Journal: Anesth Analg 106(6):1741-1748, 2008. 28 References
Reprint: Dept of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9068 (PF White, PhD, MD) RO.02 SP0822/262 ©2008
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Dexmedetomidine (Dex) is a highly selective alpha2-adrenoreceptor agonist that possesses hypnotic, sedative, anxiolytic, sympatholytic, and analgesic properties without producing significant respiratory depression. Dex has well-known anesthetic- and analgesic-sparing effects. This prospective, random¬ized, double-blind, placebo-controlled, dose-ranging study was designed to evaluate the effect of Dex on both early and late recovery after laparoscopic bariatric surgery.
Eighty morbidly obese patients, ASA PS 2 and 3, aged 22-66 years, scheduled for bariatric surgery (gastric banding or gastric bypass), were randomly assigned to one of four treatment groups (n=20 per group): (1) control group received saline infusion; (2) Dex 0.2 group received an infusion of 0.2 mcg/kg/hr; (3) Dex 0.4 group received an infusion of 0.4 mcg/kg/hr; and (4) Dex 0.8 group received an infusion of 0.8 mcg/kg/hr. Mean arterial blood pressure was maintained within ±25% of pre-induction baseline values by varying the inspired concentration of desflurane. Perioperative hemo¬dynamic variables, postoperative pain scores, and need for rescue analgesia and antiemetics were recorded at various intervals. Follow-up evaluations were performed on postoperative days 1, 2, and 7 to assess severity of pain, analgesic requirements, patient satisfaction with pain management, quality of recovery, as well as resumption of dietary intake and recovery of bowel function.
There were no significant differences among the four groups with respect to age, gender, weight, height, ASA physical status, type of bariatric surgery, perioperative cerebral state index (CSI) values, duration of study medication infusion, surgery and anesthesia time. Recovery time after disconnection of the study medication and desflurane to tracheal extubation, spontaneous eye-opening, and obeying simple commands did not differ among the four groups. The use of Dex infusion 0.2, 0.4, 0.8 mcg/kg/hr reduced the average end-tidal desflurane concentration by 19%, 20% and 22%, respectively.
Intraoperative hemodynamic values were similar in the four groups, yet arterial blood pressure values were significantly decreased in the Dex 0.2, 0.4, 0.8 groups compared with the control group on admission to PACU. The length of PACU stay was significantly decreased in the Dex groups compared to the control group. However, the PCA analgesia morphine requirement on postoperative days 1, 2, and 7 in the three Dex groups was not different among the four groups. Quality of recovery scores and time to recovery of bowel function did not differ among the four groups.
Adjunctive use of an intraoperative Dex infusion of 0.2-0.8 mc/kg/hr decreased fentanyl use, antiemetic therapy and length of stay in the PACU. However, it failed to facilitate recovery or improve the overall quality of recovery when used during bariatric surgery. A Dex infusion of 0.2 mcg/kg/hr is recom¬mended to minimize the risk of adverse perioperative cardiovascular side effects. |
