Abstract

Perioperative anxiety is common among parturients undergoing cesarean section with neuraxial anesthesia. This issue has led to alterations in hemodynamics, length of stay, opioid consumption, and postoperative pain scores. It has been demonstrated that the anxiolytic, sedative, and analgesic effects of intravenous (IV) dexmedetomidine, as opposed to midazolam, can benefit parturients who are anxious during cesarean deliveries.

A 22-year-old, gravida 2 para 1, presented for an elective repeat cesarean section. Her past medical history included gestational hypertension, GERD, and anxiety. The patient also reported that her previous cesarean section, which was performed under subarachnoid block (SAB), was uncomplicated. During SAB placement, the patient became tachycardic, tachypneic, and nauseous. Despite an adequate SAB, the patient required midazolam 2 mg and fentanyl 50 mcg IV after the delivery of the infant.

One option to mitigate anxiety is to administer the benzodiazepine, midazolam. However, this medication can cause amnesia, alter ventilation, and extend postoperative recovery. An alternative option is to administer the alpha 2 agonist, dexmedetomidine, which can provide parturients with sedation, anxiolysis, and analgesia. In several studies, researchers reported that midazolam and dexmedetomidine provided similar sedation levels. However, parturients in the dexmedetomidine group reported improved satisfaction, comfort, and pain scores. Hemodynamics were also similar in both the midazolam and dexmedetomidine groups, but some studies revealed that dexmedetomidine resulted in more episodes of maternal bradycardia. The recommended dose(s) is to administer up to 0.5 mcg/kg over 10 minutes.

In this case report, if dexmedetomidine had been administered, the parturient’s birth experience, anxiety, and pain scores may have significantly improved. Based on current research, dexmedetomidine is an appropriate and effective alternative to midazolam when caring for parturients experiencing intense anxiety during cesarean deliveries. However, before translation to practice, a protocol including inclusion criteria, maternal hemodynamics, and medication dosing must be established.

Author Details

Mary Katherine Dowdy, DNP(c), BSN; Maria Ledbetter, DNAP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Dexmedetomidine, Cesarean Delivery, Anxiety, Perioperative Anxiety

Advisor

Terri Cahoon

Second Advisor

Maria Ledbetter

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-01-28

Full Text of Presentation

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Abstract.pdf (179 kB)

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