Comparison of dexmedetomidine and benzodiazepine for intraoperative sedation in elderly patients: a randomized clinical trial

Abstract

Background and objectivesElderly individuals have a greater sensitivity to sedation, and the most commonly used drugs for sedation are benzodiazepines, which exhibit some complication. Therefore, this study aimed to compare the use of dexmedetomidine and midazolam regarding proper sedation and postoperative complications in elderly individuals who require intraoperative sedation.MethodsThis study was a parallel-randomized clinical trial, which included 120 patients aged >70 years undergoing regional anesthesia and sedation. The exclusion criteria consisted of bradycardia, heart failure, respiratory failure, a Glasgow Coma Scale ≤14, liver failure and refusal to participate. Patients were divided into two groups: the first group received midazolam (MDZ), while the second group received dexmedetomidine (DEX). The doses were titrated to achieve an intraoperative Richmond Agitation-Sedation Scale (RASS) score between −3 and −1. Incidences of complications were recorded.ResultsDuring a 120 min follow-up, the depth of sedation (RASS score) revealed variations less often in the DEX group (p=0.002). Patients in the DEX group (n=67) had lower rates of intraoperative complications (19.4% vs 73.6%, p<0.001). Intraoperatively, the incidence rates of psychomotor agitation (15.1% vs 1.5%, p=0.005), arterial hypotension (28.3% vs 3.0%, p<0.001) and respiratory depression (73.6% vs 0%, p<0.001) were higher in the MDZ group (n=53). During postanesthesia care, the incidence rates of shivering (p<0.001), residual sedation (p=0.04) and use of supplemental oxygen (p<0.001) were significantly lower in the DEX group.ConclusionsThe use of DEX for sedation during surgery provides better control over the depth of sedation and produces fewer complications in elderly individuals.Trial registration number NCT02878837.

Determination of the median effective dose of dexmedetomidine for the prevention of emergence agitation in geriatric patients undergoing major open surgery with general anesthesia: A prospective, double-blinded, dose-response trial

“…While the e cacy of midazolam and dexmedetomidine intravenous infusion were comparable in the prevention of EA during short and simple surgery (mean duration of surgery 87±44 min), [25] in another study with more complex surgery (mean duration of surgery more than 120min), the incidences of EA was signi cantly lower in the group treated with dexmedetomidine, and complications-such as depth of sedation, hypotension, and respiratory depression-were higher in the group treated with midazolam. [26] In our major open surgery(mean duration of surgery 249±40min,Table 2), dexmedetomidine appeared to effectively prevent EA in geriatric patients without any complications.…”

Drugs For Attenuation of Hemodynamic Responses In Patients Undergoing Elective Off-Pump Coronary Artery Bypass Graft: A Randomized Clinical Trial

“…Currently, these critically ill patients are hemodynamically optimized with "early goal-directed therapy" (EDGT), which in high-risk surgery has been associated with a reduction in postoperative morbidity and mortality along with a decrease in cardiac complications, particularly in the case of arrhythmias (12 ) (29 ).…”

Sedation with dexmedetomidine in elderly patients during dental surgery: a retrospective case series

“…Appropriate sedation contributes to a reduction in the patient's psychological and physiological stress. Difficulties associated with sedation in the elderly7 include airway obstruction, respiratory depression, coughing due to inhaling secretions, and hypotension. Midazolam and propofol are the most commonly used sedatives.…”