Intranasal Dexmedetomidine in Elderly Patients (Aged &gt; 65 Years) During Maxillofacial Surgery: Sedative Properties and Safety Analysis

Xu, Xianfei; Cao, Yunfei; Wu, Youhua; Ding, Miao

doi:10.1016/j.joms.2021.10.013

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…Based on the literature review, previous local experience and observations, the dose chosen for DEX treatment in the present study was 1.25 μg/kg of actual body weight. Interestingly, in studies published recently (2019–22), and therefore after the present trial had been initiated, IN DEX 100, 50 µg, or 1 µg/kg was administered before anesthesia, or after spinal/or general anesthesia in elderly healthy subjects, with a relatively good tolerance profile [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial

Dieudonné Rahm,

Zaccaria,

Gil Wey

et al. 2023

Drugs Aging

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Background Daily care procedures provoke breakthrough pain and anxiety in palliative situations. Dexmedetomidine may be an alternative to opioids during nursing procedures for older patients. Objective We aimed to compare the efficacy of intranasal dexmedetomidine with subcutaneous opioids on the intensity of pain and anxiety during comfort management procedures. Methods We conducted a randomized, active-controlled, double-blind, crossover trial (NCT03151863). Patients aged ≥ 65 years were randomized to receive, 45 min before nursing care, either intranasal dexmedetomidine together with subcutaneous placebo or intranasal placebo together with a subcutaneous opioid. Each of these two interventions were administered in a cross-over design and spaced out over a 24- or 48-h period. The primary outcome was the number of patients with an Elderly Caring Pain Assessment score > 5. Secondary outcomes included pain, sedation score, and vital signs. Results Because of difficult recruitment, the trial was interrupted after the inclusion of 24 patients. Three patients withdrew after randomization, leaving 21 patients undergoing 42 complete sessions for descriptive analyses. Of the 21 patients, 12 (57.1%) were women, and their median age was 84 years, interquartile range (75–87 years). Nine (42.9%) patients presented an Elderly Caring Pain Assessment score > 5 when receiving subcutaneous opioids, and seven (33.3%) with intranasal dexmedetomidine. Hypoxemia occurred in a single patient receiving subcutaneous opioids. No episode of bradycardia was observed. Conclusions Intranasal dexmedetomidine is feasible in elderly patients and may be an alternative to opioids to ensure comfort during nursing care. Future studies are needed to confirm the efficacy and safety of this procedure. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01027-3.

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Section: Discussionmentioning

confidence: 99%

Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial

Dieudonné Rahm,

Zaccaria,

Gil Wey

et al. 2023

Drugs Aging

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Side effects of general anaesthetics and therapeutic gases

Coleman,

Zeinali,

Hall

2023

Side Effects of Drugs Annual

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Absorption pharmacokinetics and feasibility of intranasal dexmedetomidine in patients under general anaesthesia

Tiainen,

Anderson,

Rinne

et al. 2024

Acta Anaesthesiol Scand

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BackgroundThe use of intranasal dexmedetomidine is hampered by a limited understanding of its absorption pharmacokinetics.MethodsWe examined the pharmacokinetics and feasibility of intranasal dexmedetomidine administered in the supine position to adult patients undergoing general anaesthesia. Twenty‐eight patients between 35 and 80 years of age, ASA 1–3 and weight between 50 and 100 kg, who underwent elective unilateral total hip or knee arthroplasty under general anaesthesia were recruited. All patients received 100 μg of intranasal dexmedetomidine after anaesthesia induction. Six venous blood samples (at 0, 5, 15, 45, 60, 240 min timepoints from dexmedetomidine administration) were collected from each patient and dexmedetomidine plasma concentrations were measured. Concentration‐time profiles after nasal administration were pooled with earlier data from a population analysis of intravenous dexmedetomidine (n = 202) in order to estimate absorption parameters using nonlinear mixed effects. Peak concentration (CMAX) and time (TMAX) were estimated using simulation (n = 1000) with parameter estimates and their associated variability.ResultsThere were 28 adult patients with a mean (SD) age of 66 (8) years and weight of 83 (10) kg. The mean weight‐adjusted dose of dexmedetomidine was 1.22 (0.15) μg kg−1. CMAX 0.273 μg L−1 was achieved at 98 min after intranasal administration (TMAX). The relative bioavailability of dexmedetomidine was 80% (95% CI 75–91%). The absorption half‐time (TABS = 120 min; 95% CI 90–147 min) was slower than that in previous pharmacokinetic studies on adult patients. Perioperative haemodynamics of all patients remained stable.ConclusionsAdministration of intranasal dexmedetomidine in the supine position during general anaesthesia is feasible with good bioavailability. This administration method has slower absorption when compared to awake patients in upright position, with consequent concentrations attained after TMAX for several hours.

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Intranasal Dexmedetomidine in Elderly Patients (Aged > 65 Years) During Maxillofacial Surgery: Sedative Properties and Safety Analysis

Cited by 3 publications

References 20 publications

Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial

Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial

Side effects of general anaesthetics and therapeutic gases

Absorption pharmacokinetics and feasibility of intranasal dexmedetomidine in patients under general anaesthesia

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