Key result
Dexmedetomidine maintenance at 0.4 µg/kg/hr provided higher surgeon satisfaction (p<0.001) and higher mean sedation scores at 30 minutes (3.00 vs 2.63, p<0.007) compared to 0.2 µg/kg/hr.
Why the study?
There is no consensus on a standard fixed maintenance dose of dexmedetomidine, prompting an evaluation to identify an optimal maintenance dose following a fixed loading dose during monitored anesthesia care.
Does a 0.4 µg/kg/hr maintenance dose of dexmedetomidine improve satisfaction and sedation compared to 0.2 µg/kg/hr in patients undergoing surgery under local anesthesia?
RCT (n=70)
Double-blind
Randomized
Does a 0.4 µg/kg/hr maintenance dose of dexmedetomidine improve satisfaction and sedation compared to 0.2 µg/kg/hr in patients undergoing surgery under local anesthesia?
A dexmedetomidine maintenance dose of 0.4 µg/kg/hr provides better surgeon satisfaction and quicker target sedation than 0.2 µg/kg/hr without compromising safety.
Supports preferring 0.4 µg/kg/hr maintenance in MAC for better satisfaction; extends RCT dosing optimization evidence.
Dexmedetomidine a novel αagonist is replacing the conventional sedative agents. Monitored Anesthesia Care has a gained lot of popularity in local surgery and high risk procedures. There is no dictum on use of standard fix maintenance dose of dexmedetomidine. The main objective and aim of our study was to find a better maintenance dose of Dexmedetomidine after a fixed loading dose with stable hemodynamic, good satisfaction scores, minimal side effects and less rescue drug consumption. After ethical committee approval our randomized, prospective double blinded study a total 70 patients ASA I-III aged 18-65 years divided into two groups: both groups received a loading dose of 1 µg /kg over 10 minutes followed by group A receiving 0.2 µg/kg/hr and group B receiving 0.4 µ/kg/hr till end of surgery. Patient and surgeon satisfaction evaluated by Likert scale and sedation by Ramsay sedation score and vital parameters recorded. The results were comparable in terms of mean blood pressure, heart rate, SpO, respiratory rate, pain scores and demographic data. Surgeon satisfaction was higher in group B with statistical significance(p<0.001) compared to group A. Mean sedation score at 30 minutes of infusion was 2.63±0.49 in group A and 3.00±0.00 in group B (p value<0.007). Dexmedetomidine maintenance of 0.4 µg/kg/hr is equally safe and effective compared to 0.2 µg/kg/hr but former has better surgeon satisfaction with quicker achievable target sedation. Thus Dexmedetomidine 0.4 µg/kg/hr has a better edge for maintenance.
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Zaman et al. (2020) conducted an RCT in Surgical procedures under local anesthesia (n=70). Dexmedetomidine vs. 0.2 µg/kg/hr maintenance was evaluated on Mean sedation score at 30 minutes of infusion (p=<0.007). Dexmedetomidine maintenance at 0.4 µg/kg/hr provided higher surgeon satisfaction (p<0.001) and higher mean sedation scores at 30 minutes (3.00 vs 2.63, p<0.007) compared to 0.2 µg/kg/hr.
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