Intraoperative dexmedetomidine sedation reduces the postoperative agitated behavior in elderly patients undergoing orthopedic surgery compared to the propofol sedation
Intraoperative dexmedetomidine sedation reduces the postoperative agitated behavior in elderly patients undergoing orthopedic surgery compared to the propofol sedation
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DOI：
10.23736/s0375-9393.17.11794-3
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发表时间：
2017-10-01
影响因子：
3.2
通讯作者：
Na, Hyo-Seok
中科院分区：
文献类型：
--
作者：
Shin, Hyun-Jung;Koo, Bon-Wook;Na, Hyo-Seok
背景：术后躁动或意识模糊是老年患者多动性谵妄的症状之一。我们回顾性评估了老年手术患者术后异常精神行为的发生率，根据术中使用不同的镇静剂：右美托咪定与丙泊酚。方法：将2012年7月至2015年9月期间855例接受区域麻醉的骨科手术老年患者的病历分为两组，右美托咪定组（N.= 100），263)异丙酚组（N. #25992;，然后进行评估。躁动行为作为主要结局进行评价，患者、手术和麻醉相关因素以及其他术后并发症作为次要结局进行研究。结果：在倾向评分匹配的两组中，右美托咪定组躁动行为的发生率低于丙泊酚组（6例[2.3%] vs. 17例[6.5%]，P=0.027）。两组之间的所有术前和术后实验室检查值相当，包括血红蛋白、红细胞压积、血小板计数、C反应蛋白、电解质、肌酐、肾小球滤过率和白蛋白。此外，术中丙泊酚镇静，年龄较大，较高的Charlson合并症指数，髋关节手术被发现是显着的因素发生agitation.Conclusions：这项研究表明，术中右美托咪定镇静，与丙泊酚镇静相比，可能有更大的有益效果，减少激动的行为，在老年患者接受骨科手术与区域麻醉。
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 behavior 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 orthopedic surgery with regional anesthesia between July 2012 and September 2015, were divided into two groups, the dexmedetomidine group (N.=263) and the propofol group (N.=592), and then evaluated. Agitated behavior was evaluated as the primary outcome, and patient-, surgery-, and anesthesia-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 behavior 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 hemoglobin, hematocrit, 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 behavior in elderly patients undergoing orthopedic surgery with regional anesthesia.