Association of intraoperative dexmedetomidine use with postoperative hypotension in unilateral hip and knee arthroplasties: a historical cohort study

Yang, Stephen Su; Gelinas, Charles; Yim, Edmund; Li, Mandy M. J.; Kardash, Kenneth J.; Zhang, Michelle; Lipes, Jed

doi:10.1007/s12630-022-02339-5

Cited by 12 publications

(8 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, most patients (92%) received dexmedetomidine. Given the hypotensive effect of this agent, 16,[42][43][44] this might have indirectly influenced the amount of fluid received by patients. However, this was unlikely to change the association between allogenic transfusion and fluid intake, given that almost all patients received this agent.…”

Section: Discussionmentioning

confidence: 99%

The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

Pardessus,

Loiselle,

Silins

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

IntroductionBleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis.MethodsThis prospective study included all cases of adolescent idiopathic scoliosis operated in a single center during 2 years (2018–2020). Predictors analyzed were as follows: body mass index, preoperative hemoglobin concentration, thoracoplasty, preoperative halo‐gravity, volume of intraoperative crystalloid administration, use of esophageal Doppler (for goal‐directed fluid therapy), and duration of surgery. Statistical analyses were performed using a multivariable logistic regression model.ResultsTwo hundred patients were included in the analysis. Multivariable analysis found: an increased volume of intraoperative crystalloid administration as a significant predictor of allogenic blood transfusion. Receiving operator characteristics analysis found the model exhibiting an area under the curve of 0.85 (95% confidence interval: 0.75–0.95). Optimizing stroke volume using esophageal Doppler was associated with a decrease in intraoperative crystalloid intake.ConclusionThese results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion.

show abstract

Section: Discussionmentioning

confidence: 99%

The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

Pardessus,

Loiselle,

Silins

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…83 Of note, available trials comparing dexmedetomidine sedation compared to propofol have focused on samples of relatively healthy older adults; additional research is needed to characterize outcomes of these regimens in populations at high risk for delirium, such as persons with dementia, and to assess the cardiovascular effects of propofol versus dexmedetomidine. 84…”

Section: Intravenous Sedationmentioning

confidence: 99%

Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

2023

View full text Add to dashboard Cite

Comparative effectiveness research aims to understand the benefits and harms of different treatments to assist patients and clinicians in making better decisions. Within anesthesia practice, comparing outcomes of spinal versus general anesthesia in older adults represents an important focus of comparative effectiveness research. The authors review methodologic issues involved in studying this topic and summarize available evidence from randomized studies in patients undergoing hip fracture surgery, elective knee and hip arthroplasty, and vascular surgery. Across contexts, randomized trials show that spinal and general anesthesia are likely to be equivalent in terms of safety and acceptability for most patients without contraindications. Choices between spinal and general anesthesia represent “preference-sensitive” care in which decisions should be guided by patients’ preferences and values, informed by best available evidence.

show abstract

“…If DM is used in the periarticular block, the sedating effects can improve sleep at night, a common problem after hip or knee replacements. Additional benefits include: reduced opioid usage, prolonged neuraxial analgesia, decreased postoperative delirium and reduced postoperative nausea [ 14 ]. In addition to the sedative effects described above, it also has anxiolytic, analgesic, anesthetic-sparing and sympatholytic effects [ 3 ].…”

Section: Dexmedetomidine (Presedex)mentioning

confidence: 99%

Periarticular infiltration used in total joint replacements: an update and review article

King,

Le,

Nickol

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

Periarticular infiltration following total knee and hip arthroplasty has been demonstrated to be equivalent to peripheral nerve blocks for postoperative pain management. The ideal cocktail has not been established yet. We have conducted a literature search on PubMed and Embase. Our search criteria included randomized controlled trials (RCTs) and systematic reviews (SRs). We tried to only include the most recent studies to keep the information current. The included research focused at Dexmedetomidine, Liposomal Bupivacaine, Ropivacaine, Epinephrine, Ketorolac, Morphine, Ketamine and Glucocorticosteroids. Each medication’s mode of action, duration, ideal dosage, contraindications, side effects and effectiveness have been summarized in the review article. This article will help the clinician to make an informed evidence-based decision about which medications to include in their ideal cocktail.

show abstract

Association of intraoperative dexmedetomidine use with postoperative hypotension in unilateral hip and knee arthroplasties: a historical cohort study

Cited by 12 publications

References 37 publications

The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

Periarticular infiltration used in total joint replacements: an update and review article

Contact Info

Product

Resources

About