Endovascular Aortic Repair under the Monitored Anesthesia Care with Dexmedetomidine without Local Anesthesia: A Retrospective Study

Background: Dexmedetomidine has cardiac protective effect and unique sedative as well as analgesic properties while having minimal respiratory effects, making it suitable for monitored anesthesia care (MAC). We report 13 experiences of performing Endovascular aortic repair (EVAR) under MAC with dexmedetomidine. Methods: We retrospectively reviewed records of 24 patients who underwent EVAR from August 1, 2011, until April 30, 2014. 13 patients, who underwent MAC using dexmedetomidine without local anesthesia, were enrolled. Results: MAC with dexmedetomidine, remifentanil and propofol was performed in 8 patients, MAC with dexmedetomidine and remifentanil was performed in 5 patients. All patients showed the intraoperative stable hemodynamics. Their peripheral oxygen saturation was maintained above 90% and bispectral index was maintained from 80 to 40. Transient hypoxemia, hypotension, and bradycardia were occurred at an early period of MAC in 4, 3, and 4 patients, respectively, which was completely resolved by intermittent bolus injection of naloxone, phenylephrine, ephedrine, or atropine. Patients were awakened and following simple commands within about 20 minute after the end of MAC. Conclusions: This retrospective analysis demonstrates that MAC with combination technique of dexmedetomidine and remifentanil is safe and effective to provide the intraoperative stable hemodynamics and respiratory condition during the EVAR.