Intranasal Dexmedetomidine as a Sedative Premedication for Patients Undergoing Suspension Laryngoscopy: A Randomized Double-Blind Study

Abstract

BackgroundIntranasal dexmedetomidine, a well-tolerated and convenient treatment option, has been shown to induce a favorable perioperative anxiolysis in children. We investigate intranasal dexmedetomidine as a sedative premedication for anesthesia recovery in an adult population.MethodsA prospective randomized controlled trial; 81 adult patients scheduled for elective suspension laryngoscopy received intranasal dexmedetomidine (1 μg∙kg–1) or a placebo 45–60 min before anesthetic induction. Extubation time was used as the primary outcome measure. Secondary variables included the levels of sedation (Observer’s Assessment of Alertness/Sedation scale, OAA/S) and anxiety (4-point anxiety score), anesthetic and analgesic requirements, hemodynamic fluctuations, and anesthesia recovery as well as side effects.ResultsThe levels of sedation and anxiety differed significantly between the two groups at anesthesia pre-induction (p < 0.001 and = 0.001, respectively). Repeated-measure general linear model determined no significant interaction effect between group and time on the targeted concentration of propofol (F = 1.635, p = 0.200), but a significant main effect of group existed (F = 6.880, p = 0.010). A moderate but significant decrease in the heart rate was recorded in the dexmedetomidine group at pre-induction. Episodes of tachycardia and hypertension after tracheal intubation and extubation were more frequent in the placebo group.ConclusionsIntranasal dexmedetomidine as a sedative premedication induced a favorable perioperative anxiolysis without prolongation in anesthesia recovery; the hemodynamic effect was modest.Trial RegistrationClinicalTrials.gov NCT 02108171

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

“…Postoperative agitation in children undergoing different surgical procedures has been widely investigated. However, studies on postoperative agitation in children undergoing dental treatment under general anesthesia are few [5][6][7]. In this study, the effects of intranasal dexmedetomidine and oral midazolam were compared with those of preoperative sedation and postoperative agitation in 3-6-year-old children under dental treatment.…”

Effect of intratracheal dexmedetomidine administration on recovery from general anaesthesia after gynaecological laparoscopic surgery: a randomised double-blinded study

“… 24 Furthermore, it has been demonstrated that Dex can reduce the hyperalgesia caused by remifentanil and pain stimulation, and can yield global haemodynamic stability and prevent violent injury to the throat and vocal cord. 25–27 Notably, previous reports have confirmed the efficacy of intranasal Dex as a sedative premedication to induce a favourable perioperative anxiolysis 28 and reduce emergence agitation during recovery from general anesthesia. 29 In addition, Rani et al 30 found that a single dose of Dex, administered intravenously 15 min prior to extubation, could suppress the airway reflex during recovery from general anaesthesia.…”

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

“…In this regard, the potential role of intranasal dexmedetomidine for FD patients is appealing. Intranasal dexmedetomidine has been used to pre-medicate pediatric patients undergoing diagnostic and therapeutic procedures to provide light sedation and blunt sympathetic activity [2, 8, 15, 18, 28]. Because initial management of FD crises typically occurs at home, the availability of a medication with rapid onset, effectiveness via the intranasal route, and minimal risk of respiratory depression, would pose a significant therapeutic innovation.…”