Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

Abstract

Objective The aim of this study was to report preliminary data on the use of intranasal dexmedetomidine to treat postoperative restlessness, agitation, and pain in 23 patients aged > 70 years and undergoing orthopedic surgery. Background Postoperative agitation and delirium are common among older adult patients undergoing orthopedic surgery. Most preparations used to treat agitation and delirium carry a risk for adverse events such as respiratory failure. Moreover, mere opioid therapy may be insufficient in treatment of pain. Dexmedetomidine, an α2-adrenoreceptor agonist with sedative and analgesic properties, has been shown to reduce opioid requirement and reduce postoperative delirium in older adults. Methods We studied the use of post-operative intranasal dexmedetomidine in a retrospective study cohort of geriatric patients undergoing orthopedic surgery. Primary outcomes included alterations in heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2), Modified Richmond Agitation and Sedation Score (mRASS), and opioid consumption following dexmedetomidine administration. Results We identified 23 patients with a mean (SD) age of 79.9 (7.5) years who received dexmedetomidine 100 µg intranasally postoperatively. After dexmedetomidine administration, HR decreased by 10.4 (3.7) beats/min (95% CI 2.9-17.8; p = 0.004) and MAP by 16.2 (4.4) mmHg (95% CI 7.3-25.1; p < 0.001). HR decrease was significant at 2 h and MAP decrease at 1, 2, and 3 h following dexmedetomidine administration. Dexmedetomidine administration was associated with significant reductions in opioid consumption (p < 0.001) and mRASS score (p < 0.001). SpO 2 and RR remained unchanged. Conclusions These preliminary findings suggest that intranasal dexmedetomidine reduces opioid consumption without causing respiratory depression and may be used to treat postoperative restlessness, agitation, and pain in geriatric patients. However, hemodynamic effects of dexmedetomidine may require close observation for 3 hours following administration in older adult patients.

Intraoperative dexmedetomidine on postoperative pain in gastrointestinal surgery: an observational study

“…Perioperative anxiety and helplessness are common in patients who undergo surgery and are related to negative behavioral manifestations and postoperative pain 33 . DEX can reduce postoperative anxiety and relieve postoperative restlessness, agitation, and pain in adult and pediatric patients 34 – 36 . However, Corbett et al .…”

Pharmacokinetic and Pharmacodynamic Changes in the Elderly

“…Recent literature suggests that using perioperative dexmedetomidine might also reduce postoperative delirium, a complication that is common in the elderly and associated with significant morbidity. [83][84][85] When used for procedural sedation in elderly patients, it has been shown to be associated with fewer periprocedural complications, such as hypotension and respiratory adverse events, and improved sedation quality, when compared with propofol, remifentanil, or benzodiazepines. [86][87][88] Elderly patients seem to be more sensitive than younger patients to the sedative effects, and hypotension occurred more frequently when a loading dose of 0.7 mg/kg or greater were administered.…”

Sublingual Dexmedetomidine as a Potential New Treatment for Agitation

“…Although IV dexmedetomidine is the only formulation approved by the FDA, the results of the current study by Preskorn et al and of prior studies demonstrate that dexmedetomidine is well absorbed via mucosal (sublingual, buccal, or intranasal) administration. Intranasal dexmedetomidine has been used off-label, as a sedative for pediatric procedures and to treat postoperative restlessness, agitation, and pain in older patients after orthopedic procedures . A sublingual formulation may have limited application in uncooperative, agitated patients, but intramuscular injections of dexmedetomidine also show excellent bioavailability .…”