Intravenous dexmedetomidine for cesarean delivery and its concentration in colostrum. (November 2017)

• Record Type: Journal Article
• Authors: Yoshimura, M.; Kunisawa, T.; Suno, M.; Sugawara, A.; Kurosawa, A.; Nakanishi, R.; Aoki, K.; Toriumi, T.
• Is Part Of: International journal of obstetric anesthesia. Volume 32(2017)
• Page Start: 28
• Page End: 32
• Publication Date: 2017-11
• Subjects: Dexmedetomidine -- Colostrum -- Milk-to-plasma ratio -- Relative infant dose; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2017.05.002
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Dexmedetomidine sedation during cesarean delivery under regional anesthesia. Dexmedetomidine concentration measured in blood and colostrum. Milk-to-plasma ratio did not exceed 1 in any case. Relative infant dose was very low. Dexmedetomidine was undetectable in colostrum at 24 hours Abstract: Background: Dexmedetomidine is a sedative agent with high α2 -adrenoreceptor selectivity. We investigated intravenous dexmedetomidine administration during scheduled cesarean delivery under neuraxial anesthesia; and its concentration in the colostrum. Methods: Twenty-seven participants having elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. After delivery and cord clamping, 6 μg/kg/h of intravenous dexmedetomidine was administered for 10 minutes, followed by a dose of 0.7 μg/kg/h until peritoneal closure. Sedation, vital signs and side effects were recorded. Blood and colostrum samples were collected from each participant at 6, 12, and 24 h after dexmedetomidine administration. Samples were analysed using liquid chromatography tandem-mass spectroscopy. Results: Colostrum samples were collected from 10 patients. The median [95% CI] plasma dexmedetomidine concentration was 333 [303–534] pg/ml at 0 h and 19.7 [13.5–25.8] pg/ml at 6 h. The colostrum concentration was 12.3 [8.1–20.1] pg/ml at 6 h. The dexmedetomidine completely disappeared from both within 24 h. The calculated milk-to-plasma ratio at 6 h was 0.76 [0.57–0.86]. The relative infant dose was 0.034% [0.020–0.062%]. At dexmedetomidine discontinuation, the Richmond Agitation–Sedation Scale score was −2 (range, −4 to −1). During surgery, no patients complained of nausea, peritoneal irritation or afterbirth pain. Conclusions: The dexmedetomidine milk-to-plasma ratio did not exceed 1 in any participant, and the relative infant dose was very low. Maternal sedation using dexmedetomidine is unlikely to be harmful for the infant.