Intraoperative dexmedetomidine sedation reduces the postoperative agitated behavior in elderly patients undergoing orthopedic surgery compared to the propofol sedation.

Abstract Postoperative agitation or confusion is one of the symptoms of hyperactive delirium in elderly patients. We retrospectively evaluated the incidence of postoperative abnormal psychomotor behavior in elderly surgical patients according to the use of different intraoperative sedative agents: dexmedetomidine vs. propofol. The medical records of 855 elderly patients, who underwent orthopedic surgery with regional anesthesia between July 2012 and September 2015, were divided into two groups, the dexmedetomidine group (N.=263) and the propofol group (N.=592), and then evaluated. Agitated behavior was evaluated as the primary outcome, and patient-, surgery-, and anesthesia-related factors, as well as other postoperative complications, were investigated as secondary outcomes. To reduce the risk of confounder effects between the two groups, 263 patients were selected from the propofol group by propensity score matching. In the propensity-score-matched groups, the incidence of agitated behavior was lower in the dexmedetomidine group compared with the propofol group (6 [2.3%] vs. 17 [6.5%], P=0.027). All pre- and postoperative laboratory values were comparable between the two groups, including hemoglobin, hematocrit, platelet count, C-reactive protein, electrolytes, creatinine, glomerular filtration rate, and albumin. Moreover, intraoperative propofol sedation, older age, higher Charlson comorbidity index, and hip surgery were found to be significant factors for the occurrence of agitation. This study suggests that intraoperative dexmedetomidine sedation, as compared with propofol sedation, may have a greater beneficial effect in reducing agitated behavior in elderly patients undergoing orthopedic surgery with regional anesthesia.