Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.11.002
Brazilian Journal of Anesthesiology
Scientific Article

Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients

Efeito da pré-medicação com dose baixa de dexmedetomidina sobre o consumo de propofol em pacientes geriátricos com doença renal em estágio terminal

Pinar Ergenoglu; Sule Akin; Cagla Bali; Hatice Evren Eker; Oya Yalcin Cok; Anis Aribogan

http://dx.doi.org/10.1016/j.bjane.2014.11.002 Braz J Anesthesiol, vol.65, n5, p.326-332, 2015
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Abstract

ABSTRACTBACKGROUND AND OBJECTIVE: Sedation in dialysis dependent end-stage renal disease patients requires caution as a result of performing high doses of sedatives and its complications. Multidrug sedation regimens might be superior and advantage on lesser drug consumption and by the way adverse events which occur easily in end-stage renal disease patients. We evaluated the effects of dexmedetomidine premedication on propofol consumption, sedation levels with Observer's Assessment of Alertness and Sedation scores and the bispectral index and the hemodynamic changes, potential side effects in geriatric patients with end-stage renal disease who underwent hip fracture surgery under spinal anesthesia.METHOD: In this randomized, controlled, double-blind study 60 elderly patients (age ≥ 65 years) with end-stage renal disease and hip fracture scheduled for anterograde femoral intramedullary nailing were assigned to groups that received either intravenous saline infusion (Group C) or dexmedetomidine 0.5 g/kg/10 min infusion for premedication (Group D). All the patients received propofol infusion after the induction of the spinal anesthesia.RESULTS: Total propofol consumption, propofol dose required for targeted sedation levels according to Observer's Assessment of Alertness and Sedation scores and bispectral index levels, recovery times were significantly lower in Group D (p < 0.001). The time to reach to Observer's Assessment of Alertness and Sedation score 4 and to achieve bispectral index ≤ 80 was significantly lower in Group C compared with Group D (p < 0.001). Adverse events were similar in both groups.CONCLUSION: Dexmedetomidine premedication lowers intraoperative propofol consumption to maintain targeted level of sedation. Therefore low dose dexmedetomidine premedication in addition to propofol infusion might be an alternative in geriatric patients with end-stage renal disease for sedation

Keywords

Geriatric patient, End stage renal disease, Dexmedetomidine, Propofol

Resumo

RESUMOJUSTIFICATIVA E OBJETIVO: A sedação em paciente dependente de diálise com doença renal em estágio terminal (DRET) requer cautela como resultado da administração de altas doses de sedativos e suas complicações. Os regimes de sedação com múltiplas drogas podem ser superiores e vantajosos em relação ao consumo menor de drogas e aos eventos adversos que ocorrem facilmente em pacientes com DEET. Avaliamos os efeitos da pré-medicação com dexmedetomidina sobre o consumo de propofol, os níveis de sedação com os escores da Observer's Assessment of Alertness and Sedation (OAA/S) e do índice bispectral (BIS), as alterações hemodinâmicas e os potenciais efeitos colaterais em pacientes geriátricos com DRET submetidos à cirurgia para fratura de quadril sob raquianestesia.MÉTODO: Neste estudo randômico, controlado e duplo-cego, 60 pacientes idosos (idade ≥ 65 anos), com DRET e fratura de quadril, agendados para fixação intramedular de haste femoral anterógrada foram designados para grupos para receberam infusão intravenosa de solução salina (Grupo C) ou pré-medicação com infusão de 0,5 mg kg/10 min de dexmedetomidina (DEX) (Grupo D). Todos os pacientes receberam infusão de propofol após a indução da raquianestesia.RESULTADOS: O consumo total de propofol, a dose de propofol necessária para os níveis-alvo de sedação de acordo com os escores da OAA/S, os valores do BIS e os tempos de recuperação foram significativamente menores no Grupo D (p < 0,001). O tempo para atingir o escore 4 na OAA/S e valores BIS ≤ 80 foi significativamente inferior no Grupo C em comparação com o Grupo D (p < 0,001). Os eventos adversos foram semelhantes em ambos os grupos.CONCLUSÃO: A pré-medicação com dexmedetomidina reduz o consumo de propofol no intraoperatório para manter o nível-alvo de sedação. Portanto, a pré-medicação com DEX em dose baixa em combinação com infusão de propofol pode ser uma opção para sedação em pacientes geriátricos com DRET.

Palavras-chave

Paciente geriátrico, Doença renal em estágio terminal, Dexmedetomidina, Propofol

References

Ismail N, Hakim RM, Oreopoulos DG,. Renal replacement therapies in the elderly: Part 1. Hemodialysis and chronic peri- toneal dialysis. Am J Kidney Dis. 1993;22:759-82..

Keith DS. Transplantation in the elderly patient. Clin Geriatr Med. 2013;29:707-19.

Sasaki Y, Marioni R, Kasai M,. Chronic kidney disease: a risk factor for dementia onset: a population-based study The Osaki- Tajiri Project. J Am Geriatr Soc. 2011;59:1175-81.

Le- Wendling L, Bihorac A, Baslanti TO. Regional anesthe- sia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortal- ity, and health care costs? Results of a single-centered study. Pain Med. 2012;13:948-56.

Jørgensen TSH, Hansen AH, Sahlberg M,. Falls and comorbidity: the pathway to fractures. Scand J Public Health. 2014;42:287-94.

Trainor D, Borthwick E, Ferguson A. Perioperative management of the hemodialysis patient. Semin Dial. 2011;24:314-26.

Byrick RJ. Anesthesia and end stage renal failure: is TIVA an advance?. Can J Anaesth. 1999;46:621-2.

Hadimioglu N, Ulugol H, Akbas H,. Combination of epidural anesthesia and general anesthesia attenuates stress response to renal transplantation surgery. Transplant Proc. 2012;44:2949-54.

Brown DL, Miller RD. Spinal, epidural, and caudal anesthesia. 2010:1612-27.

Eddleston JM, Pollard BJ, Blades JF,. The use of propofol for sedation of critically ill patients undergoing haemodiafiltration. Intensive Care Med. 1995;21:342-7.

Lee SM, Kim GH, Lee JJ,. Does propofol and alfentanil- induced sedation cause periodic apnoea in chronic renal failure patients?. Int J Clin Pract. 2010;64:1-5.

Beathard GA, Urbanes A, Litchfield T,. The risk of sedation/analgesia in hemodialysis patients undergoing inter- ventional procedures. Semin Dial. 2011;24:97-103.

Ok HG, Baek SH, Baik SW,. Optimal dose of dexmedetomi- dine for sedation during spinal anesthesia. Korean J Anesthesiol. 2013;64:426-31.

Rutkowska K, Knapik P, Misiolek H. The effect of dexmedeto- midine sedation on brachial plexus block in patients with end-stage renal disease. Eur J Anaesthesiol. 2009;26:851-..

De Wolf AM, Fragen RJ, Avram MJ,. The pharmacokinetics of dexmedetomidine in volunteers with severe renal impair- ment. Anesth Analg. 2001;93:1205-9.

Bagchi D, Mandal MC, Das S,. Bispectral index score and observer's assessment of awareness/sedation score may mani- fest divergence during onset of sedation: study with midazolam and propofol. Indian J Anaesth. 2013;57:351-7.

Lundström S, Twycross R, Mihalyo M,. Propofol. J Pain Symptom Manage. 2010;40:466-70.

Fechner J, Ihmsen H, Hatterscheid D,. Comparative pharmacokinetics and pharmacodynamics of the new propo- fol prodrug GPI 15715 and propofol emulsion. Anesthesiology. 2004;101:626-39.

Ickx B, Cockshott ID, Barvais L,. Propofol infusion for induc- tion and maintenance of anaesthesia in patients with end-stage renal disease. Br J Anaesth. 1998;81:854-60.

Kakinohana M, Tokumine J, Kawashima S,. Patient- controlled sedation using propofol in eight patients with endstage renal failure. J Anesth. 2004;18:39-42..

Gertler R, Brown HC, Mitchell DH,. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14:13-21.

Kunisawa T, Hanada S, Kurosawa A,. Dexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient. J Anesth. 2010;24:938-41.

Sen S, Chakraborty J, Santra S,. The effect of dexmedeto- midine infusion on propofol requirement for maintenance of optimum depth of anaesthesia during elective spine surgery. Indian J Anaesth. 2013;57:358-63.

Hall JE, Uhrich TD, Barney JA,. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res. 2013;3:475-83.

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