Replacement of dexmedetomidine loading with midazolam for sedation in elderly patients with spinal anesthesia.

Abstract:

BACKGROUND:Dexmedetomidine is an effective sedative during spinal anesthesia. However, it requires a loading dose, which can result in transient hypertension, hypotension, bradycardia, and/or sinus arrest. In addition, the time required to reach an appropriate depth of sedation may cause anxiety to the patients. Therefore, we examined whether an intravenous bolus of midazolam could replace the loading dose of dexmedetomidine for sedation during surgery in elderly patients who received spinal anesthesia. METHODS:Patients aged over 60 years who scheduled to undergo total knee arthroplasty under spinal anesthesia were enrolled in this study. The patients were randomized into 2 groups. Patients in dexmedetomidine group (group D) (n = 20) were administered a loading dose of dexmedetomidine (1.0 μg/kg over 10 min) intravenously followed by dexmedetomidine maintenance (0.5 μg/kg/h). Patients in group MD (n = 20) were administered an intravenous midazolam (0.05 mg/kg) followed by dexmedetomidine maintenance (0.5 μg/kg/h) intravenously. Heart rate (HR), mean arterial blood pressure (MBP), peripheral oxygen saturation (SpO2), and patient state index (PSI) were recorded. Ramsay sedation scale (RSS) scores were evaluated at 10 minutes after drug administration and the end of surgery. RESULTS:A total of 40 subjects were enrolled in the present study. At baseline, there was no between-group difference in HR. Ten minutes after drug administration, group D had lower HR than group MD (62.1 ± 9.4 versus 69.6 ± 13.4, P = .047). PSI was significantly lower in group MD at 10 minutes after drug administration (82.8 ± 13.0 versus 72.0 ± 16.0, P = .024); there was no between-group difference at 30 and 60 minutes, and lower values in group D at the end of surgery (70.2 ± 22.6 versus 79.7 ± 10.9, P = .011). The RSS score showed statistically significantly deeper sedation in group MD 10 minutes after drug administration, but no difference at the end of surgery. CONCLUSIONS:An intravenous bolus of midazolam is a viable alternative to dexmedetomidine loading for sedation during surgery in elderly patients who received spinal anesthesia. This is especially effective for patients who are at high risk for bradycardia or who want a faster sedation.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Park SW,Choi JH,Kim HT,Cho YH

doi

10.1097/MD.0000000000012565

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

e12565

issue

39

eissn

0025-7974

issn

1536-5964

pii

00005792-201809280-00082

journal_volume

97

pub_type

杂志文章

相关文献

MEDICINE文献大全
  • Cardiac malignant peripheral nerve sheath tumor on computed tomography and magnetic resonance imaging: A case report.

    abstract:RATIONALE:Malignant peripheral nerve sheath tumor (MPNST) is a very rare sarcoma of the heart, and few cases have been reported. Herein, we retrospectively reviewed clinical manifestations, imaging features and management of our patient and other reported cases. PATIENT CONCERNS:A 32-year-old woman was referred to the...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000017463

    authors: Li S,Qiu Y,Yu J,Liang C,Peng L

    更新日期:2019-11-01 00:00:00

  • Pain-induced peripheral artery tonometry scores in the control arm are impaired in patients with apical ballooning syndrome.

    abstract::Mental and physical stress is thought to play an important causative factor in apical ballooning syndrome (ABS) likely secondary to the vasomotor dysfunction. However, there are currently few data related to the impact of physical stress in this unique cardiomyopathy.A total 18 patients, including 8 females with histo...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000013841

    authors: Sun T,Widmer RJ,Matsuzawa Y,Lennon RJ,Park KH,Lerman LO,Lerman A

    更新日期:2019-01-01 00:00:00

  • Arthritis associated with Mycoplasma pneumoniae in a pediatric patient: A case report.

    abstract:INTRODUCTION:Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis. PATIENT CONCERNS:We report the case of a 2...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000024316

    authors: Mărginean CO,Georgescu AM,Meliţ LE

    更新日期:2021-01-15 00:00:00

  • Gout increases risk of fracture: A nationwide population-based cohort study.

    abstract::There is still debate on whether high uric acid increases bone mineral density (BMD) against osteoporotic fracture or bone resorption caused by gout inflammation. This study aimed to evaluate whether gout offers a protective effect on bone health or not. We conducted a nationwide population-based retrospective cohort ...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000004669

    authors: Tzeng HE,Lin CC,Wang IK,Huang PH,Tsai CH

    更新日期:2016-08-01 00:00:00

  • Comparison of jet injector and insulin pen in controlling plasma glucose and insulin concentrations in type 2 diabetic patients.

    abstract::This study is conducted to investigate efficacy of an insulin jet injector and an insulin pen in treatment of type 2 diabetic patients. Sixty patients with type 2 diabetes were treated with rapid-acting insulin (regular insulin) and insulin analog (insulin aspart) using the jet injector and the pen in 4 successive tes...

    journal_title:Medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/MD.0000000000005482

    authors: Guo L,Xiao X,Sun X,Qi C

    更新日期:2017-01-01 00:00:00

  • Management of an extensive odontogenic keratocyst: A rare case report with 10-year follow-up.

    abstract:INTRODUCTION:The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early ...

    journal_title:Medicine

    pub_type: 杂志文章,评审

    doi:10.1097/MD.0000000000017987

    authors: Khan AA,Qahtani SA,Dawasaz AA,Saquib SA,Asif SM,Ishfaq M,Kota MZ,Ibrahim M

    更新日期:2019-12-01 00:00:00

  • Epidemiology and clinical characteristics of traumatic brain injury in Lebanon: A systematic review.

    abstract:BACKGROUND:Traumatic brain injury (TBI) is a debilitating medical and emerging public health problem that is affecting people worldwide due to a multitude of factors including both domestic and war-related acts. The objective of this paper is to systematically review the status of TBI in Lebanon - a Middle Eastern coun...

    journal_title:Medicine

    pub_type: 杂志文章,评审

    doi:10.1097/MD.0000000000005342

    authors: Abou-Abbass H,Bahmad H,Ghandour H,Fares J,Wazzi-Mkahal R,Yacoub B,Darwish H,Mondello S,Harati H,El Sayed MJ,Tamim H,Kobeissy F

    更新日期:2016-11-01 00:00:00

  • A Rare Case of Disseminated Tuberculosis of the Bone Marrow in Systemic Lupus Erythematosus: Case Report.

    abstract::Patients with systemic lupus erythematosus (SLE) are susceptible to tuberculosis (TB), especially in endemic areas such as China. The variable and nonspecific clinical features of disseminated TB often leads to an erroneous or misdiagnosis. When a patient presents with TB of the bone marrow, the clinical condition is ...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000003552

    authors: Chen D,Yang Z,Yang Y,Zhan Z,Yang X

    更新日期:2016-05-01 00:00:00

  • The value of the air bronchogram sign on CT image in the identification of different solitary pulmonary consolidation lesions.

    abstract::The aim of the present study is to investigate the value of air bronchogram sign on computed tomography (CT) image in the differential diagnosis of solitary pulmonary consolidation lesions (SPLs).A total of 105 patients (including 39 cases of lung cancer, 43 cases of tuberculosis, and 23 cases of pneumonia) with SPLs ...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000011985

    authors: Qu H,Zhang W,Yang J,Jia S,Wang G

    更新日期:2018-08-01 00:00:00

  • Importance of continuous sequential chemotherapy and multimodal treatment for advanced testicular cancer: a high-volume Japanese center experience.

    abstract::Patients with "difficult-to-treat" advanced testicular cancer can require multiple therapies. We retrospectively assessed our patients with advanced germ cell tumors (GCTs) and characterized the clinical efficacy, outcomes, and factors affecting overall survival (OS).Two hundred fifty-three patients with advanced GCTs...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000000653

    authors: Nakamura T,Ueda T,Oishi M,Nakanishi H,Shiraishi T,Fujihara A,Naito Y,Kamoi K,Naya Y,Hongo F,Okihara K,Miki T

    更新日期:2015-03-01 00:00:00

  • Use of methotrexate in the management of recurrent Tolosa-Hunt syndrome: Two case reports.

    abstract:RATIONALE:Tolosa-Hunt syndrome (THS) is rare condition characterized by painful ophthalmoplegia that usually responds well to corticosteroid. About a half of THS patients experience recurrence within intervals of months to years from initial presentation. Recurrence is more common in younger patients, and can be ipsila...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000019882

    authors: Kwon HS,Kim TY,Kim JH,Bae JH,Koh SH,Choi H,Lee KY,Lee YJ,Kim YS,Kim HY

    更新日期:2020-04-01 00:00:00

  • Medical Comics as Tools to Aid in Obtaining Informed Consent for Stroke Care.

    abstract::Informed consent has now become common in medical practice. However, a gap still exists between doctors and patients in the understanding of clinical conditions. We designed medical comics about "subarachnoid hemorrhage" and "intracerebral hemorrhage" to help doctors obtain informed consent intuitively, quickly, and c...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000001077

    authors: Furuno Y,Sasajima H

    更新日期:2015-07-01 00:00:00

  • Serum Alpha-Fetoprotein Has High Specificity for the Early Detection of Hepatocellular Carcinoma After Hepatitis C Virus Eradication in Patients.

    abstract::Alpha-fetoprotein (AFP) has not played a large role in the surveillance of hepatocellular carcinoma due to inadequate sensitivity and specificity for active chronic hepatitis or cirrhosis. The aim of this study was to evaluate the diagnostic accuracy of AFP in small hepatocellular carcinomas after hepatitis C virus er...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000000901

    authors: Minami T,Tateishi R,Kondo M,Nakagomi R,Fujiwara N,Sato M,Uchino K,Enooku K,Nakagawa H,Asaoka Y,Kondo Y,Moriya K,Shiina S,Koike K

    更新日期:2015-06-01 00:00:00

  • Warfarin prevented de novo portal vein thrombosis after transjugular intrahepatic portosystemic shunt: A retrospective study.

    abstract::Portal vein thrombosis (PVT) might impair the prognosis of cirrhotic patients. However, formation of de novo PVT after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients without preexisting PVT was rarely reported. Moreover, it is not known whether warfarin is efficient in preventing de novo PV...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000018737

    authors: Zhang L,Huan H,Tong H,Wei B,Wang Z,Liu C,Wu H

    更新日期:2020-01-01 00:00:00

  • Successful percutaneous stent implantation for isolated dismal transverse aortic arch kinking.

    abstract:RATIONALE:Isolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered. PATIENT CONCERNS:We report a 46-year-old woman who suffered from recurrent migraine and refractor...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000006089

    authors: Zuo ZL,Tsauo JY,Chen M,Feng Y

    更新日期:2017-03-01 00:00:00

  • Solitary fibrous tumor of the seminal vesicle: A case report.

    abstract:RATIONALE:Solitary fibrous tumor (SFT) is an unusual neoplasm, especially when it originates from the seminal vesicle. Herein, we describe a case of SFT that arises from the seminal vesicle. PATIENT CONCERNS:A 66-year-old man presented to our hospital complaining of a huge irregular tumor in his pelvis during a health...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000014660

    authors: Zhao R,Shan Y,Zou L,Zhao H,Zheng S

    更新日期:2019-03-01 00:00:00

  • Bortezomib combined with lenalidomide as the first-line treatment for the rare synchronous occurrence of multiple myeloma and pulmonary adenocarcinoma: A case report.

    abstract:BACKGROUND:Simultaneous multiple myeloma (MM) and pulmonary adenocarcinoma is a rare occurrence, and thus, treatment is a challenge. This study reports on 1 such case of MM with concurrent lung cancer, where an accurate diagnosis was made and the patient underwent treatment for both cancers. CASE SUMMARY:A 68-year-old...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000005787

    authors: Zuo W,Zhu X,Yang J,Mei Z,Deng M,Lin Q,Song Y,Yin Q

    更新日期:2017-01-01 00:00:00

  • Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI): An observational cohort study.

    abstract::Acute myocardial infarction (AMI) is recognized as being a life-threatening event. Both microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have been recognized as poor prognostic factors in myocardial infarct (MI) since they adversely affect left ventricular remodeling. MVO refers to small vessels ch...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000011617

    authors: Ma M,Diao KY,Yang ZG,Zhu Y,Guo YK,Yang MX,Zhang Y,He Y

    更新日期:2018-07-01 00:00:00

  • Associated risk factors for psychological distress in patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection.

    abstract::This study aimed to evaluate the psychological distress and associated risk factors for distress among patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection (ESD).A total of 91 patients treated with ESD for gastric epithelial neoplasm between May 2015 and June 2016 were prospectively en...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000013912

    authors: Lee S,Oh ST,Lee H,Lee JS,Pak H,Choi WJ,Jeon HH

    更新日期:2018-12-01 00:00:00

  • Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals.

    abstract::Methemoglobin is a form of hemoglobin that does not bind oxygen. When its concentration is elevated in red blood cells, functional anemia and tissue hypoxia may occur. We performed a retrospective case series to describe the cases of acquired methemoglobinemia (methemoglobin level >2%) detected and the clinical circum...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/01.md.0000141096.00377.3f

    authors: Ash-Bernal R,Wise R,Wright SM

    更新日期:2004-09-01 00:00:00

  • Relationship between ABO blood group and risk of venous thrombosis in cancer patients with peripherally inserted central catheters: A protocol for systematic review and meta-analysis.

    abstract:BACKGROUND:Peripherally inserted central catheter (PICC) is closely related to venous thromboembolism (VTE). It is a common complication of hospitalized patients, and its etiology is complex. How to prevent the occurrence of VTE is the focus of clinical work. In order to provide basis for individual prevention and accu...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000023091

    authors: Liu F,Zhang Q,Rao L,Song J

    更新日期:2020-11-06 00:00:00

  • Therapeutic efficacy of Qingfei Paidu decoction combined with antiviral drugs in the treatment of corona virus disease 2019: A protocol for systematic review and meta analysis.

    abstract:BACKGROUND:The corona virus disease 2019 (COVID-19) has caused a global pandemic, there are no specific drugs and vaccines for epidemic control at present. More and more clinical practice shows that traditional Chinese medicine has played an important role in the outbreak. Among them, Qingfei Paidu decoction (QPD) comb...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000020489

    authors: Gao K,Song YP,Chen H,Zhao LT,Ma L

    更新日期:2020-05-29 00:00:00

  • Perioperative and Anesthesia-Related Mortality: An 8-Year Observational Survey From a Tertiary Teaching Hospital.

    abstract::In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in B...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000002208

    authors: Pignaton W,Braz JRC,Kusano PS,Módolo MP,de Carvalho LR,Braz MG,Braz LG

    更新日期:2016-01-01 00:00:00

  • Feasibility of measuring urethral pressure during female midurethral slings: Case report.

    abstract:RATIONALE:Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative ...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000021100

    authors: Meng LF,Wang M,Zhang W,Liu XD,Zhang YG

    更新日期:2020-07-10 00:00:00

  • Scapular metastasis of hepatocellular carcinoma presenting as acute bleeding and hematoma: A case report of safe and effective treatment.

    abstract:RATIONALE:The occurrence of bleeding and hematoma from bone metastasis of hepatocellular carcinoma (HCC) is extremely rare. PATIENT CONCERNS:We present a case of scapular metastasis of HCC in a 69-year-old man who presented with acute bleeding and hematoma. DIAGNOSES:Chest computed tomography showed a large hematoma ...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000008736

    authors: Kim KH,Oh HH,Son DJ,Hong JY,Jeong YH,Jung JS,Yu HM,Myung DS,Cho SB,Lee WS,Kim JW,Joo YE

    更新日期:2017-11-01 00:00:00

  • Estrogen supplementation to progesterone as luteal phase support in patients undergoing in vitro fertilization: systematic review and meta-analysis.

    abstract::Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analys...

    journal_title:Medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/MD.0000000000000459

    authors: Zhang XM,Lv F,Wang P,Huang XM,Liu KF,Pan Y,Dong NJ,Ji YR,She H,Hu R

    更新日期:2015-02-01 00:00:00

  • Case Report: Bazex Syndrome Associated With Pulmonary Adenocarcinoma.

    abstract::Bazex syndrome, a rare paraneoplastic syndrome characterized by psoriasiform eruptions, palmoplantar keratosis, and symmetric onychodystrophy, is most prevalent with squamous cell carcinomas of the upper aerodigestive tract.Here, we reported an uncommon case of Bazex syndrome about an 83-year-old man with pulmonary ad...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000002415

    authors: Zhao J,Zhang X,Chen Z,Wu JH

    更新日期:2016-01-01 00:00:00

  • The aura of malignant tumor: Clinical analysis of malignant tumor-related pyogenic liver abscess.

    abstract::The global incidence of pyogenic liver abscess (PLA) is increasing, but related reports of malignant tumor-related PLA are infrequent. Potential malignant tumors of PLA have been reported, but there is no relevant predictive model for this subsection of patients.To explore the risk factors of malignant tumor-related P...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000019282

    authors: Li W,Wu C,Qin M,Cai F,Huang J

    更新日期:2020-02-01 00:00:00

  • Pediatric minimally invasive surgery for malignant abdominal tumor: Single center experience.

    abstract::This study examined the safety and usefulness of minimally invasive surgery (MIS) for malignant abdominal tumors in pediatric patients and analyzed the factors affecting the resection margin, operative time, and hospital stay of neuroblastoma (NBL) patients.We retrospectively reviewed data of pediatric patients who un...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000016776

    authors: Yang HB,Kim HY,Jung SE,Choi YH,Lee JW

    更新日期:2019-08-01 00:00:00

  • Transphyseal anterior cruciate ligament reconstruction in adolescents with substantial remaining growth causes temporary growth arrest resulting in subclinical leg-length discrepancy.

    abstract::The purpose of the present study was to investigate the characteristics of growth disturbances in patients with remaining growth after transphyseal anterior cruciate ligament (ACL) reconstruction who were confirmed to have no definite postoperative physeal abnormalities on magnetic resonance imaging (MRI).Forty adoles...

    journal_title:Medicine

    pub_type: 杂志文章

    doi:10.1097/MD.0000000000016081

    authors: Jeon JY,Lee J,Kang MS

    更新日期:2019-06-01 00:00:00