Abstract
IntroductionDexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives. MethodsWe examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively.ResultsA total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p < 0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026).ConclusionsThe positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.
Highlights
Dexmedetomidine is a sedative used during spinal anaesthesia
Treatment of bradycardia in this case includes decreasing the dose or stopping the administration of dexmedetomidine and/or administering intravenous atropine. Sedatives such as clonidine and propofol used during spinal anaesthesia attenuate an increase in heart rate (HR) by intravenous atropine [8, 9], to the best of our knowledge, there have been no studies evaluating the HR response of intravenous atropine to bradycardia in patients receiving dexmedetomidine
Heart rate was significantly slower in the D group compared with the nonDnonP group 5 to 60 min after administration of atropine (5 min, p = 0.002; 10 min, p < 0.001; 15 min, p = 0.016; 20 min, p = 0.009; 30 min, p = 0.001; 60 min, p < 0.001)
Summary
Dexmedetomidine is a sedative used during spinal anaesthesia. Intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives. Treatment of bradycardia in this case includes decreasing the dose or stopping the administration of dexmedetomidine and/or administering intravenous atropine. Sedatives such as clonidine and propofol used during spinal anaesthesia attenuate an increase in heart rate (HR) by intravenous atropine [8, 9], to the best of our knowledge, there have been no studies evaluating the HR response of intravenous atropine to bradycardia in patients receiving dexmedetomidine
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