Potential Cost Reduction Research Articles

Traditional and modern methods of construction: Comparative study of the sustainability of single‐family homes

AbstractModern construction methods, such as additive manufacturing, are aimed to enhance the efficiency and quality of construction processes while potentially reducing waste generation and material use, thus contributing to sustainability performance (SP). However, comprehensively understanding the sustainability trade‐offs associated with these methods is crucial for guiding both research and practical applications toward sustainable development. This study aims at quantifying the SP of various construction methods for housing, including traditional, prefabricated, and additive manufacturing approaches. A sustainability index, integrating economic, environmental, social, and technological criteria, is utilized to assess different alternatives. Findings reveal promising aspects of 3D printing technologies, such as potential cost reductions through scale increase and process optimization, minimized material waste generation, creation of skilled employment opportunities, and enhanced construction flexibility and ease. Nevertheless, challenges persist, notably significant greenhouse gas emissions and limited supplier availability. Addressing these challenges is imperative for advancing the sustainable implementation of additive manufacturing in construction.

BIOSIMILAR MEDICINAL PRODUCTS – LEGISLATIVE DECISIONS AND MARKET ENTRY

Biosimilar drugs, structurally identical and manufactured similarly to original biologic drugs, offer potential cost reductions in therapeutic practice, albeit with variations in adoption across European countries. This review synthesizes findings from literature examining legislative decisions and their effects on biosimilar market entry in Europe. Drawing from scientific articles and official documents, the review reveals that biologics constitute 36% of European drug expenditure, with the market valued at €78.6 billion in 2021 and growing annually at 10.5% over the past five years. Approximately 15% of new active substances centrally approved by the EMA in 2020 were biologics. The European biosimilars market is projected to reach €8.8 billion in 2021. Various measures are being implemented to boost biosimilar uptake, including pricing strategies, reimbursement policies, and substitution practices. Access, measured in terms of availability and time to entry, is still difficult in a number of countries, but legislative measures are helping biosimilars enter European markets more quickly.

On Assessing a Potential Reuse of the Indonesian Post-Operation Offshore Oil/Gas Pipelines as A Cold-Water Pipe for an Ocean Thermal Energy Conversion (OTEC) System: A Thermal and Fluid Dynamic Perspective

One of the main issues arising in offshore oil and gas decommissioning is associated with significant required costs. Research assessing the potential reuse of the post-operation offshore oil and gas pipeline (POGP) in Indonesia for the Ocean Thermal Energy Conversion (OTEC) system offer double the potential cost reductions in POGP decommissioning and OTEC development. In the context of OTEC development, research on increasing system efficiency makes a significant effort by modifying working fluids and usually by employing the assumption that the temperature of the cold seawater at the surface outlet of the Cold-Water Pipe (CWP) is practically the same as that at the inlet of the CWP at a depth of about 900 m. Unfortunately, this was not the case when the POGP was to be reused for the OTEC system because there was difficulty in applying additional insulation to the existing subsea pipelines. The temperature change in the cold seawater is even more critical considering that oil and gas operations at a depth of 900 m could be associated with more than 60 km of pipeline length to reach an onshore system for a typical seabed bathymetry. This paper assesses the potential reuse of the POGP as a CWP for the Ocean OTEC system. The temperature distribution within CWP is analyzed using a thermal and fluid dynamics approach. The results show that the reuse of POGP for the OTEC system could offer an excellent opportunity for capital cost reductions because the POGP has a remaining service life of over 20 years. However, the results of the analysis of heat and mass transfers show that the temperature change in cold seawater at CWP is about 3 to 6 oC, depending on the technical scenarios of the pipelines. The POGP used in the OTEC system could be suitable for a 20 kW OTEC system with practically no cost of pipelines, which usually accounts for a significant investment cost.

Water–Energy Nexus-Based Optimization of the Water Supply Infrastructure in a Dryland Urban Setting

Managing water supply systems is essential for developing countries to face climate variability in dryland settings. This is exacerbated by high energy costs for pumping, water losses due to aging infrastructures, and increasing demand driven by population growth. Therefore, optimizing the available resources using a water–energy nexus approach can increase the reliability of the water distribution network by saving energy for distributing the same water. This study proposes a methodology that optimizes the Water Distribution Network (WDN) and its management that can be replicated elsewhere, as it is developed in a data-scarce area. Indeed, this approach shows the gathering of WDN information and a model to save energy by optimizing pump schedules, which guarantee water distribution at minimal operational costs. The approach integrates a genetic algorithm to create pumping patterns and the EPANET hydraulic simulator to test their reliability. The methodology is applied for a water utility in the dryland urban setting of Lodwar, Turkana County, Kenya. The results indicate a potential reduction in energy costs by 50% to 57% without compromising the supply reliability. The findings highlight the potential of WEN-based solutions in enhancing the efficiency and sustainability of data-scarce water utilities in dryland ecosystems.

Digital Flexible Ureteroscope: Evaluating Factors Responsible for Damage and Implementing a Mandatory Certification Program for Usage.

Objective: Digital flexible ureteroscopes (DFUs) play a crucial role in endourological procedures, and scope breakages are often avoidable with proper measures in place. We aimed to evaluate the effect of mandatory training on DFU durability and to assess the influence of various factors on instrument damage. Materials and Methods: Mandatory training involving instructional videos on DFU care was introduced for all processing and operating room staff handling DFUs. Only certified personnel were allowed to handle DFUs, with meticulous usage documentation. The average annual usage of each DFU was compared pre and post program implementation. We examined factors such as patient demographics, procedure details, and operator experience impacting scope life using negative binomial regression. Results: The average usage of DFU increased by 21%, from 6.38 to 7.74 cases. We found that post-graduate year stood out as a significant predictive factor (estimate = 3.28, p = 0.04). Moreover, the streamlined model revealed that previous ureteral-stent use (estimate = 0.94, p < 0.001), struvite stones (estimate = 3.08, p = 0.01), and a higher number of stones (estimate = 0.11, p = 0.04) were associated with an increased number of procedures before DFU breakage, whreas in situ lithotripsy in the lower calyx was associated with a reduced number of procedures before DFU breakage (estimate = -1.11, p = 0.003). Conclusion: Implementing a mandatory training program showed an increase in DFU durability by 21%, suggesting a potential reduction in annual repair and replacement costs by the same percentage. Furthermore, outcomes were more favorable when experienced practitioners conducted treatments, especially in cases involving struvite stones.

Optimization of operational strategies for industrial applications of solar-based green hydrogen

Renewable-based green hydrogen is emerging as a viable solution for decarbonizing energy-intensive industries. However, the fluctuating and intermittent nature of renewable energy sources requires careful consideration of operational strategies to ensure the safe and economical use of green hydrogen in industrial applications. This study examines the influence of operational strategies for electrolyzers and downstream processes on the cost of solar-based green hydrogen. The results demonstrate that optimal operational strategies for electrolyzers significantly impact the sizes of batteries and electrolyzers, reducing the Levelized Cost of Hydrogen (LCOH) by an average of 5.3%. Case studies further demonstrate that decentralized end-user supply strategies and cooperation with downstream processes can reduce LCOH by up to 39.8% for fully distributed end-users and by 24.2% with the introduction of supply tolerance. Additionally, the study evaluates the impact of grid backup, revealing that grid utilization can reduce LCOH by 12.9% in Houston, underscoring the potential for further cost reductions through grid decarbonization. These findings highlight the importance of optimizing operational strategies to improve the economic performance and market viability of green hydrogen systems.

A data-driven framework for occupancy optimisation strategies towards energy demand reduction in non-domestic buildings

Proactive strategies for data-driven operational schedules based on monitored occupancy patters can enable energy demand reduction and optimal resource utilisation. A replicable framework that enables strategic closure of specific thermal zones is introduced and design and operational considerations are discussed. The potential of the framework is illustrated through a case study building, where up to 6% annual energy savings were estimated, highlighting the effectiveness of zone closures. Further findings indicated that total energy savings from the simultaneous closure of multiple zones were marginally larger compared to savings from closing off zones individually, depending on zone capacity and use. Therefore, balanced considerations should take place prior to selecting which zones to close off, also taking into account user acceptability, capacity of systems and controls as well as the internal layout of the building. The research enhances the understanding of the relationship between occupancy and energy demand, while offering recommendations for more energy efficient and sustainable building design and operations that require minimal capital cost. Practical Application This paper provides design and operational considerations based on a robust and replicable framework for energy savings by optimising operational building schedules based on monitored occupancy patterns. This allows a proactive implementation of data-driven strategies that maximise resource utilisation, such as closure of specific zones during periods of low occupancy, without requiring any physical intervention. The findings on a case study building demonstrate that annual energy savings can be achieved, underscoring the potential for substantial cost reductions and improved energy efficiency. Applications can also extend to optimising energy demand for energy flexibility.

Overcoming barriers to proactive plastic recycling toward a sustainable future

The plastics sector, accounting for a significant portion of global emissions, presents a challenge and an opportunity in achieving carbon neutrality. Despite Japan's commendable polyethylene terephthalate (PET) bottle recycling rates, most plastics are thermally recycled, creating environmental issues. This study proposes an evaluation framework to enhance recycling, aligned with end-user preferences and fostering a circular plastics economy. Employing a mixed-methods approach, this study conducts fieldwork including interviews with plastic recyclers and analysis of industry data. A weighted sum multicriteria analysis integrating end-user preferences, recycling effectiveness, and market dynamics is utilized. Systemic, process, and policy challenges were shown to hinder sustainable recycling practices, while varying willingness to pay, emission and cost reduction potentials, among acceptability and sectoral diversity informed priority plastic types for recycling. Multicriteria analysis showed that although PET is favored by end users, Polyoxymethylene (POM) emerges as a potential priority target for manufacturers and recyclers. Sensitivity analysis underscores the potential impact of establishing or enhancing willingness to pay (WTP) toward certain plastic types. Moreover, manufacturer and recycler evaluations suggest a broader willingness to recycle plastics than previously assumed. The proposed evaluation framework offers insights toward plastic recycling strategies. Policy interventions such as sustained subsidies for recyclers, market incentives leveraging WTP preferences, and technological advances, including chemical recycling and the broadening of plastic type recycling in line with user and manufacturer preferences, could all contribute to promoting sustainable plastic recycling practices.

Engineering a high-sugar tolerant strain of Saccharomyces cerevisiae for efficient trehalose production using a cell surface display approach

Trehalose production via a one-step enzymatic route using trehalose synthase (TreS) holds significant promise for industrial-scale applications due to its simplicity and utilization of low-cost substrates. However, the development of a robust whole-cell biocatalyst expressing TreS remains crucial for enabling practical and economically viable production. In this study, a high-sugar tolerant strain of S. cerevisiae was screened and employed as a host cell for the cell surface display of TreS from Acidiplasma aeolicum. The resultant strain, S. cerevisiae I3A, exhibited remarkable surface displayed TreS activity of 3358 U/g CDW and achieved approximately 64% trehalose yield (10.8 g/L/h productivity) from maltose. Interestingly, no glucose by-product was observed during trehalose production. The S. cerevisiae I3A cells exhibited reusability for up to 12 cycles leading to potential cost reduction of trehalose products. Therefore, our study demonstrated the development of a high-sugar tolerant S. cerevisiae strain expressing TreS on its surface as a whole-cell biocatalyst for efficient and economical trehalose production with potential applications in the food and pharmaceutical industries.

Advanced optimization of elastic sheets for solar parabolic trough concentrators: integrating particle swarm optimization and genetic algorithms

Abstract The fabrication of solar parabolic trough concentrators using flat elastic sheets presents a straightforward and cost-effective method. This paper introduces an optimization technique centered on stiffness adjustment, harnessing elastic buckling to attain precise parabolic shapes in these concentrators. Through an enhanced Particle Swarm Optimization-Genetic Algorithm (PSO-GA), strategically punched holes are optimized on the flat sheet, allowing for the attainment of perfect parabolic shapes by controlling the chord length with a positional rod or cable. The efficacy of this approach is showcased not only through interactive finite element analysis and ray tracing software simulations but also via experimental sunlight concentration. A geometric concentration ratio of up to 145.16 is achieved, underscoring the effectiveness of this innovative concept. This approach facilitates the simple fabrication and transportation of flat mirror elements to field sites, where they can be assembled into parabolic trough concentrators, offering potential cost reductions and highly efficient solar energy solutions.

Reducing the cost of home energy upgrades in the US: An industry survey

Decarbonizing the US residential building stock requires a substantial acceleration in home energy upgrades. Numerous barriers exist to accelerating adoption of efficient and electric building technologies, but foremost among these is high upfront costs. This study uses an industry survey delivered to a sample of home energy professionals to examine promising cost reduction strategies across a range of project types, including HVAC, water heating, and envelope/insulation projects. The survey included quantitative and qualitative questions to collect evidence on the estimated cost reduction potential of these strategies and their likelihood of use in the construction industry. The 167 survey respondents included contractors, energy consultants, architects, manufacturers, and others with experience in delivering energy upgrades in single-family and multifamily buildings in the US. Results show that significant cost reductions are achievable by minimizing additional infrastructure costs (such as replacing electric panels), streamlining project planning/management, and deploying innovations that simplify installation. We find that for a typical deep retrofit project, including heat pumps for space and water heating in addition to envelope upgrades, the strategies could result in a total installed cost reduction of nearly 50 %, dramatically improving the customer economics of such a project. This research makes a novel contribution to the literature on strategies to reduce the costs of residential retrofits. We discuss how our study's insights on the highest-value cost reduction strategies for home energy upgrades can further accelerate their uptake in the US housing stock.

Analysis of graphene as a potential filtration membrane for desalination at varying operating conditions using molecular dynamics simulation and response surface methodology

ABSTRACT Water scarcity is a critical global issue exacerbated by pollution and overuse, necessitating sustainable water management solutions. Desalination using membrane technology presents a promising approach for freshwater production. This study investigated the performance of nanoporous (NPG) membranes for desalination, focusing on the influence of pressure and temperature on water flux and ion rejection. Utilizing molecular dynamics (MD) simulations with the LAMMPS package, this study evaluates NPG membranes under various conditions of pressures and temperatures. The simulations demonstrate that increasing both the pressure and temperature enhances the water flux without compromising ion rejection. The results indicate that at 300 K and 50 MPa, the water flux exceeds 2000 L/m2 h bar, significantly outperforming traditional reverse osmosis membranes, which typically achieve a capacity of approximately 1 L/m2 h bar. These findings were validated experimentally, aligning with previous research and confirming the superior performance of NPG membranes. A statistical model derived from response surface methodology revealed a linear relationship between pressure, temperature, and water flux. The study concludes that NPG membranes offer a high efficiency and scalable solution for desalination, with significant potential for energy savings and cost reduction. This study underscores the viability of NPG membranes in addressing global freshwater shortages and provides a pathway for sustainable water production.

Investigation of γ-polyglutamic acid production via asynchronous saccharification and fermentation of raw corn starch.

Starch, a crucial raw material, has been extensively investigated for biotechnological applications. However, its application in γ-polyglutamic acid (γ-PGA) production remains unexplored. Based on γ-PGA output of Bacillus subtilis SCP010-1, a novel asynchronous saccharification and fermentation process for γ-PGA synthesis was implemented. The results revealed that a starch concentration of 20%, α-amylase dosage of 75 U/g, liquefaction temperature of 72℃, and γ-PGA yield of 36.31g/L was achieved. At a glucoamylase dosage of 100 U/g, saccharification 38h at 60℃, the yield of γ-PGA increased to 48.88g/L. The contents of total sugar, glucose, maltose and oligosaccharide in saccharified liquid were determined. Through batch fermentation of saccharified liquid in fermentor, the γ-PGA output was elevated to 116.08g/L. This study can offer a potential cost reduction of 40%, which can be a promising advancement in industrial γ-PGA production. Moreover, our approach can be applied in other starch-based fermentation industries.

Two-phase matheuristic for assignment and truck loading problems

We introduce a novel two-phase matheuristic for assignment and truck loading. The scope of our approach involves scenarios with an extensive amount of items requiring assignment to a heterogeneous fleet of trucks and subsequent transportation. A distinguishing feature of our matheuristic lies in the fact that the complex underlying problem is divided into subproblems which later are merged into a global solution. The proposed matheuristic tackles the assignment problem in its first phase, followed by a complex truck loading algorithm to validate the assignment solution in the second phase. This enables the identification of optimal solutions and adaptability to diverse use cases. This approach is motivated by the ROADEF/EURO challenge 2022 and is awarded with the scientific prize of the challenge. We demonstrate superior performance on selected instances, showcasing the potential for significant cost reduction in Renault’s supply chains.

Computationally cost-efficient analysis of the flow behavior of twin-fluid atomizers using computational fluid dynamics

In industrial-scale operations, wet electrostatic precipitators (WESPs) are used to minimize particulate matter, employing atomizers such as single-fluid and twin-fluid atomizers (TFAs). While TFAs provide several benefits over single-fluid atomizers, quantifying their spray characteristics is more complex, necessitating comprehensive case studies to design the internal structure of the spray and achieve desired properties. This study employed computational fluid dynamics (CFD) to simulate the internal and external flow phenomena of TFAs in industrial-scale WESPs, aiming to facilitate various parametric studies by reducing the high computational costs associated with analyzing high-speed internal flows and particle dynamics within the spray system. To decrease computational costs, the simulation was divided into two parts using stepwise segregated scenarios: Part I focused on the high-cost internal flow analysis, examining the spatiotemporal evolution of internal flow until it is fully developed, followed by droplet size distribution estimation at the nozzle. Part II computed the external flow of the spray, assessed potential cost reductions by examining the interactions between dispersed droplets, and validated the spray angle, penetration, and coverage against experimental data. The segregated strategy employed mapping techniques to integrate the two parts seamlessly. The simulation results closely matched the experimental benchmarks for spray angle, penetration, and coverage within a minimal error margin (<5%), demonstrating the model’s accuracy in capturing actual spray phenomena in TFAs. This approach significantly reduced the computational cost by more than twentyfold compared to conventional one-step solvers, offering a viable method for conducting various case studies in spray CFD simulations.

Artificial Intelligence Supporting Early Automotive Engineering Processes

Abstract Due to progressive increase of complexity, the automotive industry is subject to constantly changing trends varying from the introduction of greener products and components to the deployment of technological advances in development and engineering processes. In relation to both, sustainable automotive products as well as the deployment of technological advances, the integration of AI (Artificial Intelligence) approaches in combination with virtual products in automotive development and engineering processes is of great importance. In combination with knowledge-based CAx (Computer-Aided engineering), the integration of AI approaches delivers an enormous potential to enhance automotive development processes. In addition to process optimizations, the integration of various AI approaches considers sustainability (e.g., optimization of component geometries and materials, reduction of emissions over the entire life cycle, CO2 reduction through improved development) and economical aspects (e.g., resources savings throughout the entire development process, time and cost savings through earlier error detection, avoidance of unnecessary process steps). The present approach deals with the integration of AI and knowledge-based engineering methods in the early phases of automotive development and engineering processes. Furthermore, the paper points to the time, cost and resources reduction potential, leading to earlier market entries and a greener industry. Finally, the paper demonstrates the integration of AI technologies into industrial development and engineering processes based on selected application scenarios.

A single dose of recombinant adenoviral vector rabies vaccine expressing two copies of glycoprotein protects mice from lethal virus challenge.

Rabies is a fatal infectious disease, that poses a major public health threat in developing countries. With an annual death toll of approximately 59,000, more than half of which are children, an urgent need exists for a safe, affordable, and effective preventive measure against rabies virus infection. A recombinant rabies vaccine called Ad5-dRVG was constructed by introducing two copies of the rabies virus glycoprotein into a human adenoviral vector. Virus-neutralizing assays and virus challenge experiments were employed to evaluate the Ad5-dRVG vaccine. Our findings demonstrate that a single dose of Ad5-dRVG, administered either intramuscularly or orally, elicited significantly stronger immune responses than Ad5-RVG. Moreover, both vaccines provided complete protection in mice. Notably, the vaccine exhibited remarkable efficacy even at low doses, suggesting potential cost reduction in production. The development of the Ad5-dRVG recombinant rabies vaccine represents a significant advancement in rabies prevention. Its enhanced immunogenicity, demonstrated efficacy and potential cost savings make it a promising candidate for widespread use.

The moderating effect of emission reduction policies on CCS mitigation efficiency

Carbon capture and storage (CCS) is a critical decarbonization technology for achieving net-zero emissions. High energy costs currently hinder the application of CCS, whereas carbon emission reduction measures directly alter the energy price and influence the cost and emission reduction potential of CCS. However, few studies have focused on the potential impacts and underlying mechanisms of emission reduction policies on CCS. In this study, we construct a computable general equilibrium model with CCS technology to assess the moderating effect of mitigation policies on CCS, and identify feasible policy portfolios to enhance CCS mitigation efficiency. Taking China as a typical case, the results show that, first, energy efficiency improvement and renewable energy policy contribute to mitigating the negative economic impacts of CCS abatement, and terminal electrification policy can enhance the emission reduction of CCS, whereas none of the three measures can achieve a win-win situation in terms of economic and emission impacts. Second, the moderating effect of mitigation policies on CCS exhibits heterogeneity among CCS deploying industries. Promoting terminal electrification is optimal for the coal power industry to improve CCS mitigation efficiency, while renewable energy development has a larger positive effect on the steel, cement, and chemical industries. Third, the combination of a high-intensity renewable energy policy with low-intensity energy efficiency improvements and terminal electrification policy is optimal for overall mitigation efficiency.

Policies and cost analyses of voluntary assisted dying (VAD) laws – a mapping review & analysis

ObjectivesTo investigate the current literature on healthcare policies and cost analyses around international Voluntary Assisted Dying (VAD) laws. The study design is a mapping literature review following Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA) guidelines.MethodsOriginal research articles published between January 1990 to March 2023, investigating the financial cost and healthcare budget effect of VAD laws internationally. Citations were screened for relevance and eligibility, and any non-full-text research that did not explore cost analysis was excluded. The following data sources were screened: MEDLINE, PubMed, EMBASE, CINAHL and any relevant international health authority annual reports were also reviewed.ResultsOf the 2790 screened articles, eight studies met the inclusion criteria and three were included in the mapping review. The reviewed studies included prospective studies, two Canadian and one US. Only one of the Canadian studies provided a cost analysis using data from current VAD laws. All three studies showed VAD laws would reduce healthcare spending, with the US approximating $627million in 1995. Canada approximating $17.1 to $77.1million in 2017 and $86.9 to $149.0million in 2021, overall, leading to an average percentage reduction in costs of approximately 87% compared to original costs of end-of-life care.ConclusionThis review identifies a scarcity in cost-analysis literature and provides a summary of the latest international VAD laws, from which a potential cost reduction is apparent. The absence of retrospectively collated financial VAD data highlights a need for future research to inform policymakers of the economic factors affecting current policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally.

Dexmedetomidine as Adjunctive Therapy for the Treatment of Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis.

Alcohol withdrawal syndrome (AWS) is defined as the cessation or reduction in heavy and prolonged alcohol use within several hours to a few days of cessation. The recommended first-line therapy for AWS ranging from mild to severe or complicated remains benzodiazepines; in cases where benzodiazepines are not adequate in controlling persistent autonomic hyperactivity or anxiety, dexmedetomidine could be utilized. The possible advantage of dexmedetomidine compared to benzodiazepines is that it does not cause respiratory depression, thus reducing the risk of intubation and hospitalization in the ICUs, with the potential reduction in healthcare costs. The purpose of this systematic review and meta-analysis (PROSPERO CRD42018084370) is to evaluate the effectiveness and safety of dexmedetomidine as adjunctive therapy to the standard of care for the treatment of AWS. We retrieved literature from PubMed, EMBASE, and CENTRAL until 10 January 2024. Eligible studies were both randomized trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was tracheal intubation; secondary outcomes were (i) bradycardia and (ii) hypotension. A total of 3585 papers were retrieved: 2635 from EMBASE, 930 from Medline, and 20 from CENTRAL. After eliminating duplicates, 2960 papers were screened by title and abstract; 75 out of the 2960 papers were read in full text. The qualitative synthesis included nine of all manuscripts read in full text. The quantitative synthesis included eight studies for the primary outcome (tracheal intubation), seven for the secondary outcome bradycardia, and six for the secondary outcome hypotension. The meta-analysis showed that Dexmedetomidine, as adjunctive therapy, is not more effective than standard therapy in reducing the risk of tracheal intubation in AWS [RR: 0.57, 95% CI: 0.25-1.3, p = 0.15]. It also appears to be less safe than sedative therapy as it significantly increases the risk of bradycardia [RR: 2.68, 95% CI: 1.79-4.16, p = 0.0016]. Hypotension was not significantly different in patients who received dexmedetomidine [RR: 1.5, 95% CI: 0.69-3.49, p = 0.21].