Intraoperative dexmedetomidine sedation reduces the postoperative agitated behavior in elderly patients undergoing orthopedic surgery compared to the propofol sedation

Hj, Shin; Bw, Koo; Bang, Seunguk; Kim, Jae‐Hun; Jw, Hwang; Sh, Do; Hs, Na

doi:10.23736/s0375-9393.17.11794-3

Cited by 20 publications

(11 citation statements)

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“…performed a retrospective cohort study that included 855 patients aged ≥ 65 y undergoing regional anaesthesia for orthopaedic surgery. Of those, 222 received dexmedetomidine and were compared with a propensity‐score‐matched sub‐group of 263 patients that received propofol sedation [37]. Dexmedetomidine was given with a starting bolus of 1 µg.kg ‐1 followed by an infusion of 0.1–0.5 µg.kg ‐1 .h ‐1 .…”

Section: Discussionmentioning

confidence: 99%

The effect of peri‐operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non‐cardiac surgical patients: a randomised, double‐blind placebo‐controlled trial

et al. 2021

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Summary Delirium occurs commonly following major non‐cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri‐operative administration of dexmedetomidine on the incidence of postoperative delirium in non‐cardiac and cardiac surgical patients. In this randomised, double‐blind placebo‐controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non‐cardiac surgery, we conclude that the peri‐operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.

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Section: Discussionmentioning

confidence: 99%

The effect of peri‐operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non‐cardiac surgical patients: a randomised, double‐blind placebo‐controlled trial

et al. 2021

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“…Previous researches have found multiple risk factors for POD, including advanced age, type of surgery, impaired cognitive status, high perioperative transfusion requirement, preoperative albumin level, and use of benzodiazepines (Bilotta et al 2013 ; Shin et al 2017 ; Steiner 2011 ). Our results showed similar related factors, including older age, higher Charlson comorbidity index, emergency surgery, and hip surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Due to its multifactorial etiology, POD is difficult to prevent or treat (Moyce et al 2014 ). Nonetheless, related study has continued to identify the related risk factors with the purpose to develop an optimal strategy for its prevention and treatment (Bitsch et al 2004 ; Shin et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

Shin

Yoon

2021

Perioper Med

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Background Delirium is an important postoperative complication. Recent research suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists may have clinical effect in the treatment and prevention of delirium. We investigated the association between 5-HT3 receptor antagonists and the occurrence of postoperative delirium (POD). Methods Retrospectively, the electronic medical records were reviewed in patients aged ≥ 65 years who underwent orthopedic lower limb surgery under regional anesthesia (spinal or combined spinal-epidural anesthesia) and administered intravenous 0.075 mg palonosetron or 0.3 mg ramosetron prior to the end of surgery between July 2012 and September 2015. POD incidence and anesthesia-, surgery-, and patient-related factors were evaluated. To investigate the association between 5-HT3 receptor antagonists and the occurrence of POD, multivariable logistic regression analysis was performed. Results Of the 855 patients included, 710 (83%) were administered 5-HT3 receptor antagonists. POD was confirmed in 46 (5.4%) patients. 5-HT3 receptor antagonists reduced the POD incidence by 63% (odds ratio [OR] 0.37; 95% confidence interval [CI], 0.15–0.94; P = 0.04). Moreover, the POD incidence decreased by 72% (OR 0.28, 95% CI 0.10–0.77, P = 0.01) when palonosetron was administered. Other identified risk factors for POD were emergency surgery, older age, hip surgery, lower body mass index, and intraoperative propofol sedation. Conclusion 5-HT3 receptor antagonists may be related with a significantly reduced risk for POD in older patients undergoing orthopedic lower limb surgery. Notably, palonosetron was more effective for POD prevention.

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“…In a previous study, the incidence of postoperative abnormal behavior after infusion of dexmedetomidine and propofol was reported as 2.3% and 6.8%, respectively. 10 To estimate the difference in incidence of postoperative delirium among the study groups, at a statistical power of 80% and a statistical significance of 5%, a total of 336 patients per group were required in the study; 748 patients were selected, estimating a dropout rate of 10%.…”

Section: Methodsmentioning

confidence: 99%

Postoperative Delirium after Dexmedetomidine versus Propofol Sedation in Healthy Older Adults Undergoing Orthopedic Lower Limb Surgery with Spinal Anesthesia: A Randomized Controlled Trial

et al. 2022

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Background Delirium is a critical postoperative complication in older patients. Based on the hypothesis that intraoperative dexmedetomidine sedation would lower postoperative delirium than propofol sedation would, the authors compared the incidence of postoperative delirium in older adults, using the mentioned sedatives. Methods This double-blinded, randomized controlled study included 748 patients, aged 65 yr or older, who were scheduled for elective lower extremity orthopedic surgery, between June 2017 and October 2021. Patients were randomized equally into two groups in a 1:1 ratio according to the intraoperative sedative used (dexmedetomidine vs. propofol). The postoperative delirium incidence was considered the primary outcome measure; it was determined using the confusion assessment method, on the first three postoperative days. The mean arterial pressure and heart rate were evaluated as secondary outcomes. Results The authors enrolled 732 patients in the intention-to-treat analyses. The delirium incidence was lower in the dexmedetomidine group than in the propofol group (11 [3.0%] vs. 24 [6.6%]; odds ratio, 0.42; 95% CI, 0.201 to 0.86; P = 0.036). During sedation, the mean arterial pressure (median [interquartile range] mmHg) was higher in the dexmedetomidine group (77 [71 to 84]) than in the propofol group (74 [69 to 79]; P < 0.001); however, it significantly fell lower (74 [68 to 80]) than that of the propofol group (80 [74 to 87]) in the postanesthesia care unit (P < 0.001). Lower heart rates (beats/min) were recorded with the use of dexmedetomidine than with propofol, both during sedation (60 [55 to 66] vs. 63 [58 to 70]) and in the postanesthesia care unit (64 [58 to 72] vs. 68 [62–77]; P < 0.001). Conclusions Dexmedetomidine showed a lower incidence of postoperative delirium than propofol in healthy older adults undergoing lower extremity orthopedic surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Intraoperative dexmedetomidine sedation reduces the postoperative agitated behavior in elderly patients undergoing orthopedic surgery compared to the propofol sedation

Cited by 20 publications

References 0 publications

The effect of peri‐operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non‐cardiac surgical patients: a randomised, double‐blind placebo‐controlled trial

The effect of peri‐operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non‐cardiac surgical patients: a randomised, double‐blind placebo‐controlled trial

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

Postoperative Delirium after Dexmedetomidine versus Propofol Sedation in Healthy Older Adults Undergoing Orthopedic Lower Limb Surgery with Spinal Anesthesia: A Randomized Controlled Trial

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