Intranasal Dexmedetomidine in Termination of First Trimester Pregnancy of Suction Evacuation

Abstract

Background and aim: Deep sedation without intubation for termination of first trimester pregnancy of suction evacuation entails use of sedatives such as propofol or a combination of propofol and sulfentanil, with unwanted complications. Dexmedetomidine is a α2-adrenorecepter agonist which provides sedation, anxiolysis and analgesia, without any of the complications associated with the popular sedatives. Methods: A total number of 90 patients were randomized to three groups: 1. Group P, treated with intranasal saline, intravenous saline and propofol; 2. Group DP, treated with intranasal dexmedetomidine, intravenous saline and propofol; and 3. Group SP, treated with intranasal saline, intravenous sulfentanil and propofol. The primary outcome was the consumption of propofol, and the secondary outcomes were numeric rating scale (NRS) anxiety score, NRS pain score of uterine cramping, amount of blood loss, use of oxytocin and NRS satisfaction scores of obstetric and gynecological (ob/gyn) physicians and patients. Results: The consumption of propofol, NRS pain score of uterine cramping after surgery, NRS anxiety score, and amount of blood loss in group DP were significantly lower than those in group P and group SP. Ob/gyn physicians’ satisfaction score in group DP was significantly higher compared with group SP and group P. Registry number for clinical trials: ChiCTR-IPR-14005654. Conclusion: Sedation with intranasal dexmedetomidine (1 μg/kg) provided effective analgesia and anxiolysis, reduced consumption of propofol and lower blood loss in termination of first trimester pregnancy of suction evacuation. Compared with propofol or the combination of propofol and sulfentanil, intranasal dexmedetomidine was associated with higher satisfaction score of ob/gyn physicians. No unforeseen perioperative respiratory and cardiovascular adverse events occurred.