The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

Sin, Jeremy Cheuk Kin; Tabah, Alexis; Campher, Matthys J J; Laupland, Kevin B.; Eley, Victoria

doi:10.1213/ane.0000000000005843

Cited by 30 publications

(15 citation statements)

References 79 publications

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“…Dexmedetomidine (as an anesthetic adjuvant) may decrease emergence delirium, nausea, vomiting, and opioid requirements, but it is associated with increased postoperative sedation. 33,34 We observed that among the patients receiving dexmedetomidine, those who were deeply sedated had a greater median dose. Furthermore, a dose response between dexmedetomidine and deep sedation was observed in our study; even low doses (50 mcg) were associated with approximately 2-fold higher odds of excessive sedation.…”

Section: Dexmedetomidinementioning

confidence: 85%

Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study

Deljou

Soleimani

Martin

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Residual deep sedation during anesthesia recovery may predict postoperative complications. We examined the incidence and risk factors for deep sedation after general anesthesia. METHODS: We retrospectively reviewed health records of adults who underwent procedures with general anesthesia and were admitted to the postanesthesia care unit from May 2018 to December 2020. Patients were dichotomized by Richmond Agitation-Sedation Scale (RASS) score: ≤−4 (deeply sedated/unarousable) or ≥−3 (not deeply sedated). Anesthesia risk factors for deep sedation were assessed with multivariable logistic regression. RESULTS: Of the 56,275 patients included, 2003 had a RASS ≤−4 (35.6 [95% CI, 34.1–37.2] cases per 1000 anesthetics administered). On adjusted analyses, the likelihood of a RASS ≤−4 increased when more soluble halogenated anesthetics were used. Compared with desflurane without propofol, the odds ratio (OR [95% CI]) for a RASS ≤−4 was higher with sevoflurane (1.85 [1.45–2.37]) and isoflurane (4.21 [3.29–5.38]) without propofol. Compared with desflurane without propofol, the odds of a RASS ≤−4 further increased with use of desflurane-propofol (2.61 [1.99–3.42]), sevoflurane-propofol (4.20 [3.28–5.39]), isoflurane-propofol (6.39 [4.90–8.34]), and total intravenous anesthesia (2.98 [2.22–3.98]). A RASS ≤−4 was also more likely with the use of dexmedetomidine (2.47 [2.10–2.89]), gabapentinoids (2.17 [1.90–2.48]), and midazolam (1.34 [1.21–1.49]). Deeply sedated patients discharged to general care wards had higher odds of opioid-induced respiratory complications (2.59 [1.32–5.10]) and higher odds of naloxone administration (2.93 [1.42–6.03]). CONCLUSIONS: Likelihood of deep sedation after recovery increased with intraoperative use of halogenated agents with higher solubility and increased further when propofol was concomitantly used. Patients who experience deep sedation during anesthesia recovery have an increased risk of opioid-induced respiratory complications on general care wards. These findings may be useful for tailoring anesthetic management to reduce postoperative oversedation.

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Section: Dexmedetomidinementioning

confidence: 85%

Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study

Deljou

Soleimani

Martin

et al. 2023

Anesthesia &Amp; Analgesia

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“…anaesthesia, Propofol or volatile anaesthetics are mostly used. In addition, various co-administrators such as Ketamine, Lidocaine, and Dexmedetomidine and their combination(s) have been increasingly used alone or in combination during the last decade [19]. This circumstance is refl ected in the Enhanced Recovery after Surgery (ERAS) recommendations for perioperative care [20].…”

Section: Duringmentioning

confidence: 99%

“…Among others, these drugs have a place as co-anaesthetics in the perioperative setting [25] . In daily use, the value of dexmedetomidine is based not only on reducing perioperative analgesia, but also on infl uencing delirium or Postoperative Cognitive Dysfunction (POCD) and preventing it, as well as reducing Postoperative Nausea and Vomiting (PONV) [19,[26][27][28][29][30]. According to my own experience the continuous administration of 0.2-0.7 mcg * kg -1* h -1 Dexmedetomidine with or without initial bolus is suffi cient during surgery and improve patient's outcome.…”

Section: Duringmentioning

confidence: 99%

Endometriosis: Where are we today? An Anesthesiologist’s Point of View

Vetter¹

2023

J Biomed Res Environ Sci

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“…The documentation on beneficial effects from intraoperative dexmedethomidine is increasing as to some analgesic effect, less shivering and less delirium or agitation, especially in children or the elderly patients, but hypotension may be a problem [56 ▪ ]. Again, as most cases in the ambulatory setting will do well without this extra adjunct, the use should be better documented and so far for the cases with extra need of analgesia.…”

Section: Other Measures and Drugsmentioning

confidence: 99%

Pain treatment and prophylaxis on pain

Ræder¹

2022

Current Opinion in Anaesthesiology

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Purpose of reviewAlso in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment.Recent findingsPostoperative pain should be addressed both pre, intra- and postoperatively. The management should be with a multimodal nonopioid-based procedure specific guideline for the routine cases. In 10–20% of cases, there will be a need to adjust and supplement the basic guideline with extra analgesic measures. This may be because there are contraindications for a drug in the guideline, the procedure is more extensive than usual or the patient has extra risk factors for strong postoperative pain. Opioids should only be used when needed on top of multimodal nonopioid prophylaxis. Opioids should be with nondepot formulations, titrated to effect in the postoperative care unit and eventually continued only when needed for a few days at maximum.SummaryMultimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.

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The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

Cited by 30 publications

References 79 publications

Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study

Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study

Endometriosis: Where are we today? An Anesthesiologist’s Point of View

Pain treatment and prophylaxis on pain

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