Dexmedetomidine-esketamine Combined Nasal Administration and Emergence Delirium
China340 participantsStarted 2024-09-02
Plain-language summary
Emergence delirium is common in older patients after surgery and associated with worse perioperative outcomes, including increased postoperative delirium. Nasal administrations of both dexmedetomidine and esketamine are approved for medical purposes. Combination of low-dose dexmedetomidine and esketamine has shown some synergic effects in analgesia and anxiolysis. In a recent randomized trial, combined nasal administration of dexmedetomidine and esketamine was more effective in reducing pre-dental anxiety in pediatric patients. The investigators hypothesize that perioperative nasal administration of dexmedetomidine-esketamine combination can reduce the incidence of emergence delirium in older patients after surgery.
Who can participate
Age range65 Years
SexALL
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Inclusion criteria
✓. Aged ≥ 65 years;
✓. Scheduled for inpatient elective or semi-elective surgery under general anesthesia, with an expected surgical duration of ≤2 hours;
✓. Planned to stay in hospital for at least 1 day after surgery.
Exclusion criteria
✕. Not suitable for intranasal drug administration due to nasal disease (e.g., rhinitis, nasal polyps, or nasal congestion due to any cause);
✕. Preoperative schizophrenia, epilepsy, Parkinson's disease, myasthenia gravis, or delirium;
✕. Inability to communicate due to coma, severe dementia, or language barrier before surgery;
✕. Brain trauma or neurosurgery;
✕. Use of sedatives or hypnotics at bedtime during the last month;
✕. History of hyperthyroidism or pheochromocytoma;
✕. Preoperative left ventricular ejection fraction \<30%, or sick sinus node syndrome, severe sinus bradycardia (heart rate \<50 beats per minute), or atrioventricular block of degree II or higher without pacemaker, or systolic blood pressure \<90 mmHg before enrollment;
What they're measuring
1
Incidence of emergence delirium after surgery
Timeframe: During stay in the post-anesthesia care unit
✕. Severe hepatic dysfunction (Child-Pugh class C), severe renal dysfunction (receiving dialysis before surgery), or American Society of Anesthesiologists classification ≥ IV;