The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes

##plugins.themes.bootstrap3.article.sidebar##

PDF (Українська)
Published: Apr 29, 2022
DOI: https://doi.org/10.30841/2307-5112.1-2.2022.260504
Keywords:
hip arthroplasty, knee arthroplasty, diabetes mellitus, complications, dexmedetomidine,

##plugins.themes.bootstrap3.article.main##

Oleksandr Halushko
P. L. Shupyk National Healthcare University of Ukraine, Ukraine
http://orcid.org/0000-0001-7027-8110
Larysa Zenkina
State Scientific Institution «Center for Innovative Medical Technologies of the National Academy of Sciences of Ukraine», Ukraine

Abstract

Hip and knee arthroplasty (HKA) is a surgical procedure when damaged parts of the joint are replaced with artificial ones that replicate the shape of a normal joint and restore its function.


Every year more than 1.5 million endoprosthetic operations are performed in the world. Replacement of a damaged joint allows patients to return to the normal life, freeing from pain and limited mobility. However, one of the common diseases that negatively affect the results of these operations is diabetes mellitus (DM).


The aim of the study: to determine the efficacy and safety of the combined multimodal low opioid anesthesia with dexmedetomidine sedation in patients with diabetes undergoing HKA surgery.


Materials and methods. The study included 45 patients who underwent HKA surgery. Patients were divided into three groups according to the scheme of anesthesia. In patients of the 1st group (n = 15) multicomponent low-flow anesthesia with artificial lung ventilation was performed, in the patients of the 2nd group (n = 15) spinal anesthesia was used, in the 3rd group (n = 15) – combined spinal – epidural anesthesia with dexmedetomidine sedation.


The groups of patients were identical in anthropometric and gender characteristics, duration of surgery and anesthesia, baseline somatic status.


Statistical analysis was performed using the IBM SPSS Statistics suite (SPSS v.16.0).


Results. The course of anesthesia in patients in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting (PONV). Only one patient from group 3 required ondansetron for the treatment of PONV against 3 and 2 patients from groups 1 and 2, respectively (p <0.05).


Conclusions. Any of the proposed techniques can be used for anesthesia during hip and knee arthroplasty, but the best results have been obtained with combined spinal-epidural anesthesia with dexmedetomidine sedation. In addition, the use of dexmedetomidine can significantly reduce the use of opioids diring the intraoperative and postoperative period.

##plugins.themes.bootstrap3.article.details##

How to Cite
Halushko, O., & Zenkina, L. (2022). The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes. Family Medicine, (1-2), 48–53. https://doi.org/10.30841/2307-5112.1-2.2022.260504
Issue
No. 1-2 (2022)
Section
For practicing physicians
Copyright (c) 2022 Oleksandr Halushko, Larysa Zenkina

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.

Author Biographies

Oleksandr Halushko, P. L. Shupyk National Healthcare University of Ukraine

Oleksandr А. Halushko,

Department of Family Medicine and Outpatient Care

Larysa Zenkina, State Scientific Institution «Center for Innovative Medical Technologies of the National Academy of Sciences of Ukraine»

Larysa M. Zenkina,

Department of Anesthesiology

References

Filipenko V, Tankut V, Mezentsev V. Causes of dislocation of the endoprosthesis head after primary hip arthroplasty. Trauma. 2018;18(1):27–33. doi:10.22141/1608-1706.1.18.2017.95587.

Weber M, Völlner F, Benditz A, Schwarz T, Wörner M, Craiovan B, et al. Kniegelenkersatz des älteren Menschen [Total knee arthroplasty in the elderly]. Orthopade. 2017;46(1):34–9. doi: 10.1007/s00132-016-3363-5.

Claßen T, Scheid C, Landgraeber S, Jäger M. Besonderheiten beim elektiven Hüftgelenkersatz des älteren Menschen [Characteristics of elective hip replacement in the elderly]. Orthopade. 2017;46(1):25–33. doi: 10.1007/s00132-016-3364-4.

Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2017;14(3):529–36. doi: 10.1111/iwj.12640.

Sloan M, Sheth N, Lee GC. Is Obesity Associated With Increased Risk of Deep Vein Thrombosis or Pulmonary Embolism After Hip and Knee Arthroplasty? A Large Database Study. Clin Orthop Relat Res. 2019;477(3):523–32. doi: 10.1097/CORR.0000000000000615.

Roger C, Debuyzer E, Dehl M, Bulaїd Y, Lamrani A, Havet E, et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study. Orthop Traumatol Surg Res. 2019;105(5):949–55. doi: 10.1016/j.otsr.2019.04.012.

Wu KT, Chen CY, Chen B, Wang JW, Lin PC, Yen SH. The Incidence and Risk Factors of Acute Kidney Disease after Total Knee Arthroplasty with Early Postoperative Volume Supplement. Biomed Res Int. 2018;2018:8718545. doi: 10.1155/2018/8718545.

International Diabets Federation. IDF Diabetes Atlas 2021 – 10th edition. Brussels: IDF; 2021. 141 p.

Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88–98. doi: 10.1038/nrendo.2017.151.

Qin W, Huang X, Yang H, Shen M. The Influence of Diabetes Mellitus on Patients Undergoing Primary Total Lower Extremity Arthroplasty: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:6661691. doi: 10.1155/2020/6661691.

Rudy MD, Ahuja NK, Aaronson AJ. Diabetes and Hyperglycemia in Lower-Extremity Total Joint Arthroplasty: Clinical Epidemiology, Outcomes, and Management. JBJS Rev. 2018;6(5):e10. doi: 10.2106/JBJS.RVW.17.00146.

Ren X, Ling L, Qi L, Liu Z, Zhang W, Yang Z, et al. Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord. 2021;22(1):776. doi: 10.1186/s12891-021-04647-1.

Maradit KH, Lewallen LW, Mabry TM, Berry DJ, Berbari EF, Osmon DR. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty. 2015;30(3):439–43. doi: 10.1016/j.arth.2014.10.009.

Statz JM, Odum SM, Johnson NR, Otero JE. Failure to Medically Optimize Before Total Hip Arthroplasty: Which Modifiable Risk Factor Is the Most Dangerous? Arthroplast Today. 2021;10:18–23. doi: 10.1016/j.artd.2021.05.021.

Prensky C, Urruela A, Guss MS, Karia R, Lenzo TJ, Egol KA. Symptomatic venous thrombo-embolism in low-energy isolated fractures in hospitalised patients. Injury. 2013;44(8):1135–9. doi: 10.1016/j.injury.2013.04.018.

Deng W, Huo L, Yuan Q, Huang D, Li Q, Tian W. Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty. BMC Musculoskelet Disord. 2021;22(1):608. doi: 10.1186/s12891-021-04453-9.

Blaudsun G, Lysakowski C, Elia N, Tramеr MR. Effect of perioperative systemic alfa-2 agonists on postoperative morphineconsumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiol. 2012;116(6):1312–22. doi: 10.1097/ALN.0b013e31825681cb.

Nair AS. Benefits of using dexmedetomidine during carotid endarterectomy: A review. Saudi J Anaesth. 2014;8(2):264–7. doi: 10.4103/1658-354X.130744.

Khizhnyak A, Ievlevа V, Volkova Y, Sharlai K. Dexmedetomidine as a component of postoperative analgosedation in patients with severe traumatic brain injury. Emergency medicine. 2017;8(87):62–6. doi: 10.22141/2224-0586.8.87.2017.121325.

Barends CR, Absalom A, Van Minnen B, Vissink A, Visser A. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety. PLoS One. 2017;12(1):e0169525. doi: 10.1371/journal.pone.0169525.

Zhang H, Wu Z, Zhao X, Qiao Y. Role of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction caused by sevoflurane inhalation anesthesia in elderly patients with esophageal carcinoma. J Cancer Res Ther. 2018;14(7):1497–502. doi: 10.4103/jcrt.JCRT_164_18.

Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246–58. doi: 10.1213/ANE.0000000000003668.

Inagaki Y, Yamakage M, Sakamoto A, Okayama A, Oya N, Hiraoka T, et al. The Efficacy and Safety of Dexmedetomidine for Sedation During Surgery Under Epidural or Spinal Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Study. Yonago Acta Med. 2022;65(1):14–25. doi: 10.33160/yam.2022.02.002.

Li CJ, Wang BJ, Mu DL, Wang DX. The effect of dexmedetomidine on intraoperative blood glucose homeostasis: secondary analysis of a randomized controlled trial. BMC Anesthesiol. 2021;21(1):139. doi: 10.1186/s12871-021-01360-3.

Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123(6):777–94. doi: 10.1016/j.bja.2019.07.027.