Abstract
Purpose
Anesthetic management of tension-free vaginal-tape (TVT) procedures is sometimes difficult to deal with, especially when surgeons request a cough test. Dexmedetomidine has unique sedative and analgesic properties while having minimal respiratory effects, making it suitable for perioperative use in monitored anesthesia care. We aimed to compare dexmedetomidine and epidural anesthesia in TVT patients.
Methods
Forty-nine women [American Society of Anesthesiologists (ASA 1–3)] with genuine stress incontinence confirmed by preoperative bladder function studies were included in this double-blind, randomized study. The patients were randomly assigned to one of two groups: group D received 0.5 μg/kg dexmedetomidine IV applied as bolus over 10 min and continued with 0.5 μg/kg/h infusion, and local anesthesia (lidocaine 2% with epinephrine) performed by the surgeon. Group E received epidural anesthesia with 15 ml of 0.25% bupivacaine + 100 μg fentanyl. Patients were monitored every 5 min for mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, respiratory rate, sedation, and intraoperative and postoperative pain. Ability to cough was also evaluated by the surgeon.
Results
There was no difference in ability to cough, and this was evaluated by the surgeon as adequate, and there was no difference in scores between groups. Significant decreases in MAP and HR were observed 10 min after the start of surgery in group D compared with group E, and they were significantly decreased until first and second postoperative hours, respectively (p < 0.05). None of the patients had respiratory rate decrease or apnea. Side effects encountered postoperatively were similar.
Conclusion
Dexmedetomidine can be an alternative to epidural anesthesia in TVT procedure requiring cough test.
Similar content being viewed by others
References
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol. 2000;53:1150–7.
Kilonzo M, Vale L, Stearns SC, Grant A, Cody J, Glazener CM, Wallace S, McCormack K. Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence. Int J Technol Assess Health Care. 2004;20:455–63.
Ulmsten U, Petros P. Intravaginal sling-plasty (IVS). An ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol. 1995;29:75–82.
Adamiak A, Milart P, Skorupski P, Kuchnicka K, Nestorowicz A, Jakowicki J, Rechberger T. The efficacy and safety of the tension-free vaginal tape procedure do not depend on the method of analgesia. Eur Urol. 2002;42:29–33.
Ohkawa A, Kondo A, Takei M, Momokazu G, Ozawa H, Kato K, Ohashi T, Nakata M, Tension-Free Vaginal Tape Trial Group. Tension-free vaginal tape surgery for stress urinary incontinence: a prospective multicentered study in Japan. Int J Urol. 2006;13:738–42.
Winton AL, Eastwood J, Powell MC, Norris AM. An evaluation of conscious sedation using propofol and remifentanil for tension-free vaginal tape insertion. Anaesthesia. 2008;63:932–7.
Szumita PM, Baroletti SA, Anger KE, Wechsler ME. Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine. Am J Health Syst Pharm. 2007;64:37–44.
Kamibayashi T, Maze M. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000;93:1345–9.
Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263–8.
Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for the surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(Suppl. 2):S5–8.
Klutke JJ, Carlin BI, Klutke CG. The tension-free vaginal tape procedure: correction of stress incontinence with minimal alteration in proximal urethra. Urology. 2000;55:512–4.
Liapis A, Bakas P, Creatsas G. Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1197–200.
Jaakola M-L, Salonen M, Lehtinen R, Scheininet H. The analgesic action of dexmedetomidine—a novel α2-adrenoceptor agonist—in healthy volunteers. Pain. 1991;46:281–5.
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol. 2008;21:457–61.
Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. Anesthesiology. 1992;77:1125–33.
Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H, Viinamäki O, Scheinin H. Effects of dexmedetomidine, a selective alpha2-adrenorecptor agonist on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989;46:33–42.
Pandharipane P, Ely EW, Maze M. Dexmedetomidine for sedation and perioperative management of critically ill patients. Semin Anesth Periop Med Pain. 2006;25:43–50.
Duckett JR, Papanikolaou NS, Eaton M. The effect of local anaesthetic infiltration on urethral function during the tension-free vaginal tape (TVT) procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:839–41.
Duckett RA, Grapsas P, Eaton M, Basu M. The effect of spinal anaesthesia on urethral function. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:257–60.
Acknowledgments
Supported by institutional and departmental sources at the Gülhane Military Medical Academy, Haydarpaşa Training Hospital Üsküdar, Istanbul, Turkey. None of the authors has a personal financial interest in this research.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Turan, A., Şen, H., Sızlan, A. et al. Dexmedetomidine: an alternative for epidural anesthesia in tension-free vaginal-tape surgery. J Anesth 25, 386–391 (2011). https://doi.org/10.1007/s00540-011-1113-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-011-1113-8