lithotripsy: a comparison of infusion doses in terms of analgesic potency and side effects. Anesth Analg 2005; 101: 365–370.CrossRefGoogle ScholarPubMed
2.Eaton, MP, Chhibber, AK, Green, DR. Subarachnoid sufentanil versus lidocaine spinal anesthesia for extracorporeal shock wave lithotripsy. Reg Anesth 1997; 22: 515–520.CrossRefGoogle ScholarPubMed
3.Beloeil, H, Corsia, G, Coriat, P, Riou, B. Remifentanil compared with sufentanil during extra-corporeal shock wave lithotripsy with spontaneous ventilation: a double-blind, randomized study. Br J Anaesth 2002; 89: 567–570.CrossRefGoogle ScholarPubMed
4.Alhashemi, JA, Kaki, AM. Dexmedetomidine in combination with morphine PCA provides superior analgesia for shockwave lithotripsy. Can J Anaesth 2004; 51: 342–347.CrossRefGoogle ScholarPubMed
5.Alhashemi, JA, Kaki, AM. Anesthesiologist-controlled versus patient-controlled propofol sedation for shockwave lithotripsy. Can J Anaesth 2006; 53: 449–455.CrossRefGoogle ScholarPubMed
6.Monk, TG, Ding, Y, White, PF, Albala, DM, Clayman, RV. Effect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures. Anesth Analg 1994; 79: 506–511.CrossRefGoogle ScholarPubMed
7.Moyer, MK, O’Gara, JP, Burrus, LE. General anesthesia for extracorporeal shock wave lithotripsy. AANA J 1988; 56: 121–126.Google ScholarPubMed
8.Coursin, DB, Maccioli, GA. Dexmedetomidine. Curr Opin Crit Care 2001; 7: 221–226.CrossRefGoogle ScholarPubMed
9.Hall, JE, Uhrich, TD, Barney, JA, Arain, SR, Ebert, TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699–705.CrossRefGoogle ScholarPubMed
10.Arain, SR, Ebert, TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95: 461–466.CrossRefGoogle ScholarPubMed
11.Alhashemi, JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth 2006; 96: 722–726.CrossRefGoogle ScholarPubMed
12.Jalowiecki, P, Rudner, R, Gonciarz, M, Kawecki, P, Petelenz, M, Dziurdzik, P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005; 103: 269–273.CrossRefGoogle ScholarPubMed
13.Koroglu, A, Teksan, H, Sagir, O, Yucel, A, Toprak, HI, Ersoy, OM. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg 2006; 103: 63–67.CrossRefGoogle ScholarPubMed
14.Mason, KP, Zgleszewski, SE, Dearden, JL et al. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg 2006; 103: 57–62.CrossRefGoogle ScholarPubMed
15.But, AK, Ozgul, U, Erdil, F et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand 2006; 50: 1207–1212.CrossRefGoogle ScholarPubMed
16.Guler, G, Akin, A, Tosun, Z, Eskitascoglu, E, Mizrak, A, Boyaci, A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005; 49: 1088–1091.CrossRefGoogle ScholarPubMed
17.Bhana, N, Goa, KL, McClellan, KJ. Dexmedetomidine. Drugs 2000; 59: 263–268.CrossRefGoogle ScholarPubMed
18.Kamibayashi, T, Maze, M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology 2000; 93: 1345–1349.CrossRefGoogle ScholarPubMed
19.Chernik, DA, Gillings, D, Laine, H et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google ScholarPubMed
20.Aldrete, JA, Kroulik, D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.CrossRefGoogle ScholarPubMed
21.Joo, HS, Perks, WJ, Kataoka, MT, Errett, L, Pace, K, Honey, RJ. A comparison of patient-controlled sedation using either remifentanil or remifentanil–propofol for shock wave lithotripsy. Anesth Analg 2001; 93: 1227–1232.CrossRefGoogle ScholarPubMed
22.Kaygusuz, K, Gokce, G, Gursoy, S, Ayan, S, Mimaroglu, C, Gultekin, Y. A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial. Anesth Analg 2008; 106: 114–119 (table of contents).CrossRefGoogle ScholarPubMed
23.Ho, AM, Chen, S, Karmakar, MK. Central apnoea after balanced general anaesthesia that included dexmedetomidine. Br J Anaesth 2005; 95: 773–775.CrossRefGoogle ScholarPubMed