Dexmedetomidine as a Sedative in the Awake Implantation of a Neuromodulative System

Objective: During implantation of a neuromodulative system, high patient satisfaction is closely associated with the equilibrium between an effective analgesia and sedation regimen, and the possibility for the patient to be awake and cooperative during procedure. This study assessed the efficacy of the sedative dexmedetomidine to achieve this balance, with patient satisfaction as the primary outcome. Methods: Ten patients undergoing implantation of a dorsal column and dorsal root ganglion stimulator received dexmedetomidine (1 mcg/kg over 10 minutes, followed by 0.6 mcg/kg/hour) in combination with remifentanil at a set dose (3 mcg/kg/hour). Sedation was titrated to a Ramsay Sedation Score of 3. Recorded were as follows: patient satisfaction score, patient comfort score, operator comfort score, pain score, rescue medication and number of adjustments of dexmedetomidine intra-operatively, as well as sedation level, hemodynamic (blood pressure and heart rate), and respiratory characteristics (SpO2). Results: Scores were high on patient satisfaction (median 8.5; IQR 2.0), patient comfort (3.0; IQR 1.25), and operator comfort (4.0; IQR 1.0). In all patients, intra-operative heart rate and mean arterial pressure were lower compared with baseline values. No respiratory depression or other complications related to anesthesia were reported. Moments of incident pain were effectively treated in 6 patients requiring an extra bolus of remifentanil. Conclusion: In this study group, dexmedetomidine combined with remifentanil provided a high level of patient satisfaction and comfort, as well as operator comfort, without any clinically relevant adverse events. All patients were highly cooperative and instructable; incident pain needs to be closely monitored.

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