Paradoxical Excitement Response During Sedation Between Dexmedetomidine and Propofol in Hazardous Alcohol Drinker (DEX)

Paradoxical Excitement Response During Sedation Between Dexmedetomidine and Propofol in Hazardous Alcohol Drinker

Comparative Study on Development of Paradoxical Excitement Response During Sedation Using Dexmedetomidine or Propofol in Hazardous Alcohol Drinkers

Adequate sedation with classical sedative agents, propofol Sedation with propofol may induce paradoxical excitement response in heavy alcohol drinkers Dexmedetomidine, α2 receptor agonist, may provide adequate sedation in heavy alcohol drinkers

Adequate sedation during surgery provide anxiolysis and comfort to patient. Insufficient sedation can't provide comfort to patient during surgery, otherwise excessive sedation can cause variable complications like respiratory depression or delayed awakening. Dexmedetomidine is a centrally acting α2 receptor agonist that is increasingly being used as a sedative for MAC and intensive care with mechanical ventilated patients because of its analgesic properties, "cooperative sedation," and lack of respiratory depression. Because of the different site of action between dexmedetomidine and propofol, we assumed that paradoxical excitement responses which appeared in heavy alcohol drinkers in midazolam or propofol-induced sedation might be less observed in dexmedetomidine-induced sedation.

Anesthesia, Spinal, Sedation, Conscious, Dexmedetomidine, Alcohol Drinking, Anesthesia, Epidural, Propofol

dexmedetomidine, 200mcg in 50mL of normal saline 0.75mcg/Kg bolus injection in 10 minutes 0.1~1.0mcg/Kg infusion during surgery

dexmedetomidine, 200mcg in 50mL of normal saline 0.75mcg/Kg bolus injection in 10 minutes 0.1~1.0mcg/Kg infusion during surgery

Paradoxical excitement responses (verbal/movement) 0, none : no excitement response mild : increased talkativeness, irrational talking / brief spontaneous movement with position remaining moderate : restlessness, loss of cooperation, spontaneous movements requiring repositioning with no need of restraint severe : agitation and spontaneous movements with a need to restrain the patient

Observer''s Assessment of Alertness/Sedation Scale (OAA/S) :Does not respond to mild prodding or shaking :Responds only after mild prodding or shaking :Responds only after name is spoken loudly and/or repeatedly :Lethargic response to name spoken in normal tone :Responds readily to name spoken in normal tone Goal to sedation : 3

Inclusion Criteria: 19~65 yr-old patients who is scheduled to undergo knee surgery with regional anesthesia Exclusion Criteria: History of taking anxiolytics, hypnotics, antiepileptic drugs Abnormal liver function test (eg: Liver cirrhosis, elevated liver enzymes) History of allergic reaction with dexmedetomidine or propofol Contraindication with regional anesthesia American society of anesthesiologist Physical status III or IV

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