D.I. Tomashchuk, D.V. Martynov, V.M. Zhenilo
Rostov State Medical University, Ministry of Healthcare of the Russian Federation, Rostov-on-Don
For correspondence: Dmitry Ivanovich Tomaschuk — Anesthesia and Intensive Care physician, Department of Anesthesiology and Intensive Care № 1, Rostov State Medical University, e-mail: firstname.lastname@example.org
For citation: Tomashchuk DI, Martynov DV, Zhenilo VM. Dexmedetomidine and Propofol Sedation in Carotid Endarterectomy Under Regional Anesthesia: What’s Better for the Patient? (Study of Patient Satisfaction). Intensive Care Herald. 2017;4:36–41.
Introduction. Carotid endarterectomy under regional anesthesia with sedation allows to realize dynamic neurologic monitoring. The main drawback of this approach is patient’s discomfort. Thus, qualitative sedation at the operation of carotid endarterectomy in case of regional anesthesia is necessary. The use of dexmedetomidine as a basic preparation for perioperative sedation is especially interesting as it has a unique effect on the central nervous system. Material and methods. 112 patients were involved and divided into two groups: group № 1 (propofol group) and group № 2 (dexmedetomidine group) in proportion 53 vs 59. There were no differences between the groups (p = 0.36). In the group № 1 after performing regional anesthesia we started the propofol infusion (TCI) up to the target level of 1.7 mg/ml in plasma. The patents from group № 2 began to receive dexmedetomidine at the rate from 0.2 mkg/kg/h to 0.9–1 mkg/kg/h by the end of regional anesthesia. Patient’s satisfaction with anesthesia was assessed according to their answers to the questionnaire on the next day after the operation. Results. Almost two thirds of patients, 38 people (64.40 %), from group № 2 expressed their satisfaction (13–15 points) with anesthesia they received, while in the group № 1 only 11 people (20.75 %) got 13–15 points (p < 0.0001); 37 people (69.81 %) from group № 1 got 10–12 points and 19 people (32.20 %) from group № 2 (p = 0.0001). Less than 10 points (“unsatisfied”) were given by 5 (9.43 %) patients from group № 1, and 2 (3.38 %) patients from group № 2, there are no significant differences between the groups (p = 0.3). It should be mentioned that all patients who considered their presence in the operating room to be uncomfortable (3 people) had also a low sum of points (< 10), which indicates the imperfection of the offered questionnaire. Conclusion. Though the patients who received dexmedetomidine as a sedative agent, had a less deep sedation and had more memories of DNM stage, in total showed comparative satisfaction with the group receiving propofol. Moreover, there were significantly more patients completely satisfied with anesthesia in the dexmedetomidine group.
Keywords: dexmedetomidine, carotid endarterectomy, regional anesthesia with sedation, patient satisfaction
- Куликов А.С., Шмигельский А.В., Лубнин А.Ю. Седация дексмедетомидином при проведении каротидной эндартерэктомии в сознании. Регионарная анестезия и лечение острой боли. Т. 2013; 4: 30–34. [Kulikov A.S., Shmigel’skiy A.V., Lubnin A.Yu. Dexmedetomidine sedation for awake carotid endarterectomy. Vol. VII. 2013; 4: 30–34. (In Russ)]
- Licker M. Regional or general anaesthesia for carotid endarter Does it matter? European Journal of Anaesthesiology. 2016; 33: 241–243. doi: 10.1097/EJA.0000000000000376.
- Stoneham M.D., Stamou D., Mason J. Regional anaesthesia for carotid British Journal of Anaesthesia. 2015; 114(3): 372–383. doi: 10.1093/bja/aeu304.
- Wilke H.J., Ellis J.E., McKinsey J.F. Carotid endarterectomy: intraoperative anaesthesia and Journal Cardiothoracic Vascular Anaesthesia. 1996; 10: 928–949. doi: 10.1016/ s1053-0770(96)80060-7.
- Quigley T.M., Ryan W.R., Morgan S. Patient satisfaction after carotid endarterectomy using a selective policy of local anaesthesia. American Journal of Surgery. 2000; 179(5): 382–385. doi: 1016/s0002-9610(00)00371-8.
- McCarthy J., Trigg R., John C., Gough M.J., Horrocks M. Patient satisfaction for carotid endarterectomy performed under local anaesthesia. European Journal Vascular Endovascular Surgery. 2004; 27(6): 654–659. doi: 10.1016/j.ejvs.2004.03.010.
- Attigah N., Kutter J., Demirel S., Hakimi M., Hinz U. et al. Assessment of patients satisfaction in carotid surgery under local anaesthesia by psychometrical testing. A prospective cohort study. European Journal Vascular Endovascular Surgery. 2011; 41(1): 76–82. doi: 1016/j.ejvs.2010.08.020.
- Marcucci G., Siani A., Accrocca F., Gabrielli R., Giorda- no A. et al. Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience. Interactive Cardiovascular Thoracic Surgery Journal [Internet]. 2011; 13(6): 601–605. doi: 1510/icvts.2011.280321.
- Martin E., Ramsay G., Mantz J., Sum-Ping S.T. The role of the a2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. Journal Intensive Care Med. 2003; 18: 29–41. doi: 1177/0885066602239122.
- Venn R.M., Grounds R.N. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. British Journal of Anesthesia. 2001; 87: 684–690. doi: 1093/bja/87.5.684.
- Ebert T.J., Hall J.E., Barney J.A., Uhrich T.D., Colinco M.D. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000; 93: 382–394. doi: 1097/00000542-200008000-00016.
- Hall J.E., Uhrich T.D., Barney J.A., Arain S.R., Ebert T.J. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine Anesthesia Analgesia. 2000; 90: 699–705. doi: 10.1097/00000539-200003000-00035.
- Ji F., Li Z., Nguyen H., Young N., Shi P., Fleming N. et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. 2013; 128: e339–e340. doi: 10.1161/CIR- CULATIONAHA.113.005450.
- Benggon M., Chen H., Applegate R., Martin R., Zhang J.H. Effect of dexmedetomidine on brain edema and neurological outcomes in surgical brain injury in rats. Anesthesia Analgesia. 2012; 115: 154–159. doi: 1213/ANE.0b013e31824e2b86.
- Zhu Y.M., Wang C.C., Chen L., Qian L.B., Ma L.L .et a Both PI3K/Akt and ERK1/2 pathways participate in the protection by dexmedetomidine against transient focal cerebral ischemia/reperfusion injury in rats. Brain. Res. 2013; 1494: 1–8. doi: 10.1016/j.brainres.2012.11.047.