Maternal hemodynamic effects associated with intravenous and neuraxial dexmedetomidine during labor and cesarean delivery: a single center retrospective study (2021-2024).

BACKGROUND

Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events

METHODS

We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022-2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.

RESULTS

There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.

CONCLUSIONS

Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.