Is Dexmedetomidine An Effective Prophylaxis ED among Combat Veterans?


Name: Tyler Wilson

Rank: LTC

Organization: Henry M. Jackson Foundation for the Advancement of Military Medicine

Performance Site: Uniformed Services University of the Health Science, Bethesda, MD; Walter Reed National Military Medical Center, Bethesda, MD

Year Published: 2014

Abstract Status: Completed


The incidence of emergence delirium (ED) among combat veterans is 20%. The violent awakening from general anesthesia, termed ED, is characterized by agitation, confusion, and violent physical and verbal behavior in the operating room (OR) or the post-anesthesia care unit (PACU). As a consequence of this erratic behavior, patients as well as healthcare providers are at risk for bodily harm which can result in longer hospital stays and ultimately, increase the financial burden of healthcare facilities. Mental health decline among military veterans has long been associated with exposure to combat. Recently, a prospective investigation described the relationship between anxiety, depression, and PTSD as it relates to ED. Preoperative state anxiety was shown to be the best predictor. The large majority of past research has critically examined ED in pediatric patients because the incidence appears to be greater among this vulnerable population (18-57%) as compared to adults (4.7-5.3%). The increased incidence among combat veterans is of particular concern to military nurses that are involved in their care. Perioperative use of dexmedetomidine, a specific α 2-adrenergic receptor agonist, has been effective at reducing the incidence of ED in children. Considering the increased incidence of ED among combat veterans, it is important to investigate possible prophylactic treatment options for ED in the combat veteran population. 

The aims are to determine if an intraoperative intravenous dose of dexmedetomidine 1 μg/kg bolus, followed by a 0.6 μg/kg/hr infusion (dexmedetomidine group), is an effective prophylactic treatment for ED as compared to a placebo infusion (placebo group) in a sample of high risk combat veterans as determined by the State-Trait Anxiety Inventory (STAI) (state ≥39) and to determine the incidence of emergence delirium in a sample of combat veterans. Once identified, evidence-based recommendations can be made to anesthesia practitioners in regard to the use of dexmedetomidine in those patients that are high risk for ED in order to decrease the incidence and severity. This will lead to a program of research in which the military anesthesia community can discover new treatments in the anesthetic management of our veterans of combat deployment.


Final Report is available on NTRL: