EFFECT OF SEDATION WITH INTRAVENOUS INFUSION OF DEXMEDETOMIDINE AND FENTANYL DURING SURGERIES DONE UNDER REGIONAL ANAESTHESIA IN PAEDIATRIC PATIENTS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 22
Abstract
BACKGROUND In adults, extraperitoneal lower abdominal and lower limb procedures are performed under epidural or spinal anaesthesia without supplemental general anaesthesia. However, similar procedures in paediatric population to be performed under regional anaesthesia require additional sedation, analgesia to immobilise the child during institution of the regional anaesthetic technique and continued sedation during the surgical procedure to ensure cooperation of the child. Aims and Objectives- To evaluate the efficacy and safety of a combination of intravenous infusion of dexmedetomidine and fentanyl for sedation during surgeries done under regional anaesthesia in children. MATERIALS AND METHODS 22 children, ranging in age from 2 to 12 years of both sexes posted for lower limb deformity correction, lower abdominal, extraperitoneal and hypospadias repair were selected continuously for this study. Sample size since there were no previous similar studies, we selected continuously all patients who met the eligibility criteria during the study period. Pharmacological Interventions: Intravenous access was secured and the loading dose of intravenous Dexmedetomidine and Fentanyl, both at the rate of 1 ug/kg /hr was infused over 10 minutes using a syringe pump. At the end of 10 minutes, a maintenance dose of 1 ug/kg of the same was continued. Lumbar epidural catheter was inserted using 19-G epidural Tuohy needle (PORTEX) and 0.5% Bupivacaine 0.5 mL/kg up to a maximum dose of 2.5 mg/kg was deposited and the catheter was secured. Surgical procedure was conducted with the child breathing spontaneously with supplementation of oxygen 3 L/minute through a face mask. Inj. Propofol 1mg/kg was used as rescue sedation. The perioperative monitoring to evaluate the efficacy of sedation under the study regimen and need to opt for rescue sedation included ECG, Heart rate, NIBP, SPO2, EtCO2, the Respiratory rate, level of sedation and time to achieve Ramsay score of 2 in recovery room. Design- Descriptive. Setting- 250 bedded paediatric referral hospital offering tertiary care to South Asian population. RESULTS Effective sedation in all 22 patients was achieved intraoperatively with intravenous infusion of Fentanyl 1 ug/kg/hour and Dexmedetomidine 1 ug/kg/hour combined with epidural block with Bupivacaine 0.5%. Primary outcome measured was the need for rescue sedation which was required in 3 out of 22 cases, i.e. 13.6%. The vital parameters were as follows. The maximum change in mean heart rate from baseline was during the intraoperative period (P4), being 28.4 ± 28.7 (p < 0.001). The lowest recorded value was 58/m. Blood pressure changes showed a maximum mean change from baseline seen in both the systolic as well as diastolic pressures at the end of 10 minutes of bolus and was -7.7 ± 18 and -7.8 ± 16 mmHg. No patient’s respiratory rate decreased to less than 12 breaths/min or increased above 28 breaths/min during the procedural sedation. The highest EtCO2 was 30 mmHg. Oxygen saturation remained between 97 to 100% during the study in all patients. The mean recovery time taken as a return to Ramsay sedation score of 2 or 3 was 15 minutes. Varying RR interval was seen in 3 cases (13.6%). CONCLUSION A combination of fentanyl and dexmedetomidine infusion provides effective sedation during cases done under regional anaesthesia in infants and children with limited effects on cardiovascular and ventilatory function.
Authors and Affiliations
Nishtala Madhavi, Bhargavi Sanket
Keywords
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- EP ID EP433340
- DOI 10.14260/jemds/2018/600
- Views 92
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