EFFECTS OF INTRAOPERATIVE DEXMED INFUSION ON RECOVERY PROFILE, POSTOPERATIVE DELIRIUM AND AGITATION
Main Article Content
Keywords
Dexmedetomidine, Postoperative Delirium, Recovery Profile, Elective Surgery, Analgesics, Perioperative Care.
Abstract
Objective: This study aimed to evaluate the effects of administering dexmedetomidine (DEX) during surgery on recovery patterns and the occurrence of postoperative delirium and agitation in patients undergoing elective procedures.
Method: This study was a double-blind, randomized controlled trial. It included 60 patients scheduled for elective surgery at LUMHS, Jamshoro in the duration from January, 2021 to December, 2021. Subjects were randomly assigned to receive either DEX (1 mcg/kg in 100 ml saline) or a placebo (100 ml saline) during surgery. The main objectives were to assess postoperative heart rates and the occurrence of delirium, using the Nursing Delirium Screening Scale (NDSS). Additional outcomes were the need for pain relievers, the occurrence of nausea/vomiting, and desaturation, evaluated with the Ricker Sedation-Agitation Scale (RSAS).
Results: Patients in the DEX group showed a significant decrease in heart rate following eye opening (63.1 bpm vs. 89.0 bpm, p<0.0001) and 10 minutes after extubation (69.1 bpm vs. 98.0 bpm, p<0.0001) compared to the control group. The occurrence of postoperative delirium was notably lower in the DEX group (NDSS score: 0.93 vs. 1.57, p=0.0087). The requirement for additional pain relief was lower in the DEX group (0.88% vs. 2.63%, p=0.042), as were the occurrences of nausea/vomiting (0.35% vs. 1.93%, p=0.025) and desaturation (0.35% vs. 1.93%, p=0.025).
Conclusion: Administering dexmedetomidine during surgery significantly improves recovery. It reduces postoperative heart rates and delirium. It also lowers the need for extra pain medication and decreases occurrences of nausea, vomiting, and desaturation. These findings support incorporating DEX into perioperative care to enhance patient outcomes and optimize recovery.
References
2. Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis. Intensive Care Med. 2010;36(6):926-939.
3. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha-2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116(6):1312-1322.
4. Bulow NM, Colpo E, Pereira RP, et al. Dexmedetomidine decreases the requirement for and prolongs the duration of spinal anesthesia. Anesth Analg. 2006;102(4):1116-1119.
5. Ramsay MAE, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology. 2004;101(3):787-790.
6. Grewal A. Dexmedetomidine: new avenues. J Anaesthesiol Clin Pharmacol. 2011;27(3):297-302.
7. Lawrence CJ, De Lange S. Effects of a dexmedetomidine infusion on hemodynamic responses to surgical stimulation in patients undergoing vascular surgery. Anaesthesia. 1997;52(6):576-580.
8. Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012;62(1):118-133.
9. Albrecht S, Tschernko E, Moertl M, et al. Dexmedetomidine as an adjuvant to propofol anesthesia in endoscopic retrograde cholangiopancreatography: a randomized trial. J Clin Anesth. 2014;26(2):105-111.
10. Pandharipande PP, Sanders RD, Girard TD, et al. Effect of dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644-2653.
11. Deiner S, Luo X, Lin HM, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. JAMA Surg. 2017;152(8).
12. Parker SD, Breslow MJ, Frank SM, et al. Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. J Clin Anesth. 1995;7(2):93-98.
13. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306.
14. Jones GM, Papadopoulos S, Hubbard C, et al. Continuous intravenous infusion of dexmedetomidine for sedation following cardiac surgery in a mixed surgical/cardiac intensive care unit: a retrospective review. Hosp Pharm. 2007;42(3):209-216.
15. Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35(2):282-290.
16. Kumar AH, Sukhani R, Parsa MH, et al. A prospective, randomized, double-blind comparison of epidural dexmedetomidine versus clonidine in combination with bupivacaine in lower limb surgeries. Saudi J Anaesth. 2014;8(2):155-161.
17. Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of pediatric perioperative and periprocedural applications. Saudi J Anaesth. 2011;5(4):364-373.
18. Hao S, Liu Y, Jin Z, et al. Efficacy and safety of dexmedetomidine in cardiac surgery patients: a meta-analysis and systematic review. PLoS One. 2021;16(9).
19. Martin E, Ramsay G, Mantz J, Sum-Ping ST. The role of the alpha2-adrenoceptor agonist dexmedetomidine in post-surgical sedation in the intensive care unit. J Intensive Care Med. 2003;18(1):29-41.
20. Liu Y, Liang F, Liu X, et al. Clinical practice guideline on dexmedetomidine use for mechanical ventilation patients in intensive care unit. Chin Med J (Beijing). 2020;133(1):74-86.
21. Xu H, Liu F, Liu J, et al. Dexmedetomidine versus propofol on cognitive dysfunction and inflammatory response in patients after surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(44).
22. Duan X, Coburn M, Rossaint R, et al. Efficacy of dexmedetomidine compared with propofol for sedation in intensive care unit patients: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2014;112(3):710-720.
23. Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med. 2013;5(2):489-494.
24. Turan A, Kasuya Y, Govinda R, et al. Effects of Dexmedetomidine on recovery after abdominal hysterectomy. J Clin Anesth. 2008;20(5):373-378.
25. Hu J, Vacas S, Feng X, et al. Dexmedetomidine prevents cognitive decline by enhancing resolution of high mobility group box 1 protein-induced inflammation through a vagomimetic action in mice. Anesthesiology. 2018;128(5):921-931.
26. Zhang H, Lu Y, Liu M, et al. Strategies for preventing postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. 2013;17(2).
27. Skrobik Y, Duprey MS, Hill NS, et al. Low-dose nocturnal dexmedetomidine prevents ICU delirium. A randomized placebo-controlled trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156.
28. Zhou Y, Meng Q, Zhu L, et al. Effects of dexmedetomidine on perioperative stress inflammatory response and postoperative delirium in elderly patients undergoing major orthopedic surgery. Medicine (Baltimore). 2019;98(12)
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Dr Mamoona Shaikh
Assistant Professor, Anaesthesia Department, LUMHS Jamshoro, Pakistan
Dr Jamil Ahmed
Associate Professor Anaesthesiology Isra University Hospital Hyderabad, Pakistan
Dr Kauser Shaikh
General Surgeon Shah Bhittai Hospital Hyderabad, Pakistan
Dr Shafaq Ansari
Anaesthetist LUMHS Jamshoro, Pakistan