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Effect of dexamethasone on intraoperative remifentanil dose in total knee arthroplasty surgery under general anaesthesia

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@article{a106a19605ec48f18d61fa28b3bcbc34,
title = "Effect of dexamethasone on intraoperative remifentanil dose in total knee arthroplasty surgery under general anaesthesia",
abstract = "BACKGROUND: The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty (TKA) surgery under general anaesthesia.METHODS: In this post hoc subgroup analysis, we included patients randomised in the DEX-2-TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight-corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight-corrected infusion rate of propofol, median intraoperative bispectral index and time spent in the post-anaesthesia care unit.RESULTS: Eighty-seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p = .02. None of the secondary outcomes resulted in statistically significant differences between groups.CONCLUSION: This explorative post hoc analysis of the randomised DEX-2-TKA trail showed that patients undergoing TKA surgery under general anaesthesia and who received dexamethasone seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05002361 (12 August 2021).",
keywords = "alloplastic surgery, dexamethasone, glucocorticoid, intraoperative pain, intraoperative remifentanil, remifentanil anaesthesia, total knee arthroplasty, total knee replacement, Dexamethasone, Humans, Remifentanil, Analgesics, Anesthetics, Intravenous/pharmacology, Arthroplasty, Replacement, Knee, Piperidines/pharmacology, Propofol, Anesthesia, General/methods",
author = "Maria Gantzel and Gasbjerg, {Kasper Smidt} and Daniel H{\"a}gi-Pedersen and Meyhoff, {Christian Sylvest} and Olsen, {Markus Harboe} and Ole Mathiesen and Jakobsen, {Janus Christian} and Lunn, {Troels Haxholdt}",
note = "This article is protected by copyright. All rights reserved.",
year = "2022",
month = oct,
doi = "10.1111/aas.14118",
language = "English",
volume = "66",
pages = "1070--1076",
journal = "Acta Anaesthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Wiley-Blackwell Munksgaard",
number = "9",

}

RIS

TY - JOUR

T1 - Effect of dexamethasone on intraoperative remifentanil dose in total knee arthroplasty surgery under general anaesthesia

AU - Gantzel, Maria

AU - Gasbjerg, Kasper Smidt

AU - Hägi-Pedersen, Daniel

AU - Meyhoff, Christian Sylvest

AU - Olsen, Markus Harboe

AU - Mathiesen, Ole

AU - Jakobsen, Janus Christian

AU - Lunn, Troels Haxholdt

N1 - This article is protected by copyright. All rights reserved.

PY - 2022/10

Y1 - 2022/10

N2 - BACKGROUND: The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty (TKA) surgery under general anaesthesia.METHODS: In this post hoc subgroup analysis, we included patients randomised in the DEX-2-TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight-corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight-corrected infusion rate of propofol, median intraoperative bispectral index and time spent in the post-anaesthesia care unit.RESULTS: Eighty-seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p = .02. None of the secondary outcomes resulted in statistically significant differences between groups.CONCLUSION: This explorative post hoc analysis of the randomised DEX-2-TKA trail showed that patients undergoing TKA surgery under general anaesthesia and who received dexamethasone seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05002361 (12 August 2021).

AB - BACKGROUND: The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty (TKA) surgery under general anaesthesia.METHODS: In this post hoc subgroup analysis, we included patients randomised in the DEX-2-TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight-corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight-corrected infusion rate of propofol, median intraoperative bispectral index and time spent in the post-anaesthesia care unit.RESULTS: Eighty-seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p = .02. None of the secondary outcomes resulted in statistically significant differences between groups.CONCLUSION: This explorative post hoc analysis of the randomised DEX-2-TKA trail showed that patients undergoing TKA surgery under general anaesthesia and who received dexamethasone seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05002361 (12 August 2021).

KW - alloplastic surgery

KW - dexamethasone

KW - glucocorticoid

KW - intraoperative pain

KW - intraoperative remifentanil

KW - remifentanil anaesthesia

KW - total knee arthroplasty

KW - total knee replacement

KW - Dexamethasone

KW - Humans

KW - Remifentanil

KW - Analgesics

KW - Anesthetics, Intravenous/pharmacology

KW - Arthroplasty, Replacement, Knee

KW - Piperidines/pharmacology

KW - Propofol

KW - Anesthesia, General/methods

UR - http://www.scopus.com/inward/record.url?scp=85135397472&partnerID=8YFLogxK

U2 - 10.1111/aas.14118

DO - 10.1111/aas.14118

M3 - Journal article

C2 - 35908167

VL - 66

SP - 1070

EP - 1076

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 9

ER -

ID: 80048571