Dexmedetomidine and Propofol Sedation in Carotid Endarterectomy Under Regional Anesthesia: What’s Better for the Patient? (Study of Patient Satisfaction)

• Published in: Vestnik intensivnoĭ terapii no. 4; pp. 36 - 41
• Main Authors: Tomaschuk, Dmitry I., Martynov, D. V., Zhenilo, V. M.
• Format: Journal Article
• Language: English
• Published: 25.12.2017
• ISSN: 1726-9806; 1818-474X
• DOI: 10.21320/1818-474X-2017-4-36-41

Introduction. Carotid endarterectomy under regional anesthesia with sedation allows to realize dynamic neurologic monitoring. The main drawback of this approach is patient’s discomfort. Thus, qualitative sedation at the operation of carotid endarterectomy in case of regional anesthesia is necessary. The use of dexmedetomidine as a basic preparation for perioperative sedation is especially interesting as it has a unique effect on the central nervous system. Material and methods. 112 patients were involved and divided into two groups: group № 1 (propofol group) and group № 2 (dexmedetomidine group) in proportion 53 vs 59. There were no differences between the groups (p = 0.36). In the group № 1 after performing regional anesthesia we started the propofol infusion (TCI) up to the target level of 1.7 mg/ml in plasma. The patents from group № 2 began to receive dexmedetomidine at the rate from 0.2 mkg/kg/h to 0.9–1 mkg/kg/h by the end of regional anesthesia. Patient’s satisfaction with anesthesia was assessed according to their answers to the questionnaire on the next day after the operation. Results. Almost two thirds of patients, 38 people (64.40 %), from group № 2 expressed their satisfaction (13–15 points) with anesthesia they received, while in the group № 1 only 11 people (20.75 %) got 13–15 points (p < 0.0001); 37 people (69.81 %) from group № 1 got 10–12 points and 19 people (32.20 %) from group № 2 (p = 0.0001). Less than 10 points (“unsatisfied”) were given by 5 (9.43 %) patients from group № 1, and 2 (3.38 %) patients from group № 2, there are no significant differences between the groups (p = 0.3). It should be mentioned that all patients who considered their presence in the operating room to be uncomfortable (3 people) had also a low sum of points (< 10), which indicates the imperfection of the offered questionnaire. Conclusion. Though the patients who received dexmedetomidine as a sedative agent, had a less deep sedation and had more memories of DNM stage, in total showed comparative satisfaction with the group receiving propofol. Moreover, there were significantly more patients completely satisfied with anesthesia in the dexmedetomidine group.