Comparison of Three Doses of Dexmedetomidine on Cardiovascular, Maternal and Neonatal Outcome in Patients Undergoing Elective Caesarean Delivery

Background: Many institutions frequently use general anaesthesia (GA) when a patient refuses neuraxial anaesthesia or when there is an urgent need for a caesarean delivery, even though central neuraxial blocking is now the preferred method.There is need to find effective drug and best dose to attenuate endocrine and haemodynamic respone of caesarean section under GA.Objective: To compare the impact of pre-operative IV administration of dexmedetomidine (0.2, 0.4, and 0.6 g/kg/h) on perioperative maternal hemodynamic, maternal and neonatal outcome.Methods: Twenty minutes before to inducing anaesthesia, the three groups (n = 30 each) were given an IV infusion of 0.1 mL/kg/h of a solution comprising 2, 4, as well as 6 g/mL of "dexmedetomidine (DEX 0.2, DEX 0.4, and DEX 0.6, respectively)".Two-thirds of the infusion rates were cut to 0.03 mL/kg/h following peritoneal closing, and this reduction was maintained until skin closure.Maternal outcome, haemodynamic parameters and neonatal outcomes were recorded.Results: There was significantly greater uterine relaxation with more need of oxytocin in lower doses of dexmedetomidine (p <0.001 and p = 0.0002 respectively).Time to extubation was significantly lower in lower doses of dexmedetomidine (p=0.0147) with better quality of intubation (p= 0.0003).MAC-sevo was significantly less in higher doses of dexmedetomidine with greater degree of sedation (p<0.0001).There was one case of PONV in DEX (0.2) group as compared to no cases in DEX (0.4) or DEX (0.6) group. Conclusion:Pre-operative administration of dexmedetomidine at dosage of 0.4 or 0.6 mcg/kg/hour is more effective with more effective uterine contraction and greater sedation level.Haemodynamic as well as endocrine reactions of caesarean section under GA was also better attenuated at these doses.