Анестезия и клинические исследования
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Evaluation the Effects of Intravenous vs. Spinal Dexmedetomidine during Anesthesia for Cesarean Sections with Severe Pre-Eclampsia

Ahmed Said Elgebaly

Background: Side effects of low-dose spinal anesthesia with opioids and adjuvants raised the essential requirement to look for better alternatives like dexmedetomidine for patients with severe pre-eclampsia undergoing cesarean section to provide satisfactory spinal anesthesia and improve its outcomes.
Aim: Evaluate and compare effects of intravenous and intrathecal dexmedetomidine on duration of spinal block, postoperative analgesia and incidence of adverse effects in parturient with severe Pre-eclampsia undergo Caesarean section.
Settings and design: A prospective, double blind controlled randomized and comparative study.
Methods: Sixty ASA II patients were randomized into 3 groups: Group I: (control group) (n=30) each patient received intrathecal hyperbaric bupivacaine 10 mg with 3 mL total volume. Group II: (Intrathecal dexmedetomidine group) (n=0) each patient received dexmedetomidine 5 μg diluted i n 0.5 ml saline and hyperbaric bupivacaine 10 mg with 3 mL total volume. Group III: (Intravenous dexmedetomidine group) (n=30) each patient received intravenous dexmedetomidine started at a loading dose of 1 μg/kg diluted in 50 ml saline and administered within 10 min. as a loading dose, followed by maintenance at a dose of 0.4 μg/kg/h diluted in 200 ml saline till the end of surgery and hyperbaric bupivacaine 10 mg in 3 ml total volume. Primary outcome is the duration of spinal block while secondary outcomes are the postoperative analgesia and the incidence of side effects.
Results: Time (min) to sensory regression to s1 level in group I, II, III was (200.23 ± 3.25, 230.4 ± 2.5, 294.1 ± 15.1) respectively, showed significance increase in group III. Time to reach motor block Bromage 3 was (5.5 ± 0.2, 5.7 ± 0.9, 8.5 ± 0.3) in group I, II, III respectively, there was significance increase in group III. Time of regression to Bromage 0 was assessed as (170.5 ± 2.35, 190.6 ± 3.51, 249.2 ± 20.2) in groups I, II, III respectively, showed significance increase in group III. Onset of 1st post-operative analgesic dose was assessed in the study groups (242.23 ± 15.01, 270.15 ± 25.00, 371.25 ± 88.54), showed significance increase in group III. Side effects showed significance decrease in group III.
Conclusion: Intravenously administered dexmedetomidine prolonged the duration of sensory and motor blockade with reduced side effects.