Intramuscular dexmedetomidine premedication--an alternative to midazolam-fentanyl-combination in elective hysterectomy?

Abstract

Sedation, anxiolysis, intubation responses and fentanyl anaesthetic requirements were investigated in a double-blind, randomized study in twenty ASA I-II elective hysterectomy patients. Ten patients received dexmedetomidine 2.5 micrograms kg-1 i.m. 60 min before induction and saline placebo i.v. 2 min prior to induction (= DP group). Ten patients received midazolam 0.08 mg kg-1 i.m. 60 min and fentanyl 1.5 micrograms kg-1 i.v. (= MF group) 2 min before induction of anaesthesia with thiopentone 4 mg kg-1. Anaesthesia was maintained with 70% nitrous oxide in oxygen and with fentanyl 2 micrograms kg-1 i.v. increments according to predetermined criteria. Both premedications induced sedation (P < 0.01 in both groups) and anxiolysis (P < 0.01 in DP vs P < 0.05 in MF group) without any differences between the groups. Haemodynamic changes following tracheal intubation did not significantly differ between the groups. Intraoperatively systolic and diastolic arterial pressure were 15% and 13% lower in DP group (P < 0.01 and P < 0.05 for drug effect), the mean heart rate was approximately 9 beats min-1 lower in DP group (n.s.). Fentanyl was required more often in MF group: median 3.5 (QD 1.5) vs. 2.5 (QD 0.5) times in DP group (P < 0.05), the total amount being 57% smaller in DP group: 0.03 (QD 0.01) vs. 0.07 (QD 0.02) micrograms kg-1 min-1 (P < 0.05). Postoperative course and analgesic requirements were similar in both groups. Dexmedetomidine premedication may offer an alternative to current anaesthesia practice in elective hysterectomy.