Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia

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/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.

• Publication year

  2016

• Venue

  Medical Science Monitor

• Publication date

  2016-10-04

• Fields of study

  Medicine

• Identifiers
  DOI 10.12659/MSM.896461PMID 27701366PMCID 5053123
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose–response study by age group

  2015cited by this paper
• Rotigotine transdermal system as add-on to oral dopamine agonist in advanced Parkinson’s disease: an open-label study

  2015cited by this paper
• The effects of different loading doses of dexmedetomidine on sedation

  2014cited by this paper
• Effects of Intravenous and Intrathecal Dexmedetomidine in Spinal Anesthesia: A Meta‐Analysis

  2013cited by this paper
• Effects of intravenous dexmedetomidine on low‐dose bupivacaine spinal anaesthesia in elderly patients

  2012cited by this paper
• Evaluation of the sedative and cardiovascular effects of intramuscular administration of dexmedetomidine with and without concurrent atropine administration in dogs.

  2011cited by this paper
• Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia

  2010cited by this paper
• Evaluation of cardiorespiratory effects of combinations of dexmedetomidine and atropine in cats

  2009cited by this paper
• A comparison of dexmedetomidine and midazolam for sedation in third molar surgery *

  2007cited by this paper
• Spinal Versus General Anesthesia for Orthopedic Surgery: Anesthesia Drug and Supply Costs

  2006cited by this paper
• Effects of Low and High Plasma Concentrations of Dexmedetomidine on Myocardial Perfusion and Cardiac Function in Healthy Male Subjects

  2006cited by this paper
• Bispectral index-guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo-controlled phase II study*

  2002cited by this paper
• T HE U SE OF M IDAZOLAM FOR P REHOSPITAL R APID - SEQUENCE I NTUBATION M AY B E A SSOCIATED WITH A D OSE - RELATED I NCREASE IN H YPOTENSION

  2001cited by this paper
• Dexmedetomidine: A Novel Sedative-Analgesic Agent

  2001cited by this paper
• Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions

  2000cited by this paper
• Sympathetic Block During Spinal Anesthesia in Volunteers Using Lidocaine, Tetracaine, and Bupivacaine

  1997cited by this paper
• Mechanism of the negative inotropic effect of midazolam and diazepam in cultured foetal mouse cardiac myocytes.

  1997cited by this paper
• Propofol versus midazolam for intensive care unit sedation after coronary artery bypass grafting

  1994cited by this paper
• Oral Dexmedetomidine Preserves Baroreceptor Function and Decreases Anesthetic Requirements of Halothane‐anesthetized Dogs

  1994cited by this paper
• Incidence and risk factors for side effects of spinal anesthesia.

  1992cited by this paper
• Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes.

  1992cited by this paper
• Effects of Diazepam and Midazolam on Baroreflex Control of Heart Rate and on Sympathetic Activity in Humans

  1986cited by this paper
• Drug infusion with a Paceport Swan-Ganz catheter during cardiopulmonary bypass.

  1986cited by this paper
• Drug Infusion with a PaceportTMSwan-Ganz Catheter during Cardiopulmonary Bypass

  1986cited by this paper

• Extrapolation of Midazolam Disposition in Neonates Using Physiological‐Based Pharmacokinetic/Pharmacodynamic Modeling

  2025cites this paper
• Comparison emergence of sedation, using dexmedetomidine and remimazolam, in spinal anaesthesia - double blinded randomized controlled trial

  2024cites this paper
• Comparison between Effects of Propofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

  2023cites this paper
• Comparison between Effects of Ketofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

  2023cites this paper
• Effectiveness of platelet rich plasma versus corticosteroid in the treatment of plantar fasciitis: a double-blind randomized controlled trial

  2022cites this paper
• Postoperative pain relief in pediatric surgery patients: Effect of intravenous paracetamol in comparison with diclofenac suppository

  2022cites this paper
• Comparison between effects of Clonazepam and Dexmedetomidine as sedative in elective Caesarean section under Subarachnoid anaesthesia

  2022cites this paper
• Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial

  2022cites this paper
• The effects of dexmedetomidine on trauma-induced secondary injury in rat brain

  2021cites this paper
• The efficacy of intramuscular ephedrine in preventing hemodynamic perturbations in patients with spinal anesthesia and dexmedetomidine sedation

  2020cites this paper
• Intraoperative Dexmedetomidine Versus Midazolam in Patients Undergoing Peripheral Surgery With Mild Traumatic Brain Injuries: A Retrospective Cohort Analysis

  2020cites this paper
• Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

  2020cites this paper
• The effects of dexmedetomidine in general anesthesia on the perioperative hemodynamics and postoperative cognitive functions of patients with sleep apnea syndrome in the perioperative period of uvulopalatopharyngoplasty

  2020cites this paper
• Preventive Effects of Dexmedetomidine on Renal Dysfunction and Hemodynamic Stability in Malignant Obstructive Jaundice Patients During Peri-Operative Period

  2019cites this paper
• Bispectral index-guided dexmedetomidine sedation during subthalamic nucleus deep brain stimulation surgery

  2019cites this paper
• Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial

  2019cites this paper
• Target‐controlled infusion of dexmedetomidine effect‐site concentration for sedation in patients undergoing spinal anaesthesia

  2019cites this paper
• Effects of Dexmedetomidine Combined with Sufentanil on Postoperative Delirium in Young Patients After General Anesthesia

  2018cites this paper
• Comparative Evaluation of Efficacy of Propofol and Midazolam during Spinal Anesthesia: A Hospital Based Study

  2018cites this paper
• A comparative study of intravenous dexmedetomidine and midazolam on prolongation of spinal anesthesia

  2018influential citation
• Delirium Risk of Dexmedetomidine and Midazolam in Patients Treated with Postoperative Mechanical Ventilation: a Meta-analysis

  2017cites this paper