Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery

Abstract

ImportancePosttraumatic stress disorder (PTSD) is common in people who have experienced trauma, especially those hospitalized for surgery. Dexmedetomidine may reduce or reverse the early consolidation and formation of conditioned fear memory and prevent the occurrence of postoperative PTSD.ObjectiveTo evaluate the effects of intraoperative and postoperative low-dose intravenous pumping dexmedetomidine on PTSD among patients with trauma undergoing emergency surgery.Design, Setting, and ParticipantsThis double-blind, randomized clinical trial was conducted from January 22 to October 20, 2022, with follow-up 1 month postoperatively, in patients with trauma undergoing emergency surgery at 4 hospital centers in Jiangsu Province, China. A total of 477 participants were screened. The observers were blinded to patient groupings, particularly for subjective measurements.InterventionsDexmedetomidine or placebo (normal saline) was administered at a maintenance dose of 0.1 μg/kg hourly from the start of anesthesia until the end of surgery and at the same rate after surgery from 9 pm to 7 am on days 1 to 3.Main Outcomes and MeasuresThe primary outcome was the difference in the incidence of PTSD 1 month after surgery in the 2 groups. This outcome was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (CAPS-5). The secondary outcomes were the pain score within 48 hours and 1 month postoperatively; incidence of postoperative delirium, nausea, and pruritus; subjective sleep quality; anxiety; and occurrence of adverse events.ResultsA total of 310 patients (154 in the normal saline group and 156 in the dexmedetomidine group) were included in the modified intention-to-treat analysis (mean [SD] age, 40.2 [10.3] years; 179 men [57.7%]). The incidence of PTSD was significantly lower in the dexmedetomidine group than in the control group 1 month postoperatively (14.1% vs 24.0%; P = .03). The participants in the dexmedetomidine group had a significantly lower CAPS-5 score than those in the control group (17.3 [5.3] vs 18.9 [6.6]; mean difference, 1.65; 95% CI, 0.31-2.99; P = .02). After adjusting for potential confounders, the patients in the dexmedetomidine group were less likely to develop PTSD than those in the control group 1 month postoperatively (adjusted odds ratio, 0.51; 95% CI, 0.27-0.94; P = .03).Conclusions and RelevanceIn this randomized clinical trial, the administration of intraoperative and postoperative dexmedetomidine reduced the incidence of PTSD among patients with trauma. The findings of this trial support the use of dexmedetomidine in emergency trauma surgery.Trial RegistrationChinese Clinical Trial Register Identifier: ChiCTR2200056162

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“…Intensive Care Unit (ICU)-acquired delirium is a severe complication of critical illness characterized by acute brain dysfunction, including inattention, disturbance of consciousness, and changes in cognitive function ( 8 ). To detect and prevent delirium in a timely manner, the Richmond Agitation-Sedation Scale (RASS) and Cornell Assessment of Pediatric Delirium (CAPD) were administered to the patient every 12 hours ( 9 - 11 ). Several studies have indicated that delirium can be caused by various medications, although the exact reasons remain unclear ( 9 - 11 ).…”

“…To detect and prevent delirium in a timely manner, the Richmond Agitation-Sedation Scale (RASS) and Cornell Assessment of Pediatric Delirium (CAPD) were administered to the patient every 12 hours ( 9 - 11 ). Several studies have indicated that delirium can be caused by various medications, although the exact reasons remain unclear ( 9 - 11 ). Delirium can lead to adverse effects such as increased mortality, prolonged hospital stay, and negative impacts on growth and development ( 12 , 13 ).…”