Low-dose intramuscular dexmedetomidine as premedication: a randomized controlled trial

Abstract

Background: Dexmedetomidine-induced bradycardia or hypotension has recently attracted considerable attention because of potentially grave consequences, including sinus arrest and refractory cardiogenic shock. A route other than intravenous injection or a low dose may help minimize cardiovascular risks associated with dexmedetomidine. However, few studies have addressed the clinical effects of low-dose intramuscular dexmedetomidine as premedication.

Material and methods: Forty American Society of Anesthesiologists physical status I adult patients undergoing suspension laryngoscopic surgery were randomized to receive intramuscular dexmedetomidine (1 µg·kg-1) or midazolam (0.02 mg·kg-1) 30 minutes prior to anaesthesia induction. The sedative, hemodynamic, and adjuvant anaesthetic effects of both premedications were assessed.

Results: The levels of sedation (Observer's Assessment of Alertness/Sedation scales) and anxiety (visual analog score) at pre-induction, and the times to eye-opening and extubation, were not different between the groups. The heart rate response following tracheal intubation and extubation, and mean arterial pressure responses after extubation, were attenuated in the dexmedetomidine group compared to the midazolam group. No bradycardia or hypotension was noted in any patients. Propofol target concentrations at intubation and at start and completion of surgery were decreased in the dexmedetomidine group, whereas no difference in respective remifentanil levels was detected.

Conclusions: This study provides further evidence that dexmedetomidine premedication in low dose (1 μg·kg-1) by intramuscular route can induce preoperative sedation and adjuvant anaesthetic effects without clinically significant bradycardia or hypotension.

Trial registration: ClinicalTrials.gov NCT01937611.

Figures

Figure 1

CONSORT flow diagram.

Figure 2

Hemodynamic responses at different time points in patients receiving intramuscular midazolam 0.02 mg/kg or dexmedetomidine 1 μg·kg−1. (A) Heart rate response. (B) Mean arterial pressure response. Time point 1 represents baseline, 2 at pre-induction, 3 after induction, 4 at eye opening, and 5 after extubation. The bar represents mean (SD). * P=0.003; ** P=0.031; # P=0.035.

Figure 3

Predicted effect-site concentrations of anaesthetics after intramuscular midazolam 0.02 mg/kg or dexmedetomidine 1 μg·kg−1. (A) propofol, (B) remifentanil. Time point 1 represents at induction, 2 at start of surgery, 3 at completion of surgery, 4 at eye opening, and 5 at extubation. TCI = target-controlled infusion. The bar represents mean (SD). * P=0.021; ** P=0.016.