Effects of intranasal dexmedetomidine premedication on hemodynamics, oxygenation and bleeding in patients undergoing total knee arthroplasty under spinal anesthesia - a secondary analysis of a prospective, double-blinded, randomized controlled trial (TKADEX)

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-06-11 DOI:10.1016/j.jclinane.2025.111899

Suvi-Maria Tiainen , Atte Koskinen , Sanna Mäkelä , Ruut Laitio , Eliisa Löyttyniemi , Keijo Mäkelä , Carl-Olof Pirttikangas , Teijo I. Saari , Panu Uusalo

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引用次数: 0

Abstract

Background

Dexmedetomidine is a sedative adjunct with sympatholytic properties. Despite many beneficial effects, hemodynamic effects limit its use.

Methods

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.

Results

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.

Conclusions

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.

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鼻内右美托咪定预用药对脊柱麻醉下全膝关节置换术患者血流动力学、氧合和出血的影响——一项前瞻性、双盲、随机对照试验（TKADEX）的二次分析

右美托咪定是一种具有交感神经溶解特性的镇静剂。尽管有许多有益的作用，但血流动力学的影响限制了它的使用。方法对TKADEX研究数据进行二次分析。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）的受试者鼻内右美托咪定（1 μg kg-1）和鼻内生理盐水的用药前（1 μg kg-1）。分析围术期血流动力学、氧合、术中出血量及血红蛋白、血小板的变化。结果与基线测量值相比，右美托咪定组平均动脉压（MAP）降低36.3 (1.7)mmHg (95% CI 32.9-39.7；p & lt;0.001)，安慰剂组为26.5 (1.7)mmHg (95% CI 23.2-29.7；p & lt;0.001)，右美托咪定组的心率（HR）为11.6 (1.3)bpm (95% CI 9.1-14.1；p & lt;0.001)，安慰剂组为9.7 (1.2)bpm (95% CI 7.3-12.2；p & lt;0.001)。右美托咪定组患者术中MAP较低(最大差- 8.5 (2.5)mmHg；95% ci -13.5 - -3.5；p & lt;0.001)和心率(最大差异- 6.1 (2.2)bpm；95% ci -10.5 - -1.7；P = 0.007)。安慰剂组术中高血压发生率较高（p = 0.03）。两组在氧合、术中心动过缓、心动过速、低血压发生率、术中出血量、围术期血细胞计数变化等方面均无差异。结论经鼻右美托咪定是脊髓麻醉下TKA患者血液动力学耐受良好的前用药。它似乎可以降低术中高血压的发生率，但对术中出血没有影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.