A contemporary approach to sedation during regional anaesthesia in gynaecology
Resume. Safe and adequate sedation during regional anesthesia is one of the issues at the current time. According to the basic principles of modern anesthesiology, safe and effective sedation should protect the patient’s psychoemotional sphere, provide absence of awareness, pain and fear during surgery as well as nausea and vomiting in the postoperative period. At the same time, it should neither cause respiratory depression and haemodynamics changes, nor be accompanied by a slow recovery of psychomotor function.
After studying modern literature and analyzing our own observations, we reached the point that sedation with dexmedetomidine rather than propofol is more preferred during regional anaesthesia. Sedation with dexmedetomidine decreases frequency of cognitive impairment in the early postoperative period, intensity of the pain syndrome, and has beneficial effect on recovery and activation after surgery. Additionally, it is associated with lower risk of hypoxemia and arterial hypotension during surgery.
Key words: sedation, regional anesthesia, dexmedetomidine.
Grizhimalsky Ye. V., Garga A. I., maternity hospital “Leleka”, Kyiv.
- Svetlov VA, Zaytsev AYu, Kozlov SP. Balanced anesthesia based on regional blockades: strategy and tactics [Sbalan-sirovannaya anesteziya na osnove regionarnykh blokad: strategiya i taktika]. Anesteziologiya i reanimatologiya. 2006;4:4–33. [In Russian]
- Precedex (dexmedetomidine). Hospira, Inc., Lake Forest, IL 60045 USA. Available from: http://medlibrary.org/lib/rx/meds/precedex/page/1–7/
- Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored Anesthesia Care with Dexmedetomidine: A Prospective, Randomized, Double-Blind, Multicenter Trial. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2010 Jan;110(1):47–56. Available from: https://doi.org/10.1213/ane.0b013e3181ae08564.
- Bergese SD, Candiotti KA, Bokesch PM, Zura A, Wiseman-dle W, Bekker AY. A Phase IIIb, Randomized, Double-blind, Placebo-controlled, Multicenter Study Evaluating the Safety and Efficacy of Dexmedetomidine for Sedation During Awake Fiberoptic Intubation. American Journal of Ther-apeutics [Internet]. Ovid Technologies (Wolters Kluwer Health); 2010 Nov;17(6):586–95. Available from: https://doi.org/10.1097/mjt.0b013e3181d690725.
- Wu W, Chen Q, Zhang L, Chen W. Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endosco-py. Journal of International Medical Research [Internet]. SAGE Publications; 2014 Feb 10;42(2):516–22. Available from: https://doi.org/10.1177/03000605135154376.
- Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The Effects of Increasing Plasma Concentrations of Dexmede-tomidine in Humans. Anesthesiology [Internet]. Ovid Tech-nologies (Wolters Kluwer Health); 2000 Aug;93(2):382–94. Available from: https://doi.org/10.1097/00000542–200008000–000167.
- Krasenkova EA, Ovechkin AY, Pyregov AV. Influence of anesthetic techniques on occurrence of postoperative cognitive dysfunction in elderly patients undergoing gyne-cological surgery. Bulletin of Russian State Medical Univer-sity [Internet]. Pirogov Russian National Research Medical University; 2016;(4):51–5. Available from: https://doi.org/10.24075/brsmu.2016–04–088.
- Karelov АE, Lebedinskiy KM, Buravtsov VI. Anesthetic, analgetic, hypnotic – are the definitions important?. Anes-teziologii I Reanimatologii, 2015;12(5):3–11. [In Russian]
- Kulikov АS, Lubnin АYu. Dexmedetomidine: new oppor-tunities in the anesthesiology. Anesteziologiya i Reanima-tologiya. 2013;(1):37–41. [In Russian]