Tiainen Suvi-Maria, Koskinen Atte, Mäkelä Sanna, Laitio Ruut, Löyttyniemi Eliisa, Mäkelä Keijo, Pirttikangas Carl-Olof, Saari Teijo I, Uusalo Panu
Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Department of Anesthesiology and Intensive Care, Satasairaala Central Hospital, Satakunta Hospital District, Pori, Finland.
Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
J Clin Anesth. 2025 Jul;105:111899. doi: 10.1016/j.jclinane.2025.111899. Epub 2025 Jun 11.
Dexmedetomidine is a sedative adjunct with sympatholytic properties. Despite many beneficial effects, hemodynamic effects limit its use.
We performed a secondary analysis of the data from TKADEX study. This single-center, double-blind, two-arm study compared intranasal dexmedetomidine premedication (1 μg kg-1) with intranasal saline in 101 planned subjects undergoing total knee arthroplasty (TKA). We analyzed the perioperative hemodynamics, oxygenation, amount of intraoperative bleeding and perioperative change in hemoglobin and thrombocytes.
Compared to baseline measurements, mean arterial pressure (MAP) decreased in the dexmedetomidine group 36.3 (1.7) mmHg (95 % CI 32.9-39.7; p < 0.001) and in the placebo group 26.5 (1.7) mmHg (95 % CI 23.2-29.7; p < 0.001), and heart rate (HR) in the dexmedetomidine group 11.6 (1.3) bpm (95 % CI 9.1-14.1; p < 0.001) and in the placebo group 9.7 (1.2) bpm (95 % CI 7.3-12.2; p < 0.001) after induction of spinal anesthesia. Patients in the dexmedetomidine group had lower intraoperative MAP (maximal difference - 8.5 (2.5) mmHg; 95 % CI -13.5 - -3.5; p < 0.001) and HR (maximal difference - 6.1 (2.2) bpm; 95 % CI -10.5 - -1.7; p = 0.007) compared to the placebo group. There was higher incidence of intraoperative hypertension in the placebo group (p = 0.03). There was no difference in oxygenation, in the incidence of intraoperative bradycardia, tachycardia or hypotension, in the amount of intraoperative bleeding or in the change in perioperative blood count between the groups.
Intranasal dexmedetomidine appears to be hemodynamically well tolerated premedication for patients undergoing TKA under spinal anesthesia. It appears to lower the incidence of intraoperative hypertension without effects on intraoperative bleeding.
右美托咪定是一种具有抗交感神经特性的镇静辅助药物。尽管有许多有益作用，但其血流动力学效应限制了其应用。
我们对TKADEX研究的数据进行了二次分析。这项单中心、双盲、双臂研究比较了101例计划接受全膝关节置换术（TKA）的受试者鼻内给予右美托咪定（1μg/kg）进行术前用药与鼻内给予生理盐水的效果。我们分析了围手术期的血流动力学、氧合、术中出血量以及血红蛋白和血小板的围手术期变化。
与基线测量值相比，右美托咪定组的平均动脉压（MAP）下降了36.3（1.7）mmHg（95%CI 32.9 - 39.7；p < 0.001），安慰剂组下降了26.5（1.7）mmHg（95%CI 23.2 - 29.7；p < 0.001）；脊髓麻醉诱导后，右美托咪定组的心率（HR）下降了11.6（1.3）次/分钟（95%CI 9.1 - 14.1；p < 0.001），安慰剂组下降了9.7（1.2）次/分钟（95%CI 7.3 - 12.2；p < 0.001）。与安慰剂组相比，右美托咪定组患者术中的MAP（最大差值 - 8.5（2.5）mmHg；95%CI -13.5 - -3.5；p < 0.001）和HR（最大差值 - 6.1（2.2）次/分钟；95%CI -10.5 - -1.7；p = 0.007）更低。安慰剂组术中高血压的发生率更高（p = 0.03）。两组在氧合、术中心动过缓、心动过速或低血压的发生率、术中出血量或围手术期血细胞计数变化方面没有差异。
对于脊髓麻醉下接受TKA的患者，鼻内给予右美托咪定似乎是一种血流动力学耐受性良好的术前用药。它似乎能降低术中高血压的发生率，且对术中出血无影响。
