Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position
10.3344/kjp.2014.27.4.313
- Author:
Kyung Hoon KIM
1
Author Information
1. Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea. pain@pusan.ac.kr
- Publication Type:Review
- Keywords:
adrenergic alpha-2 receptor agonists;
conscious sedation;
dexmedetomidine;
minimally invasive surgical procedures;
percutaneous discectomy
- MeSH:
Adrenergic alpha-2 Receptor Agonists;
Analgesia;
Analgesics;
Analgesics, Opioid;
Anesthesia, General;
Anxiety;
Conscious Sedation;
Dexmedetomidine;
Diskectomy;
Diskectomy, Percutaneous;
Eye Movements;
Fires;
Humans;
Hypnosis;
Hypnotics and Sedatives;
Hypothalamus, Anterior;
Ketamine;
Ketorolac;
Locus Coeruleus;
Midazolam;
Pons;
Prone Position;
Propofol;
Respiratory Insufficiency;
Spine;
Surgical Procedures, Minimally Invasive
- From:The Korean Journal of Pain
2014;27(4):313-320
- CountryRepublic of Korea
- Language:English
-
Abstract:
Dexmedetomidine, an imidazoline compound, is a highly selective alpha2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an alpha2-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.
