Effect of low-dose dexmedetomidine on postoperative inflammatory response and delirium in elderly patients with hip fractures

doi:10.3969/j.issn.1006-7795.2024.02.008

Abstract

Abstract: Objective To evaluate the effect of prophylactic administration of low-dose dexmedetomidine (DEX) on inflammatory response in elderly patients after hip fracture surgery. Methods Elderly patients with hip fractures who admitted to the intensive care unit (ICU) after surgery were randomly divided to two groups, labeled “DEX group” or “control group” DEX. DEX group were received a continuous infusion of 0.1 μ g·kg^-1·h^-1 DEX. Control group received 0.025 mL·kg^-1·h^-1 of 0.9% saline intravenously. The serum levels of procalcitonin and interleukin-6 in patients at 0 hours (immediate), 6 hours, 12 hours, and 18 hours after administration were detected. The hemodynamic parameters (heart index, stroke volume index, mean arterial pressure, heart rate) and the occurrence of delirium were recorded. Results There was no statistically significant difference in the levels of procalcitonin and interleukin-6 between the two groups at each time points (P>0.05).The incidence of delirium in the DEX group was significantly lower than that in the control group (P=0.034). The number of cases of additional use of opioid in the DEX group (P=0.039) and hypertension (P=0.012) were significantly lower than those in the control group. Conclusion Low dose DEX did not significantly reduce postoperative inflammatory indicators in elderly patients with hip fractures, but it helped to reduce the occurrence of delirium and use of opioid analyesics in patients. Low dose DEX has minimal impact on hemodynamics and may have a circulatory protective effect on patients with postoperative hypertension.

Key words: dexmedetomidine, hip fracture in the elderly, delirium, hemodynamic, inflammatory response

CLC Number:

Cui Zhen, Yu Miaomiao, Kong Yueyue, Ke Li, Zhang Liu, Bai Ying, Wang Hao. Effect of low-dose dexmedetomidine on postoperative inflammatory response and delirium in elderly patients with hip fractures[J]. Journal of Capital Medical University, 2024, 45(2): 220-225.

References

［1］ McDonough C M, Harris-Hayes M, Kristensen M T, et al. Physical therapy management of older adults with hip fracture［J］. J Orthop Sports Phys Ther, 2021, 51(2): CPG1-CPG81.
［2］ Kluger M T, Skarin M, Collier J, et al. Steroids to reduce the impact on delirium (STRIDE): a double-blind, randomised, placebo-controlled feasibility trial of pre-operative dexamethasone in people with hip fracture［J］. Anaesthesia, 2021, 76(8): 1031-1041.
［3］ Pang Y, Li Y T, Zhang Y G, et al. Effects of inflammation and oxidative stress on postoperative delirium in cardiac surgery［J］. Front Cardiovasc Med, 2022, 9: 1049600.
［4］ Hughes C G, Mailloux P T, Devlin J W, et al. Dexmedetomidine or propofol for sedation in mechanically ventilated adults with sepsis［J］. N Engl J Med, 2021, 384(15): 1424-1436.
［5］ Ohta Y, Miyamoto K, Kawazoe Y, et al. Effect of dexmedetomidine on inflammation in patients with sepsis requiring mechanical ventilation: a sub-analysis of a multicenter randomized clinical trial［J］. Crit Care, 2020, 24(1): 493.
［6］ Su X, Meng Z T, Wu X H, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial［J］. Lancet, 2016, 388(10054): 1893-1902.
［7］ Skrobik Y, Duprey M S, Hill N S, et al. Low-dose nocturnal dexmedetomidine prevents ICU delirium. A randomized, placebo-controlled trial［J］. Am J Respir Crit Care Med, 2018, 197(9): 1147-1156.
［8］ Maldonado J R. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium［J］. Crit Care Clin, 2017, 33(3): 461-519.
［9］ van Munster B C, Korse C M, de Rooij S E, et al. Markers of cerebral damage during delirium in elderly patients with hip fracture［J］. BMC Neurol, 2009, 9: 21.
［10］ Clemmesen C G, Tavenier J, Andersen O, et al. Methylprednisolone and inflammatory stress response in older people undergoing surgery for hip fracture: a secondary analysis of a randomized controlled trial［J］. Eur Geriatr Med, 2019, 10(6): 913-921.
［11］ Venn R M, Bradshaw C J, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit［J］. Anaesthesia, 1999, 54(12): 1136-1142.
［12］ Mei B, Li J, Zuo Z Y. Dexmedetomidine attenuates sepsis-associated inflammation and encephalopathy via central α2A adrenoceptor［J］. Brain Behav Immun, 2021, 91: 296-314.
［13］ Cui J J, Gao M T, Huang H Q, et al. Dexmedetomidine improves lung function by promoting inflammation resolution in patients undergoing totally thoracoscopic cardiac surgery［J］. Oxid Med Cell Longev, 2020, 2020: 8638301.
［14］ Fan W, Yang H K, Sun Y, et al. Comparison of the pro-postoperative analgesia of intraoperative dexmedetomidine with and without loading dose following general anesthesia: a prospective, randomized, controlled clinical trial［J］. Medicine (Baltimore), 2017, 96(7): e6106.
［15］ Lee J, Hwang H W, Jeong J Y, et al. The effect of low-dose dexmedetomidine on pain and inflammation in patients undergoing laparoscopic hysterectomy［J］. J Clin Med, 2022, 11(10): 2802.
［16］ Moon J, Yoo Y C, Kim M H, et al. Administration of low-dose dexmedetomidine did not affect acute inflammatory response after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: a double-blind randomized controlled trial［J］. J Clin Med, 2021, 10(14): 3145.
［17］ Jiang Y X, Xia M Z, Huang Q, et al. Protective effect of dexmedetomidine against organ dysfunction in a two-hit model of hemorrhage/resuscitation and endotoxemia in rats［J］. Braz J Med Biol Res, 2019, 52(3): e7905.
［18］ Sanson G, Khlopenyuk Y, Milocco S, et al. Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects［J］. Heart Lung, 2018, 47(4): 408-417.
［19］ Sun Y M, Zhu S N, Zhang C, et al. Effect of low-dose dexmedetomidine on sleep quality in postoperative patients with mechanical ventilation in the intensive care unit: a pilot randomized trial［J］. Front Med (Lausanne), 2022, 9: 931084.

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