<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Abstract

The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine. Methods: A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were >6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use. Results: In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43-0.56]) and matched cohort (0.49 [95% CI: 0.42-0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13-0.33; P<0.0001) and 0.30 (95% CI,0.19-0.47; P<0.0001), respectively. In addition, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31-0.44; P<0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P<0.0001) than that in the medium-(0.4-0.6 μg•kg −1 •h −1) and high-dose (0.6-0.8 μg•kg −1 •h −1) groups. Conclusion: Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) is most effective for prevention of postoperative sleep disturbance.

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

“…In our study, the median (IQR) of age of the two groups was 59 (55,65) and 62 (56,67) years, so in consideration of concentration related adverse circulatory effects for elderly patients, we chose a 0.4 μg/kg infusion over 10 min, followed by a dose of 0.4 μg/kg/h to maintain the anesthesia. The similar low DEX infusion dosing could be found in many other studies [10,[29][30][31]. And our study also indicated that this dose of DEX continuous infusion did not increase the prevalence of bradycardia or hypotension, so we thought that our DEX dose was proper for safety evaluation.…”

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

“…In our study, the median (IQR) of age of the two groups was 59 (55,65) and 62 (56,67) years, so in consideration of concentration related adverse circulatory effects for elderly patients, we chose a 0.4 μg/kg infusion over 10 min, followed by a dose of 0.4 μg/kg/h to maintain the anesthesia. The similar low DEX infusion dosing could be found in many other studies 10,[30][31][32] . And our study also indicated that this dose of DEX continuous infusion did not increase the prevalence of bradycardia or hypotension, so we thought that our DEX dose was proper for safety evaluation.…”

Effect of Dexmedetomidine on Postoperative Sleep Quality: A Systematic Review

“…As for the different time point, the DEX was used during the surgery for sedation in nine studies, 5 , 7 , 10 , 15–18 , 21 , 26 as an adjuvant for the regional block in one studies, 22 for postoperative analgesia in nine studies 8 , 12–14 , 19 , 23–25 , 27 and both in surgery and after surgery in eight studies. 9 , 11 , 20 And in 2 retrospective study 15 , 16 and one RCT 25 compared the effect of sleep quality of low dose of DEX (<0.2 μg/kg/h) and high dose (>0.2 μg/kg/h). As for other RCT studies, nine studies used DEX at a low dose and ten studies used DEX at a high dose.…”

“… 14 Five other studies found no significant benefit of DEX in reducing PONV. 10 , 16 , 18 , 19 , 24 …”

“…14 Five other studies found no significant benefit of DEX in reducing PONV. 10,16,18,19,24 Pain A total of 13 studies have compared the effects of DEX on postoperative pain. The pain was assessed by numeric rating scales, visual analog scales (VAS), or the use of the postoperative pain reliever.…”