Dexmedetomidine use efficacious for reducing PTSD during emergency trauma surgery

The study published in JAMA Network Open posttraumatic stress disorder occurred in 14.1% of patients in the dexmedetomidine group and 24.0% in the control group 1 month postoperatively.

People with trauma commonly experience posttraumatic stress disorder, particularly those hospitalized for surgery. Dexmedetomidine may lessen or reverse the early consolidation and formation of conditioned fear memory and postoperative PTSD occurrence. Youjia Yu, Suzhou Xiangcheng People's Hospital, Suzhou, China, and colleagues aimed to evaluate the effects of intraoperative and postoperative low-dose intravenous pumping dexmedetomidine on PTSD among trauma patients undergoing emergency surgery in a double-blind, randomized clinical trial conducted from January 22 to October 20, 2022.

The study, with a follow-up one month postoperatively, included patients with trauma undergoing emergency surgery at four hospital centres in China. A Screening of a total of 477 participants was done. The observers were blinded to patient groupings, specifically for subjective measurements.

Three hundred ten patients (mean age, 40.2 years; 57.7% men) were randomized to the dexmedetomidine group (n=156) or the placebo (normal saline group; n=154) and were included in the modified intention-to-treat analysis. Dexmedetomidine or placebo was administered at a maintenance dose of f 0.1 μg/kg hourly from anaesthesia start until the end of surgery and at the same rate after surgery from 9 pm to 7 am on days 1 to 3.

The authors reported the following findings:

• The incidence of PTSD was significantly lower in the dexmedetomidine group than in the control group 1 month postoperatively (14.1% vs 24.0%).
• The participants in the dexmedetomidine group had a significantly lower CAPS-5 score than those in the control group (17.3 versus 18.9; mean difference, 1.65).
• After adjusting for potential confounders, the patients in the dexmedetomidine group were less likely to develop PTSD than those in the control group 1 month postoperatively (adjusted odds ratio, 0.51).

"In this randomized clinical trial, intraoperative and postoperative dexmedetomidine administration reduced the PTSD incidence among trauma patients," the authors wrote. "The trial findings support dexmedetomidine use in emergency trauma surgery."

"Therefore, we recommend low-dose dexmedetomidine sedation during and after surgery for trauma patients under suitable conditions," they concluded.

Reference:

Yu Y, Li Y, Han D, et al. Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(6):e2318611. doi:10.1001/jamanetworkopen.2023.18611