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Fluid loading during spinal anesthesia can reduce bradycardia after intravenous dexmedetomidine infusion
Anesth Pain Med 2019;14(1):19-28
Published online January 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Wonjin Lee1,2 , Yongjae Han1 , Se Hun Lim1 , Sung-ho Moon1 , Kwangrae Cho1 , and Myoung-hun Kim1
1Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, 2Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea
Correspondence to: Se Hun Lim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6520 Fax: 82-51-898-4216 E-mail: anespc@naver.com ORCID https://orcid.org/0000-0001-8450-0595
Received May 16, 2018; Revised August 17, 2018; Accepted August 23, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Dexmedetomidine has been widely used during spinal anesthesia to provide sedation. However, dexmedetomidine frequently causes significant bradycardia. This study was designed to evaluate whether fluid loading could reduce the incidence of bradycardia after intravenous dexmedetomidine infusion in patients under spinal anesthesia.
Methods: A total of 99 patients, 18 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, who were scheduled for elective total knee replacement or internal fixation of lower leg fracture under spinal anesthesia were enrolled. The patients were randomly assigned into one of the three groups, and fluid was loaded as follows: group LOW - 4 ml/kg, group MID - 8 ml/kg, and group HI - 12 ml/kg. After fluid loading and spinal anesthesia, dexmedetomidine was infused as follows: 1 μg/kg of loading dose for 10 minutes, thereafter continuous infusion at 0.4 μg/kg/h.
Results: The heart rate of group HI was significantly higher than that of group LOW (P = 0.049). The dosage of atropine administration was significantly lower in group HI than in group LOW (P = 0.003). The change in thoracic fluid contents was significantly higher in group HI than in group LOW (P = 0.018).
Conclusions: Fluid loading during spinal anesthesia can reduce the incidence and extent of bradycardia after intravenous dexmedetomidine infusion.
Key Words : Bradycardia; Dexmedetomidine; Fluid therapy; Heart rate; Spinal anesthesia.


January 2019, 14 (1)
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