Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 51, 20521, Turku, Finland.
Drugs Aging. 2021 May;38(5):441-450. doi: 10.1007/s40266-021-00846-6. Epub 2021 Mar 16.
The aim of this study was to report preliminary data on the use of intranasal dexmedetomidine to treat postoperative restlessness, agitation, and pain in 23 patients aged > 70 years and undergoing orthopedic surgery.
Postoperative agitation and delirium are common among older adult patients undergoing orthopedic surgery. Most preparations used to treat agitation and delirium carry a risk for adverse events such as respiratory failure. Moreover, mere opioid therapy may be insufficient in treatment of pain. Dexmedetomidine, an α2-adrenoreceptor agonist with sedative and analgesic properties, has been shown to reduce opioid requirement and reduce postoperative delirium in older adults.
We studied the use of post-operative intranasal dexmedetomidine in a retrospective study cohort of geriatric patients undergoing orthopedic surgery. Primary outcomes included alterations in heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2), Modified Richmond Agitation and Sedation Score (mRASS), and opioid consumption following dexmedetomidine administration.
We identified 23 patients with a mean (SD) age of 79.9 (7.5) years who received dexmedetomidine 100 µg intranasally postoperatively. After dexmedetomidine administration, HR decreased by 10.4 (3.7) beats/min (95% CI 2.9-17.8; p = 0.004) and MAP by 16.2 (4.4) mmHg (95% CI 7.3-25.1; p < 0.001). HR decrease was significant at 2 h and MAP decrease at 1, 2, and 3 h following dexmedetomidine administration. Dexmedetomidine administration was associated with significant reductions in opioid consumption (p < 0.001) and mRASS score (p < 0.001). SpO and RR remained unchanged.
These preliminary findings suggest that intranasal dexmedetomidine reduces opioid consumption without causing respiratory depression and may be used to treat postoperative restlessness, agitation, and pain in geriatric patients. However, hemodynamic effects of dexmedetomidine may require close observation for 3 hours following administration in older adult patients.
本研究旨在报告 23 例>70 岁行骨科手术患者使用鼻内给予右美托咪定治疗术后躁动、激越和疼痛的初步数据。
老年患者行骨科手术后常发生术后躁动和谵妄。大多数用于治疗躁动和谵妄的药物都存在不良事件风险，如呼吸衰竭。此外，单纯使用阿片类药物可能不足以治疗疼痛。右美托咪定是一种具有镇静和镇痛作用的α2-肾上腺素受体激动剂，已被证明可减少阿片类药物的需求，并减少老年患者术后谵妄。
我们对行骨科手术的老年患者进行了一项回顾性研究队列中使用术后鼻内给予右美托咪定的研究。主要结局包括右美托咪定给药后心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、外周血氧饱和度（SpO2）、改良 Richmond 躁动和镇静评分（mRASS）以及阿片类药物消耗的变化。
我们确定了 23 例患者，平均（标准差）年龄为 79.9（7.5）岁，术后接受了 100µg 右美托咪定鼻内给药。给予右美托咪定后，HR 下降 10.4（3.7）次/分钟（95%CI 2.9-17.8；p=0.004），MAP 下降 16.2（4.4）mmHg（95%CI 7.3-25.1；p<0.001）。HR 下降在右美托咪定给药后 2 小时显著，MAP 下降在 1、2 和 3 小时显著。给予右美托咪定与阿片类药物消耗显著减少（p<0.001）和 mRASS 评分显著降低（p<0.001）相关。SpO2 和 RR 保持不变。
这些初步发现表明，鼻内给予右美托咪定可减少阿片类药物的消耗，而不会引起呼吸抑制，可用于治疗老年患者的术后躁动、激越和疼痛。然而，右美托咪定的血流动力学效应可能需要在老年患者给药后 3 小时内密切观察。
