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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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12-10-2022 | Hypotension | Reports of Original Investigations

Association of intraoperative dexmedetomidine use with postoperative hypotension in unilateral hip and knee arthroplasties: a historical cohort study

Authors: Stephen Su Yang, MD, MSc, FRCPC, Charles Gelinas, MD, Edmund Yim, MD, Mandy M. J. Li, MD, MSc, Kenneth Kardash, MD, FRCPC, Michelle Zhang, MD, FRCPC, Jed Lipes, MD, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 12/2022

Abstract

Purpose

Dexmedetomidine is frequently used as a sedative agent for orthopedic surgery patients undergoing total hip or knee arthroplasty. Although the benefits of dexmedetomidine are well described in the literature, there is also potential for harm, especially regarding the hemodynamic effects of dexmedetomidine in the postoperative setting.

Methods

This historical cohort study included all primary unilateral total hip or knee arthroplasties conducted from April 2017 to February 2020 in a single, university-affiliated, tertiary care centre (Jewish General Hospital, Montreal, QC, Canada). We used multivariable logistic regression to analyze the predictors for postoperative hypotension, defined as a systolic blood pressure < 90 mm Hg or any systolic blood pressure while on a vasopressor infusion in the postanesthesia care unit. Models were validated using calibration and discrimination with bootstrapping technique.

Results

One thousand five hundred and eighty-eight patients were included in this study. Postoperative hypotension occurred in 413 (26%) patients. Statistically significant predictors for postoperative hypotension included female sex (adjusted odds ratio [aOR], 3.24; 95% confidence interval [CI], 2.29 to 4.58), a history of transient ischemic attack or cerebrovascular accident (aOR, 1.97; 95% CI, 1.04 to 3.72), and intraoperative dexmedetomidine use (aOR, 2.61; 95% CI, 1.99 to 3.42). Moreover, the risk of postoperative hypotension was approximately two times higher than baseline, with a total intraoperative dexmedetomidine dose above 50 μg (relative risk, 1.99; 95% CI, 1.63 to 2.44; P < 0.001). A higher preoperative systolic blood pressure (aOR, 0.98; 95% CI, 0.97 to 0.99) was a protective factor for postoperative hypotension.

Conclusion

In this historical cohort study, dexmedetomidine was a strong risk factor for postoperative hypotension in total hip or knee arthroplasty patients. Dexmedetomidine, and particularly at high cumulative doses above 50 μg, should be administered judiciously in high-risk surgical patients to minimize the risk of postoperative hypotension.

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Title: Association of intraoperative dexmedetomidine use with postoperative hypotension in unilateral hip and knee arthroplasties: a historical cohort study
Authors: Stephen Su Yang, MD, MSc, FRCPC
Charles Gelinas, MD
Edmund Yim, MD
Mandy M. J. Li, MD, MSc
Kenneth Kardash, MD, FRCPC
Michelle Zhang, MD, FRCPC
Jed Lipes, MD, FRCPC
Publication date: 12-10-2022
Publisher: Springer International Publishing
Keywords: Hypotension
Hypotension
Hip-TEP
Hip-TEP
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 12/2022
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02339-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Association of intraoperative dexmedetomidine use with postoperative hypotension in unilateral hip and knee arthroplasties: a historical cohort study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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