Intranasal Dexmedetomidine as a Sedative Premedication for Patients Undergoing Suspension Laryngoscopy: A Randomized Double-Blind Study

Chengxiang Lu, Li-Ming Zhang, Yuehong Zhang, Yanlu Ying, Ling Li, Lixin Xu, Xiangcai Ruan, Chengxiang Lu, Li-Ming Zhang, Yuehong Zhang, Yanlu Ying, Ling Li, Lixin Xu, Xiangcai Ruan

Abstract

Background: Intranasal dexmedetomidine, a well-tolerated and convenient treatment option, has been shown to induce a favorable perioperative anxiolysis in children. We investigate intranasal dexmedetomidine as a sedative premedication for anesthesia recovery in an adult population.

Methods: A prospective randomized controlled trial; 81 adult patients scheduled for elective suspension laryngoscopy received intranasal dexmedetomidine (1 μg∙kg-1) or a placebo 45-60 min before anesthetic induction. Extubation time was used as the primary outcome measure. Secondary variables included the levels of sedation (Observer's Assessment of Alertness/Sedation scale, OAA/S) and anxiety (4-point anxiety score), anesthetic and analgesic requirements, hemodynamic fluctuations, and anesthesia recovery as well as side effects.

Results: The levels of sedation and anxiety differed significantly between the two groups at anesthesia pre-induction (p < 0.001 and = 0.001, respectively). Repeated-measure general linear model determined no significant interaction effect between group and time on the targeted concentration of propofol (F = 1.635, p = 0.200), but a significant main effect of group existed (F = 6.880, p = 0.010). A moderate but significant decrease in the heart rate was recorded in the dexmedetomidine group at pre-induction. Episodes of tachycardia and hypertension after tracheal intubation and extubation were more frequent in the placebo group.

Conclusions: Intranasal dexmedetomidine as a sedative premedication induced a favorable perioperative anxiolysis without prolongation in anesthesia recovery; the hemodynamic effect was modest.

Trial registration: ClinicalTrials.gov NCT 02108171.

Trial registration: ClinicalTrials.gov NCT02108171.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Patient-flow diagram.
Fig 1. Patient-flow diagram.
Fig 2
Fig 2
Predicted effect-site concentrations of propofol (a) and remifentanil (b) after intranasal placebo or dexmedetomidine.The target concentrations of propofol or remifentanil were recorded at induction (T1), before insertion (T2), and upon removal of the operative laryngoscope (T3), at the return of spontaneous breathing (T4), at emergence (T5), and at extubation (T6). TCI stands for target-controlled infusion. Error bars represent standard deviation.
Fig 3. Anesthesia recovery times were similar…
Fig 3. Anesthesia recovery times were similar between patients receiving intranasal placebo and those receiving dexmedetomidine.
The times elapsed between stopping anesthetic infusions and adequate ventilation, consciousness, and extubation were also recorded as time to spontaneous breathing, emergency, and time to extubation. Error bars represent standard deviation.

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