A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patients undergoing bariatric surgery
Lakshmi Jayaraman, Aparna Sinha, Dinesh Punhani, Lakshmi Jayaraman, Aparna Sinha, Dinesh Punhani
Abstract
Background: Morbidly obese patients with obstructive sleep apnea are extremely sensitive to sedative premedication. Intranasal dexmedetomidine is painless and quick acting. Intranasal dexmedetomidine can be used for premedication as it produces adequate sedation and also obtund hemodynamic response to laryngoscopy and tracheal intubation.
Materials and methods: Forty morbidly obese patients with BMI > 35 were chosen and divided into two groups. Group DEX received intranasal dexmedetomidine 1 mcg/kg (ideal body weight) while other group (AZ) received oral alprazolam 0.5 mg. Sedation scale, heart rate and the mean arterial pressure was assessed in both the groups at 0 hour, 45 minutes, during laryngoscopy and tracheal intubation.
Results: The demographic profile, baseline heart rate, means arterial pressure, oxygen saturation and sedation scale was comparable between the two groups. The sedation scores, after 45 min, were statistically significant between the two groups i.e., 2.40 ± 1.09 in the AZ group as compared to 3.20 ± 1.79 in DEX group P value 0.034. The heart rate, mean arterial pressure and oxygen saturation were statistically similar between the two groups, after 45 min. The heart rate was significantly lower in the DEX group as compared to the AZ group. There was no statistical difference in the mean arterial pressure between the two groups either during laryngoscopy or tracheal intubation.
Conclusion: Intranasal dexmedetomidine is a better premedication agent in morbidly obese patients than oral alprazolam.
Keywords: Intranasal; dexmedetomidine; morbidly obese; obstructive sleep apnea; sedative premedication.
Conflict of interest statement
Conflict of Interest: None declared.
References
- Yuen VM, Hui TW, Irwin MG, Yuen MK. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in paediatric anesthesia: A double-blinded randomized controlled trial. Anesth Analg. 2008;106:1715–21.
- Gill M, Green SM, Krauss B. A study of the Bispectral Index Monitor during procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2003;41:234–41.
- Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH. A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg. 2007;105:374–80.
- Mason KP, Zgleszewski SE, Dearden JL, Dumont RS, Pirich MA, Stark CD, et al. Dexmedetomedine for pediatric sedation for computed tomography imaging studies. Anesth Analg. 2006;103:57–62.
- Talon MD. Intranasal dexmedetomedine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. J Burn Care Res. 2009;30:599–605.
- Cheung CW. Analgesic and sedative effects of intranasal dexmedetomedine in third molar surgery under local anaesthesia. Br J Anaesth. 2011;107:430–7.
- De Witte JL, Alegret C, Sessler DI, Cammu G. Preoperative alprazolam reduces anxiety in ambulatory surgery patients: A comparison with oral midazolam. Anesth Analg. 2002;95:1601–6.
Source: PubMed