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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Apr 19

DOI: 10.23736/S0375-9393.17.11794-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intraoperative dexmedetomidine sedation reduces the postoperative agitated behaviour in elderly patients undergoing orthopaedic surgery compared to the propofol sedation: a retrospective analysis of 855 patients

Hyun-Jung SHIN 1, Bon-Wook KOO 1, Seung-Uk BANG 2, Jin-Hee KIM 1, Jung-Won HWANG 1, Sang-Hwan DO 1, Hyo-Seok NA 1

1 Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; 2 Department of Anaesthesiology and Pain Medicine, Daejeon Saint Mary’s Hospital, Daejeon, South Korea


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BACKGROUND: Postoperative agitation or confusion is one of the symptoms of hyperactive delirium in elderly patients. We retrospectively evaluated the incidence of postoperative abnormal psychomotor behaviour in elderly surgical patients according to the use of different intraoperative sedative agents: dexmedetomidine vs. propofol.
METHODS: The medical records of 855 elderly patients, who underwent orthopaedic surgery with regional anaesthesia between July 2012 and September 2015, were divided into two groups—the dexmedetomidine group (n=263) and the propofol group (n=592)—and evaluated. Agitated behaviour was evaluated as the primary outcome, and patient-, surgery-, and anaesthesia-related factors, as well as other postoperative complications, were investigated as secondary outcomes. To reduce the risk of confounder effects between the two groups, 263 patients were selected from the propofol group by propensity score matching.
RESULTS: In the propensity-score-matched groups, the incidence of agitated behaviour was lower in the dexmedetomidine group compared with the propofol group [6 (2.3%) vs. 17 (6.5%), P = 0.027]. All pre- and postoperative laboratory values were comparable between the two groups, including haemoglobin, haematocrit, platelet count, C-reactive protein, electrolytes, creatinine, glomerular filtration rate, and albumin. Moreover, intraoperative propofol sedation, older age, higher Charlson comorbidity index, and hip surgery were found to be significant factors for the occurrence of agitation.
CONCLUSIONS: This study suggests that intraoperative dexmedetomidine sedation, as compared with propofol sedation, may have a greater beneficial effect in reducing agitated behaviour in elderly patients undergoing orthopaedic surgery with regional anaesthesia.


KEY WORDS: Complications–agitation - Analgesics, non-narcotic–dexmedetomidine - Anesthesia and analgesia–sedation

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hsknana@gmail.com