Abstract
Background This study was designed to investigate and compare the effective doses of dexmedetomidine for sedation in parturient patients who underwent Cesarean section (CS) and nonpregnant women who underwent elective gynecologic surgery. Methods The study comprised 60 females aged between 25 and 35. They were divided into two groups. The parturient group received a bolus dose of dexmedetomidine over 15 min after the delivery of the fetus and placenta. In the nonpregnant women group, a bolus of dexmedetomidine was administered intravenously upon the completion of spinal anesthesia. The subsequent dose required by patients in each group was then determined through a modified two-stage Dixon up-and-down sequential method. Probit analysis was used to calculate the ED50 and the ED95 of dexmedetomidine for adequate sedation. Results The ED50 of dexmedetomidine for adequate sedation in parturient patients was 1.58 μg/kg (1.51–1.66 μg/kg); in nonpregnant women, it was 0.96 μg/kg (0.91–1.01 μg/kg) (95% CI). The ED95 of dexmedetomidine in parturients was 1.80 μg/kg (1.70–2.16) μg/kg and that of nonpregnant women was 1.10 μg/kg (1.04–1.30 μg/kg) (95% CI). The ED50 in parturients was significantly higher than that in nonpregnant women (P < 0.05). Conclusion The ED50 of dexmedetomidine for target sedation in parturients who received spinal anesthesia for CS is greater than 1.5 times that in nonpregnant women who received spinal anesthesia for lower abdominal gynecologic surgery. This study postulates that the dose of dexmedetomidine required to achieve optimal sedation following spinal anesthesia is much higher in parturients than in nonpregnant women undergoing gynecologic surgeries. This trial is registered with NCT02111421.
Highlights
Spinal anesthesia is widely employed in Cesarean section (CS), due to its advantages of spontaneous ventilation, muscle relaxation, and rapid onset
Parturients continue to experience emotional upheavals and a sympathetic surge with hemodynamic changes. All of these responses can be significantly attenuated by administering a sedative or hypnotic drug after spinal anesthesia during CS, which would enable the patient to get some rest after childbirth
Our study found that the ED50 of dexmedetomidine for effective sedation in postpartum parturients was 1.58 μg/kg (1.51–1.66 μg/kg) and in nonpregnant women it was 0.96 μg/ kg (0.91–1.01 μg/kg). ese results indicate that the ED50 of dexmedetomidine for adequate sedation in postpartum parturients is greater than 1.5 times that in nonpregnant women, all of whom had received spinal anesthesia for their respective surgeries. erefore, a higher dose of dexmedetomidine should be used to achieve target sedation goals for parturients after childbirth in CS under spinal anesthesia
Summary
Spinal anesthesia is widely employed in Cesarean section (CS), due to its advantages of spontaneous ventilation, muscle relaxation, and rapid onset. Parturients continue to experience emotional upheavals and a sympathetic surge with hemodynamic changes. All of these responses can be significantly attenuated by administering a sedative or hypnotic drug after spinal anesthesia during CS, which would enable the patient to get some rest after childbirth. Often given for uterine atony or excessive bleeding to enhance uterine contractility in CS [1], can commonly cause nausea, vomiting, and chest pain—symptoms that may already be present due to peritoneal traction and delivery. Ese side effects, too, can be Anesthesiology Research and Practice mitigated by a sedative/hypnotic drug that can be given to supplement the spinal anesthesia during CS immediately after delivery Often given for uterine atony or excessive bleeding to enhance uterine contractility in CS [1], can commonly cause nausea, vomiting, and chest pain—symptoms that may already be present due to peritoneal traction and delivery. ese side effects, too, can be Anesthesiology Research and Practice mitigated by a sedative/hypnotic drug that can be given to supplement the spinal anesthesia during CS immediately after delivery
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