Effect of Atropine or Glycopyrrolate on the Prevention of Bradycardia During Sedation Using Dexmedetomidine in Adult Patients Undergoing Lower Extremity Surgery Under Spinal Anesthesia
Study Details
Study Description
Brief Summary
Patients undergoing lower extremity surgery with spinal anesthesia are often sedated to reduce patient discomfort due to large noises during surgery and also to reduce anxiety. Most commonly used sedatives include propofol and midazolam, but these agents are known to often cause hypotension or respiratory depression. Dexmedetomidine is a selective alpha 2 adrenergic drug, which acts as a sedative and also has analgesia effects. In contrast to propofol or midazolam, dexmedetomidine rarely causes respiratory depression, and therefore is often used in critically ill patients in the ICU and also in patients undergoing simple procedures. Hemodynamically, dexmedetomidine evokes a biphasic blood pressure response with a short hypertensive phase and subsequent hypotension. Bradycardia is also observed in many patients, which may lead to more serious outcomes when progressing to sinus pause or shock. Therefore, drugs to prevent bradycardia during dexmedetomidine infusion may help patients maintain a more stable hemodynamic state. The present study aims to compare the ability of atropine and glycopyrrolate to prevent bradycardia during dexmedetomidine infusion in patients undergoing lower extremity orthopedic surgery with spinal anesthesia.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Atropine group Patients that receive atropine 0.01 mg/kg (max 0.5mg) before spinal anesthesia |
Drug: Atropine
Atropine injection (0.01 mg/kg, max 0.5 mg) 3 minutes before spinal anesthesia
|
Active Comparator: Glycopyrrolate group Patients that receive glycopyrrolate 0.004mg/kg (max 0.2 mg) before spinal anesthesia |
Drug: Glycopyrrolate
Glycopyrrolate (0.00 4mg/kg, max 0.2 mg) 3 minutes before spinal anesthesia
|
Outcome Measures
Primary Outcome Measures
- Pulse rate [From 5 minutes before spinal anesthesia~end of surgery (Intraoperatively)]
measured as beats per minute, heart rate below 60 bpm or decrease of more than 30% from baseline is defined as bradycardia.
- blood pressure [From 5 minutes before spinal anesthesia~end of surgery (Intraoperatively)]
measured as mmHg, mean blood pressure lower than 60 mmHg or decrease of more than 30% from baseline is defined as hypotension.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients 65 years or older undergoing total knee replacement surgery under spinal anesthesia.
-
ASA class 1-3
Exclusion Criteria:
-
Patients with coagulation abnormalities
-
End organ diseases of liver, lung or kidney
-
Severe aortic stenosis
-
High degree AV block
-
Heart failure
-
Patients on MAO inhibitors
-
History of seizures or epilepsy
-
Glaucoma
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine | Seoul | Korea, Republic of | 03722 |
Sponsors and Collaborators
- Yonsei University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 4-2013-0763