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09 June 2024 : Clinical Research  

Determining the Optimal Dosage of Dexmedetomidine for Smooth Emergence in Older Patients Undergoing Spinal Surgery: A Study of 44 Cases

Hyoeun Ahn1CDEF, Yun Jeong Chae1DEF, Gyu Bin Choi1BF, Min Gyu Lee1BF, Ji Young Yoo1ABCF*

DOI: 10.12659/MSM.944427

Med Sci Monit 2024; 30:e944427

Abstract

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BACKGROUND: Emergence agitation, or delirium, occurs during early recovery from general anesthesia and involves disorientation, excitation, and uncontrolled physical movements. Dexmedetomidine is an alpha agonist that has sedative, anxiolytic, analgesic, and sympatholytic activities and is used as a continuous infusion to prevent emergence agitation. This study aimed to evaluate patients aged 65 years and older undergoing general anesthesia to determine the 90% effective dose (ED90) of dexmedetomidine continuous intraoperative infusion to prevent emergence agitation.

MATERIAL AND METHODS: We enrolled 44 patients aged 65 years and older undergoing spinal surgery under general anesthesia. Dexmedetomidine administration commenced 30 minutes before surgery completion, with a predetermined infusion dose (μg/kg/h), without a loading dose. The initial dose was 0.2 μg/kg/h, and subsequent step size was ±0.05 μg/kg/h. We tried to find ED90 of dexmedetomidine using the biased-coin design. Vital signs, extubation quality scores, extubation-related complications, and postoperative outcomes were monitored.

RESULTS: Dexmedetomidine ED₉₀ for smooth emergence in older patients was 0.34 μg/kg/h. Peri-extubation vital signs remained within 20% of baseline values, without requiring pharmacological intervention. No hypoxia, hypoventilation, or post-extubation agitation occurred. In the recovery room, 1 patient briefly exhibited excitement but quickly calmed. Nine patients initially unresponsive in the recovery room fully awoke and were promptly discharged.

CONCLUSIONS: For older patients who are vulnerable to adverse effects of anesthetics and opioids, dexmedetomidine enables gentle awakening without adverse vital sign changes, respiratory depression, excessive sedation, or emergence agitation (ED₉₀=0.34 μg/kg/h). Further studies should involve a larger patient cohort, considering diverse medical conditions in older individuals.

Keywords: Dexmedetomidine, Anesthesia, General, Aged, Emergence Delirium, Respiratory Insufficiency

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Editorial

01 June 2024 : Editorial  

Editorial: Concerns as Highly Pathogenic Avian Influenza (HPAI) Virus of the H5N1 Subtype is Identified in Dairy Cows and Other Mammals

Dinah V. Parums

DOI: 10.12659/MSM.945315

Med Sci Monit 2024; 30:e945315

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750