Mikiko Ohtsuka1. 1. Department of Anesthesia, Jujo Rehabilitation Hospital, Kyoto 601-8325.
Abstract
BACKGROUND: Dexmedetomidine (DEX) has analgesic, anxiolytic, and antidelirium effects, and causes little respiratory depression. Behavioral disturbances such as agitation, aggression, and sleep disorder are common in cognitive impairment; this impairment may be one of the risk factors for postoperative delirium. We studied the effects of postoperative DEX administration in elderly patients with cognitive impairment. METHODS: Ten patients with cognitive impairment, aged 70 to 90 years, were maintained under both general and local anesthesia. We administered DEX (0.2-0.4 microg x kg(-1) x hr(-1)) to these patients 30 to 60 min before the end of the operation. The dose of DEX was reduced to 0.1-0.2 microg x kg(-1) hr(-1) by the time of extubation, and was increased in incremental doses 0.1 microg x kg(-1) x hr(-1) depending on postoperative agitation. RESULTS: Seven of 10 patients were calm; however, in 3 patients, the dose had to be increased by 0.1 microg x kg(-1) x hr(-1). No serious complication was observed, except bradycardia in 2 patients. CONCLUSIONS: Low-dose DEX is safe and useful for postoperative sedation in elderly patients with cognitive impairment.
BACKGROUND:Dexmedetomidine (DEX) has analgesic, anxiolytic, and antidelirium effects, and causes little respiratory depression. Behavioral disturbances such as agitation, aggression, and sleep disorder are common in cognitive impairment; this impairment may be one of the risk factors for postoperative delirium. We studied the effects of postoperative DEX administration in elderly patients with cognitive impairment. METHODS: Ten patients with cognitive impairment, aged 70 to 90 years, were maintained under both general and local anesthesia. We administered DEX (0.2-0.4 microg x kg(-1) x hr(-1)) to these patients 30 to 60 min before the end of the operation. The dose of DEX was reduced to 0.1-0.2 microg x kg(-1) hr(-1) by the time of extubation, and was increased in incremental doses 0.1 microg x kg(-1) x hr(-1) depending on postoperative agitation. RESULTS: Seven of 10 patients were calm; however, in 3 patients, the dose had to be increased by 0.1 microg x kg(-1) x hr(-1). No serious complication was observed, except bradycardia in 2 patients. CONCLUSIONS: Low-dose DEX is safe and useful for postoperative sedation in elderly patients with cognitive impairment.