Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T15:52:21.303Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of dexmedetomidine on the duration of anaesthesia and wakefulness in bupivacaine epidural block

Published online by Cambridge University Press:  01 June 2007

I. Coskuner ,
M. Tekin ,
I. Kati ,
C. Yagmur  and
K. Elcicek
I. Coskuner
Affiliation:
Yuzuncu Yil University, Medical Faculty, Anesthesiology and Reanimation Department, Van, Turkey
M. Tekin
Affiliation:
Yuzuncu Yil University, Medical Faculty, Anesthesiology and Reanimation Department, Van, Turkey
I. Kati*
Affiliation:
Yuzuncu Yil University, Medical Faculty, Anesthesiology and Reanimation Department, Van, Turkey
C. Yagmur
Affiliation:
Yuzuncu Yil University, Medical Faculty, Anesthesiology and Reanimation Department, Van, Turkey
K. Elcicek
Affiliation:
Yuzuncu Yil University, Medical Faculty, Anesthesiology and Reanimation Department, Van, Turkey
*
Correspondence to: Ismail Kati, Anesthesiology and Reanimation Department, Medical Faculty, Yuzuncu Yil University, Van, Turkey. E-mail: ismaikati@hotmail.com; Tel: +90 432 2122651; Fax: +90 432 2122651
Get access

Summary

Background

The purpose of this study was to examine the effects of intravenous dexmedetomidine on the duration of bupivacaine-induced epidural anaesthesia and level of wakefulness and the respective side-effects.

Methods

Sixty ASA I–II patients were included in the study. Consecutive patients were allocated to groups according to the last digit (odd/even) of their admission numbers. All patients had epidural anaesthesia with bupivacaine 0.5% performed by the same experienced anaesthesiologist. In the first group, the patients were administered intravenous dexmedetomidine infusion just after the epidural block and continued during the operation, while those in the second group were administered physiologic saline infusion at the same amount and duration.

Results

The recovery time of sensory block was significantly longer in the first group. The bispectral index values were lower in the first group than in the second. Also, heart rate was significantly lower in Group I than in Group II. Regarding side-effects, shivering was significantly less frequent in the first group, whereas there was a significant increase in the requirement of atropine in the first group as dexmedetomidine caused bradycardia.

Conclusion

Intravenous administration of dexmedetomidine prolonged the duration of epidural anaesthesia, provided sedation and had few side-effects.

Keywords

BUPIVACAINEANAESTHESIA EPIDURALbispectral indexDEXMEDETOMIDINESEDATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 535 - 540
Copyright
Copyright © European Society of Anaesthesiology 2007

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.Holmstrom, B, Laugaland, K, Rawal, N, Hallberg, S. Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery. Can J Anaesth 1993; 40: 601–606.CrossRefGoogle ScholarPubMed
2.Ferrante, FM, Fanciullo, GJ, Grichnik, KP, Vaisman, J, Sacks, GM, Concepcion, MA. Regression of sensory anesthesia during continuous epidural infusions of bupivacaine and opioid for total knee replacement. Anesth Analg 1993; 77: 1179–1184.CrossRefGoogle ScholarPubMed
3.Katz, JA, Bridenbaugh, PO, Knarr, DC, Helton, SH, Denson, DD. Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg 1990; 70: 16–21.CrossRefGoogle ScholarPubMed
4.Lauwers, MH, Vanlersberghe, C, Camu, F. Comparison of remifentanil and propofol infusions for sedation during regional anesthesia. Reg Anesth Pain Med 1998; 23: 64–70.Google ScholarPubMed
5.Monica, MSR, White, PF. Monitored anesthesia care. In: Miller, RD, ed. Anesthesia, 5th edn. Philadelphia: Churchill-Livingstone, 2000: 1452–1469.Google Scholar
6.Liu, J, Singh, H, White, PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84: 185–189.CrossRefGoogle ScholarPubMed
7.Rosow, C, Manberg, PJ. Bispectral index monitoring. Anesthesiol Clin North America 2001; 19: 947–966.CrossRefGoogle ScholarPubMed
8.Shapiro, BA. Bispectral index: better information for sedation in the intensive care unit? Crit Care Med 1999; 27: 1663–1664.CrossRefGoogle ScholarPubMed
9.Glass, PS, Bloom, M, Kearse, L, Rosow, C, Sebel, P, Manberg, P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.CrossRefGoogle ScholarPubMed
10.Yli-Hankala, A, Vakkuri, A, Annila, P, Korttila, K. EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery. Acta Anaesthesiol Scand 1999; 43: 545–549.CrossRefGoogle ScholarPubMed
11.Burrow, B, McKenzie, B, Case, C. Do anaesthetized patients recover better after bispectral index monitoring? Anaesth Intens Care 2001; 29: 239–245.CrossRefGoogle ScholarPubMed
12.Rhee, K, Kang, K, Kim, J, Jeon, Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand 2003; 47: 1001–1005.CrossRefGoogle ScholarPubMed
13.Collins, JV. Principles of Anesthesiology, 3rd edn. Philadelphia: Lea and Febiger, 1993: 1283–1302.Google Scholar
14.Lee, JJ, Rubin, AP. Comparison of a bupivacaine–clonidine mixture with plain bupivacaine for caudal analgesia in children. Br J Anaesth 1994; 72: 258–262.CrossRefGoogle ScholarPubMed
15.Bernard, CM. Epidural and spinal anesthesia. In: Barash, PG, ed. Clinical Anesthesia, 4th edn. Philadelphia: Lippincott Williams & Wilkins Publisher, 2001: 645–668.Google Scholar
16.Pouttu, J, Tuominen, M, Scheinin, M, Rosenbert, PH. Effect of oral clonidine premedication on concentrations of cortisol and monoamine neurotransmitters and their metabolites in cerebrospinal fluid and plasma. Acta Anaesthesiol Scand 1989; 33: 137–141.CrossRefGoogle ScholarPubMed
17.Almeida, RA, Lauretti, GR, Mattos, AL. Antinociceptive effect of low-dose intrathecal neostigmine combined with intrathecal morphine following gynecologic surgery. Anesthesiology 2003; 98: 495–498.CrossRefGoogle ScholarPubMed
18.Passariello, M, Almenrader, N, Canneti, A, Rubeo, L, Haiberger, R, Pietropaoli, P. Caudal analgesia in children: S(+)-ketamine vs. S(+)-ketamine plus clonidine. Paediatr Anaesth 2004; 14: 851–855.CrossRefGoogle Scholar
19.Jaakola, ML, Salonen, M, Lehtinen, R, Scheinin, H. The analgesic action of dexmedetomidine a novel alpha 2-adrenoceptor agonist-in healthy volunteers. Pain 1991; 46: 281–285.CrossRefGoogle ScholarPubMed
20.Kanazi, GE, Aouad, MT, Jabbour-Khoury, SI et al. . Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006; 50 (2): 222–227.CrossRefGoogle ScholarPubMed
21.Wahlander, S, Frumento, RJ, Wagener, G et al. . A prospective, double-blind, randomized, placebo-controlled study of dexmedetomidine as an adjunct to epidural analgesia after thoracic surgery. J Cardiothorac Vasc Anesth 2005; 19 (5): 630–635.CrossRefGoogle ScholarPubMed
22.Lauwers, M, Camu, F, Breivik, H et al. . The safety and effectiveness of remifentanil as an adjunct sedative for regional anesthesia. Anesth Analg 1999; 88: 134–140.CrossRefGoogle ScholarPubMed
23.Liu, J, Singh, H, White, PF. Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69.CrossRefGoogle ScholarPubMed
24.Gentili, M, Huu, PC, Enel, D, Hollande, J, Bonnet, F. Sedation depends on the level of sensory block induced by spinal anaesthesia. Br J Anaesth 1998; 81: 970–971.CrossRefGoogle ScholarPubMed
25.Kallio, A, Scheinin, M, Koulu, M et al. . Effects of dexmedetomidine, a selective a2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther 1989; 46: 33–42.CrossRefGoogle Scholar
26.Pollock, JE, Neal, JM, Liu, SS, Burkhead, D, Polissar, N. Sedation during spinal anesthesia. Anesthesiology 2000; 93: 728–734.CrossRefGoogle ScholarPubMed
27.Ozaki, M, Kurz, A, Sessler, DI et al. . Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology 1994; 81: 282–288.CrossRefGoogle ScholarPubMed
28.Jaakola, ML. Dexmedetomidine premedication before intravenous regional anesthesia in minor outpatient hand surgery. J Clin Anesth 1994; 6: 204–211.CrossRefGoogle ScholarPubMed
29.Bloor, BC, Ward, DS, Belleville, JP et al. . Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77: 1134–1142.CrossRefGoogle ScholarPubMed
30.Lesser, JB, Sanborn, KV, Valskys, R, Kuroda, M. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Anesthesiology 2003; 99: 859–866.CrossRefGoogle ScholarPubMed
31.Kock, S, Hopf, HB. Incidence and predisposing factors of persistent backache after lumbar catheter epidural anesthesia in a non-obstetrical settingo. Anasthesiol Intens Med Notfallmed Schmerzther 1998; 33: 648–652.CrossRefGoogle Scholar
32.Sessler, DL. Shivering during epidural anesthesia. Acta Anesthesiol Scand 1995; 39: 551–553.Google Scholar