Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty

Mei, Bin; Meng, Gaige; Xu, Gaowei; Cheng, Xinqi; Chen, Shishou; Zhang, Ye; Zhang, Ming; Liu, Xuesheng; Gu, Erwei

doi:10.1097/ajp.0000000000000605

Cited by 59 publications

(56 citation statements)

References 34 publications

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“…Two RCTs did not state study dates [ 39 , 40 ]. Sixteen RCTs dealt with surgical patients, nine of which were cardiac surgery RCTs [ 36 , 39 , 41 , 42 , 45 – 47 , 51 , 53 ] and seven non-cardiac surgery RCTs, meaning microvascular free flap surgery [ 34 ], joint replacement [ 49 ] or total hip arthroplasty [ 54 ], major abdominal surgery [ 52 ], major laparoscopic surgery [ 55 ], and elective non-cardiac surgery under general anesthesia [ 33 , 48 ]. The remaining nine RCTs consisted of six studies examining MV patients [ 32 , 38 , 40 , 43 , 44 , 50 ] two examining noninvasively ventilated patients [ 35 , 37 ] and one where dexmedetomidine was used for nightly sedation [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

Flükiger

Hollinger

Speich

et al. 2018

Ann. Intensive Care

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BackgroundTo determine the preventive and therapeutic effect of dexmedetomidine on intensive care unit (ICU) delirium.MethodsThe literature search using PubMed and the Cochrane Central Register of Controlled Trials was performed (August 1, 2018) to detect all randomized controlled trials (RCTs) of adult ICU patients receiving dexmedetomidine. Articles were included if they assessed the influence of dexmedetomidine compared to a sedative agent on incidence of ICU delirium or treatment of this syndrome. Accordingly, relevant articles were allocated to the following two groups: (1) articles that assessed the delirium incidence (incidence comparison) or articles that assessed the treatment of delirium (treatment comparison). Incidence of delirium and delirium resolution were the primary outcomes. We combined treatment effects comparing dexmedetomidine versus (1) placebo, (2) standard sedatives, and (3) opioids in random-effects meta-analyses. Risk of bias for each included RCT was assessed following Cochrane standards.ResultsThe literature search resulted in 28 articles (25 articles/4975 patients for the incidence comparison and three articles/166 patients for the treatment comparison). In the incidence comparison, heterogeneity was present in different subgroups. Administration of dexmedetomidine was associated with significantly lower overall incidence of delirium when compared to placebo (RR 0.52; 95% CI 0.39–0.70; I2 = 37%), standard sedatives (RR 0.63; 95% CI 0.46–0.86; I2 = 69%), as well as to opioids (RR 0.61; 95% CI 0.44–0.83; I2 = 0%). Use of dexmedetomidine significantly increased the risks of bradycardia and hypotension. Limited data were available on circulatory insufficiency and mortality. In the treatment comparison, the comparison drugs in the three RCTs were placebo, midazolam, and haloperidol. The resolution of delirium was measured differently in each study. Two out of the three studies indicated clear favorable effects for dexmedetomidine (i.e., compared to placebo and midazolam). The study comparing dexmedetomidine with haloperidol was a pilot study (n = 20) with high variability in the results.ConclusionFindings suggest that dexmedetomidine reduces incidence and duration of ICU delirium. Furthermore, our systematic searches show that there is limited evidence if a delirium shall be treated with dexmedetomidine.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0437-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

Flükiger

Hollinger

Speich

et al. 2018

Ann. Intensive Care

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“…In a case report, it was reported that DEX was effective as a sedative and analgesic for a total hip replacement patient [31]. In a recent research, Mei et al reported that the intraoperative sedation of DEX was better than propofol in THA for elder patients [32]. In addition, the combined use of DEX and other block anesthetic methods have also been reported in several studies.…”

Section: Discussionmentioning

confidence: 97%

Combination of post-fascia iliaca compartment block and dexmedetomidine in pain and inflammation control after total hip arthroplasty for elder patients: a randomized control study

Liu

et al. 2020

J Orthop Surg Res

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Objective: This study aims to investigate the efficiency of fascia iliaca compartment block (FICB) combined with dexmedetomidine (DEX) in postoperative and inflammation management for elder patients after total hip arthroplasty. Methods: The present randomized controlled study included a total of 119 elder patients who received total hip arthroplasty in our hospital from March 2016 to December 2018. These patients were divided into three groups: control group, patients received routine general anesthesia; FICB group, patients received additional FICB after surgery; and combined group, patients received both pre-treatment of DEX and post-treatment of fascia iliaca compartment block. The serum levels of interleukin (IL)-1β, IL-6, and C-reactive protein (CRP) were measured by ELISA. The visual analog scale (VAS) score was measured at 12, 24, 48, and 72 h after surgery, and the patientcontrolled intravenous analgesia (PCIA) pressing time within 48 h after surgery was also recorded. The Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and at 1 month after surgery. Results: The VAS scores were significantly lower in patients in the combined group, when compared with the other two groups, at 12, 24, 48, and 72 h after surgery. In addition, the VAS scores at all time points were significantly lower in the FICB group than the control group. The PCIA pressing times were also remarkably lower in the combined group. At 4, 24, 48, and 72 h after surgery, the serum levels of these inflammatory factors were the lowest in the combined group, and the PSQI scores were significantly lower in the combined group, when compared with the other two groups, while the control group had the highest PSQI scores among the three groups. There was no severe side effects and significant difference observed. Conclusion: FICB combined with DEX reduced the postoperative pain, improved the sleep condition, and decreased the serum levels of inflammatory factors after total hip arthroplasty.

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“…Intraoperative sedation during RA has the benefit of avoiding postural discomfort, preventing intraoperative recall, and reducing autonomic reflexes [17]. Recently, prophylactic low-dose DEX significantly decreases the occurrence of postoperative delirium after noncardiac surgery and hip arthroplasty [17,18]. Patients presenting with proximal femur fracture are usually elderly and therefore a significant proportion have coexistent disease and a high risk factor of postoperative delirium (POD).…”

Section: Discussionmentioning

confidence: 99%

Analgesia for positioning of spinal anesthesia in elderly patients with proximal femoral fracture under dexmedetomidine infusioin: Ketamine versus fentanyl

Lee¹,

Lee²,

Park³

et al. 2019

Preprint

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Background Changes in posture due to spinal anesthesia in instances of femur fracture can cause severe pain and stress in elderly patients. Dexmedetomidine (DEX) infusion is effective in preventing stress and inducing sleep, but DEX alone has limitations in controlling the pain caused by postural changes. To improve pain relief, we compared the analgesic effects of intravenous DEX–ketamine and DEX–fentanyl combinations to facilitate lateral positioning for spinal anesthesia in proximal femoral fractured patients. Methods Forty-six patients were randomly assigned to the group K or group F. Group K was intravenously given ketamine (1 mg/kg) for 10 minutes, while group F received intravenous fentanyl (1 mcg/kg) for 10 minutes. All patients in both groups received concomitantly a bolus of DEX 1 μg/kg over 10 minutes. Ten minutes after the administration of ketamine with DEX or fentanyl with DEX, patients were placed in the lateral position with the fracture site positioned up. Pain score and quality scores during spinal anesthesia (i.e., lateral positioning, hip flexion, and spinal block) were recorded. Results Pain scores during lateral positioning and hip flexion were significantly lower in group K than in group F (P < 0.0001). The quality scores of patients during all periods of spinal anesthesia were significantly lower in Group K than in Group F (P < 0.05). Hemodynamic parameters were not significantly different between the two groups. Conclusions Intravenous DEX–ketamine is a more effective combination of the lateral position for spinal anesthesia in patients undergoing surgery for proximal femoral fracture in comparison with intravenous DEX–fentanyl.

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Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty

Cited by 59 publications

References 34 publications

Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

Combination of post-fascia iliaca compartment block and dexmedetomidine in pain and inflammation control after total hip arthroplasty for elder patients: a randomized control study

Analgesia for positioning of spinal anesthesia in elderly patients with proximal femoral fracture under dexmedetomidine infusioin: Ketamine versus fentanyl

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