Intranasal dexmedetomidine combined with local anesthesia for conscious sedation during breast lumpectomy: A prospective randomized trial

Abstract

Breast lumpectomy is usually performed under general or local anesthesia. To the best of our knowledge, whether conscious sedation with intranasal dexmedetomidine and local anesthesia is an effective anesthetic technique has not been studied. Thus, the present study aimed to investigate the effectiveness of conscious sedation with intranasal dexmedetomidine combined with local anesthesia in breast lumpectomy, and to identify its optimal dose. A prospective randomized, double-blinded, placebo-controlled, single-center study was designed, and patients undergoing breast lumpectomies were recruited based on the inclusion and exclusion criteria. All patients were randomly allocated to four groups: i) Local anesthesia with 0.9% intranasal saline (placebo); local anesthesia with ii) 1 µg.kg-1 ; iii) 1.5 µg.kg-1 ; or iv) 2 µg.kg-1 intranasal dexmedetomidine. The sedation status, pain relief, vital signs, adverse events, and satisfaction of patient and surgeon were recorded. Patients in the three dexmedetomidine groups were significantly more sedated and experienced less pain compared with the placebo group 45 min after intranasal dexmedetomidine administration and during 30 min in the post-anesthesia care unit. Patients in the 1.5 µg.kg-1 group were more sedated compared with the 1 µg.kg-1 group (without reaching statistical significance), whereas the 1.5 µg.kg-1 group exhibited a similar level of sedation 45 min after intranasal dexmedetomidine administration compared with the 2 µg.kg-1 group. In addition, patients in the 1 and 1.5 µg.kg-1 group experienced no adverse hemodynamic effects. Patient and surgeon satisfaction were greater in the 1.5 µg.kg-1 group compared with the 1 and 2 µg.kg-1 groups. Taken together, the results of the present study suggested that conscious sedation with intranasal dexmedetomidine and local anesthesia may be an effective anesthetic for breast lumpectomy surgery, and that the optimal dose for intranasal dexmedetomidine administration may be 1.5 µg.kg-1 , as it resulted in good sedation and patient satisfaction without adverse effects.

Low-Dose Intranasal Dexmedetomidine Premedication Improves Epidural Labor Analgesia Onset and Reduces Procedural Distress on Epidural Puncture: A Prospective Randomized Double-blind Clinical Study

“…We found that dosages of 0.8 and 1.0 µg/kg reduce uterine contractions and extend the rst stage of labor. This result was inconsistent with the report in a previous study [22]. The rst reason was that most of the subjects were children who have different pharmacokinetics and apparent volumes of distribution than older subjects.…”

“…DEX induces cooperative and conscious analgesia and sedation, modulates the release of catecholamines and relieves maternal anxiety. YUAN et al showed that IND combined with local anesthesia resulted in conscious analgesia, sedation and improved anesthetic effects during breast lumpectomy [22]. Here, IND was used to relieve maternal anxiety and didn't affect cooperation during delivery.…”

“…A number of studies have showed that administering DEX intranasally is safe, effective, more comfortable and convenient than intravenous approach [22]. To the best of our knowledge, few study have investigated the e cacy of IND as an adjuvant for epidural labor analgesia to date.…”

“…DEX have also been con rmed to improve sedation during the later stages of labor in epidural access [8,9]. YUAN et al demonstrated that IND provided good clinical analgesia and sedation for up to at least 70 minutes after administration [22].…”

Epiretinal Membrane Surgery for a Patient with Dyskinesia Related to Parkinson’s Disease Using Intravenous Dexmedetomidine Administration

“…While DEX is mainly utilized in intensive care units due to its demonstrated suitability for achieving both short- and longer term sedation [ 1 , 2 ], it has more recently been applied in conjunction with local anesthesia in various surgical fields due to its minimal effects on respiratory depression. Several studies have noted that incorporating DEX into the regimen can induce light intraoperative sedation, which can help alleviate the fear of surgery in patients undergoing ophthalmological procedures [ 3 , 4 , 5 ].…”