Dexmedetomidine premedication increases preoperative sedation and inhibits stress induced by tracheal intubation

1. The use of oral dexmedetomidine as premedication prior to neurosurgery increased preoperative sedation and reduced the stress reaction induced by tracheal intubation under general anesthesia. 

Evidence Rating Level: 1 (Excellent) 

Preoperative anxiety can significantly impact an individual’s experience prior to surgery and cause many physical manifestations such as increased incidence of nausea, vomiting, and postoperative pain. There is evidence that suggests that premedication for peri-operative anxiety improves quality of anesthesia and surgical recovery. There are medications such as opioids or benzodiazepines that are routinely used; however, there is minimal clinical evidence supporting the use of routine sedative premedication in general anesthesia. Dexmedetomidine (DEX) is a highly selective alpha-2 agonist receptor with sedative, anxiolytic, and analgesic features but not much about this medication is known in the context of surgery pre-medication. In this prospective randomized clinical study, 115 patients scheduled for elective neurosurgery were randomized to either the control group or the oral DEX premedication group. In the intervention group, DEX was administered orally two hours prior to general anesthesia induction. After induction and confirming muscle relaxation, tracheal intubation was performed with video laryngoscope. The primary outcome of this study was differences in patient sedation which was assessed using the Richmond Agitation-Sedation Scale (RASS) score, measured prior to DEX administration and one hour after. Secondary outcomes included stress response induced by tracheal intubation and family member satisfaction. The results of this study showed that DEX administration significantly increased the level of patient sedation compared to the placebo group (RASS score -0.90 in DEX and 1.12 in control, P < 0.05). Additionally, the DEX premedication group had reductions in blood cortisol levels compared to the control group during tracheal intubation, suggesting lower stress levels in this group. However, the quantity of anesthetics used between both groups was similar. In conclusion, this study confirms that the use of oral DEX as premedication prior to surgery is an efficient intervention in increasing preoperative sedation and reducing stress during tracheal intubation. It is important to note several limitations in this study. Firstly, anxiety levels of the participants were not adequately assessed pre- and post-surgery, which may bias these results. As well, this methodology was conducted only in the context of neurosurgery and these findings cannot be generalized to other types of surgeries. Nevertheless, future multicenter trials investigating the use of DEX perioperatively can be very beneficial in improving post-surgery outcomes.  

Click to read the study in BMC Anesthesiology

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