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Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery.

Kim DJ, Kim SH, So KY, Jung KT - BMC Anesthesiol (2015)

Bottom Line: Intraoperative dexmedetomidine may decrease postoperative emergence agitation in elderly patients due to its sedative effect.All anaesthetics and dexmedetomidine were discontinued at surgical conclusion, and the recovery times (durations to a BIS = 60, 70, and 80; eye opening; and extubation) were measured.The VAS score was lower in the SD group than in the SN group, and the PONV did not differ regardless of the use of dexmedetomidine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, South Korea. mypigfarm@naver.com.

ABSTRACT

Background: Intraoperative dexmedetomidine may decrease postoperative emergence agitation in elderly patients due to its sedative effect. In this study, we evaluated the effect of adjuvant dexmedetomidine on smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.

Methods: A total 115 patients (ASA I-II, aged over 65 years) were randomly allocated into four groups. Anaesthesia was maintained with either sevoflurane or total intravenous anaesthesia (TIVA) comprising propofol and remifentanil. Patients were also administered either dexmedetomidine (0.4 μg kg(-1) hr(-1); SD and TD) intraoperatively or normal saline (SN or TN) as a control. The bispectral index (BIS) score was maintained from 40-60 intraoperatively. All anaesthetics and dexmedetomidine were discontinued at surgical conclusion, and the recovery times (durations to a BIS = 60, 70, and 80; eye opening; and extubation) were measured. The mean arterial pressure, heart rate, Ricker's agitation-sedation scale (RSAS), visual analogue scale (VAS) for pain, and incidences of emergence agitation and postoperative nausea and vomiting (PONV) were measured in the recovery room.

Results: Dexmedetomidine significantly decreased the RSAS score in the SD and TD groups, and a calm state postoperatively occurred more frequently in these groups than in the control groups. The heart rate and incidence of emergence agitation were lower in the dexmedetomidine groups. Recovery time was higher in the SD group than in the SN group, and no significant differences occurred between the TN and TD groups. The VAS score was lower in the SD group than in the SN group, and the PONV did not differ regardless of the use of dexmedetomidine.

Conclusions: Dexmedetomidine may be an effective intraoperative adjuvant for a reducing emergence agitation and smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.

Trial registration: Current Controlled Trials NCT01851005 .

No MeSH data available.


Related in: MedlinePlus

Hemodynamic changes during infusion of adjuvant drugs and during anaesthetic emergence. a Mean arterial pressure and (b) heart rate measured. Pre-infusion, before infusion of adjuvant drugs; In-10 min, 10 min after infusion of adjuvant drugs; In-30 min, 30 min after infusion of adjuvant drugs; RR, at arrival to recovery room;, RR-15 min, 15 min after arrival to recovery room; RR-30 min, 30 min after arrival to recovery room. Group SN, inhalation anaesthesia using sevoflurane and normal saline administered as a control; Group SD, inhalation anaesthesia using sevoflurane and adjuvant dexmedetomidine; Group TN, TIVA using propofol and remifentanil and normal saline administered as a control; Group TD, TIVA using propofol and remifentanil, and adjuvant dexmedetomidine. *P < 0.05 compared with the SN group. †P < 0.05 compared with the TN group
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Fig5: Hemodynamic changes during infusion of adjuvant drugs and during anaesthetic emergence. a Mean arterial pressure and (b) heart rate measured. Pre-infusion, before infusion of adjuvant drugs; In-10 min, 10 min after infusion of adjuvant drugs; In-30 min, 30 min after infusion of adjuvant drugs; RR, at arrival to recovery room;, RR-15 min, 15 min after arrival to recovery room; RR-30 min, 30 min after arrival to recovery room. Group SN, inhalation anaesthesia using sevoflurane and normal saline administered as a control; Group SD, inhalation anaesthesia using sevoflurane and adjuvant dexmedetomidine; Group TN, TIVA using propofol and remifentanil and normal saline administered as a control; Group TD, TIVA using propofol and remifentanil, and adjuvant dexmedetomidine. *P < 0.05 compared with the SN group. †P < 0.05 compared with the TN group

Mentions: There were no significant differences in MAP during infusion of adjuvant drugs and between the dexmedetomidine and control groups (P > 0.05, Fig. 5). The HR was lower in the SD group compared to that in the SN group 15 min after the patients arrived in the recovery room. The HR was also lower in the TD group TD compared to that in the TN group 30 min after arrival to the recovery room.Fig. 5


Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery.

Kim DJ, Kim SH, So KY, Jung KT - BMC Anesthesiol (2015)

Hemodynamic changes during infusion of adjuvant drugs and during anaesthetic emergence. a Mean arterial pressure and (b) heart rate measured. Pre-infusion, before infusion of adjuvant drugs; In-10 min, 10 min after infusion of adjuvant drugs; In-30 min, 30 min after infusion of adjuvant drugs; RR, at arrival to recovery room;, RR-15 min, 15 min after arrival to recovery room; RR-30 min, 30 min after arrival to recovery room. Group SN, inhalation anaesthesia using sevoflurane and normal saline administered as a control; Group SD, inhalation anaesthesia using sevoflurane and adjuvant dexmedetomidine; Group TN, TIVA using propofol and remifentanil and normal saline administered as a control; Group TD, TIVA using propofol and remifentanil, and adjuvant dexmedetomidine. *P < 0.05 compared with the SN group. †P < 0.05 compared with the TN group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597422&req=5

Fig5: Hemodynamic changes during infusion of adjuvant drugs and during anaesthetic emergence. a Mean arterial pressure and (b) heart rate measured. Pre-infusion, before infusion of adjuvant drugs; In-10 min, 10 min after infusion of adjuvant drugs; In-30 min, 30 min after infusion of adjuvant drugs; RR, at arrival to recovery room;, RR-15 min, 15 min after arrival to recovery room; RR-30 min, 30 min after arrival to recovery room. Group SN, inhalation anaesthesia using sevoflurane and normal saline administered as a control; Group SD, inhalation anaesthesia using sevoflurane and adjuvant dexmedetomidine; Group TN, TIVA using propofol and remifentanil and normal saline administered as a control; Group TD, TIVA using propofol and remifentanil, and adjuvant dexmedetomidine. *P < 0.05 compared with the SN group. †P < 0.05 compared with the TN group
Mentions: There were no significant differences in MAP during infusion of adjuvant drugs and between the dexmedetomidine and control groups (P > 0.05, Fig. 5). The HR was lower in the SD group compared to that in the SN group 15 min after the patients arrived in the recovery room. The HR was also lower in the TD group TD compared to that in the TN group 30 min after arrival to the recovery room.Fig. 5

Bottom Line: Intraoperative dexmedetomidine may decrease postoperative emergence agitation in elderly patients due to its sedative effect.All anaesthetics and dexmedetomidine were discontinued at surgical conclusion, and the recovery times (durations to a BIS = 60, 70, and 80; eye opening; and extubation) were measured.The VAS score was lower in the SD group than in the SN group, and the PONV did not differ regardless of the use of dexmedetomidine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, South Korea. mypigfarm@naver.com.

ABSTRACT

Background: Intraoperative dexmedetomidine may decrease postoperative emergence agitation in elderly patients due to its sedative effect. In this study, we evaluated the effect of adjuvant dexmedetomidine on smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.

Methods: A total 115 patients (ASA I-II, aged over 65 years) were randomly allocated into four groups. Anaesthesia was maintained with either sevoflurane or total intravenous anaesthesia (TIVA) comprising propofol and remifentanil. Patients were also administered either dexmedetomidine (0.4 μg kg(-1) hr(-1); SD and TD) intraoperatively or normal saline (SN or TN) as a control. The bispectral index (BIS) score was maintained from 40-60 intraoperatively. All anaesthetics and dexmedetomidine were discontinued at surgical conclusion, and the recovery times (durations to a BIS = 60, 70, and 80; eye opening; and extubation) were measured. The mean arterial pressure, heart rate, Ricker's agitation-sedation scale (RSAS), visual analogue scale (VAS) for pain, and incidences of emergence agitation and postoperative nausea and vomiting (PONV) were measured in the recovery room.

Results: Dexmedetomidine significantly decreased the RSAS score in the SD and TD groups, and a calm state postoperatively occurred more frequently in these groups than in the control groups. The heart rate and incidence of emergence agitation were lower in the dexmedetomidine groups. Recovery time was higher in the SD group than in the SN group, and no significant differences occurred between the TN and TD groups. The VAS score was lower in the SD group than in the SN group, and the PONV did not differ regardless of the use of dexmedetomidine.

Conclusions: Dexmedetomidine may be an effective intraoperative adjuvant for a reducing emergence agitation and smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.

Trial registration: Current Controlled Trials NCT01851005 .

No MeSH data available.


Related in: MedlinePlus