Journal Article

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)

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

2025

Overview

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. •Intranasal dexmedetomidine can be used as premedication for patients undergoing total knee arthroplasty under spinal anesthesia.•Intranasal dexmedetomidine is hemodynamically well tolerated in spinal anesthesia for knee arthroplasty.•Intranasal dexmedetomidine premedication reduced intraoperative hypertension without affecting surgical bleeding.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adjuvants / Administration, Intranasal / Aged / Anesthesia / Anesthesia, Spinal - adverse effects / Anesthesia, Spinal - methods / Arthroplasty, Replacement, Knee - adverse effects / Arthroplasty, Replacement, Knee - methods / Blood Loss, Surgical - prevention & control / Blood Loss, Surgical - statistics & numerical data / Blood platelets / Blood pressure / Cardiac arrhythmia / Clinical outcomes / Clinical significance / Clinical trials / Consent / Dexmedetomidine / Dexmedetomidine - administration & dosage / Dexmedetomidine - adverse effects / Double-Blind Method / Drug dosages / Female / Heart rate / Heart Rate - drug effects / Hemodynamics / Hemodynamics - drug effects / Hemoglobin / Hospitals / Humans / Hypertension / Hypnotics and Sedatives - administration & dosage / Hypnotics and Sedatives - adverse effects / Hypotension / Joint replacement surgery / Joint surgery / Male / Middle Aged / Narcotics / Oxygen - blood / Oxygen saturation / Pain / Pain Medicine / Patient satisfaction / Perioperative care / Premedication / Premedication - methods / Prospective Studies / Surgical blood loss