+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables

Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables

Anesthesia and Analgesia 106(6): 1741-1748

Dexmedetomidine (Dex), an alpha(2) agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, double-blind, and placebo-controlled dose-ranging study to evaluate the effect of Dex on both early and late recovery after laparoscopic bariatric surgery. Eighty consenting ASA II-III morbidly obese patients were randomly assigned to 1 of 4 treatment groups: (1) control group received a saline infusion during surgery, (2) Dex 0.2 group received an infusion of 0.2 microg x kg(-1) x h(-1) IV, (3) Dex 0.4 group received an infusion of 0.4 microg x kg(-1) x h(-1) IV, and (4) Dex 0.8 group received an infusion of 0.8 microg x kg(-1) x h(-1) IV. Mean arterial blood pressure values were maintained within +/-25% of the preinduction baseline values by varying the inspired desflurane concentration. Perioperative hemodynamic variables, postoperative pain scores, and the need for "rescue" analgesics and antiemetics were recorded at specific intervals. Follow-up evaluations were performed on postoperative days (PODs) 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. Dex infusion, 0.2, 0.4, and 0.8 microg x kg(-1) x h(-1), reduced the average end-tidal desflurane concentration by 19, 20, and 22%, respectively. However, it failed to facilitate a significantly faster emergence from anesthesia. Although the intraoperative hemodynamic values were similar in the four groups, arterial blood pressure values were significantly reduced in the Dex 0.2, 0.4, and 0.8 groups compared with the control group on admission to the postanesthesia care unit (PACU) (P < 0.05). The length of the PACU stay was significantly reduced in the Dex groups (81 +/- 31 to 87 +/- 24 vs 104 +/- 33 min in the control group, P < 0.05). The amount of rescue fentanyl administered in the PACU was significantly less in the Dex 0.2, 0.4, and 0.8 groups versus control group (113 +/- 85, 108 +/- 67, and 120 +/- 78 vs 187 +/- 99 microg, respectively, P < 0.05). The percentage of patients requiring antiemetic therapy was also reduced in the Dex groups (30, 30, and 10% vs 70% in the control group). However, the patient-controlled analgesia morphine requirements on PODs 1 and 2 were not different among the four groups. Pain scores in the PACU, and on PODs 1, 2, and 7, in the three Dex groups were not different from the control group. Finally, quality of recovery scores and times to recovery of bowel function and hospital discharge did not differ among the four groups. Adjunctive use of an intraoperative Dex infusion (0.2-0.8 microg x kg(-1) x h(-1)) decreased fentanyl use, antiemetic therapy, and the length of stay in the PACU. However, it failed to facilitate late recovery (e.g., bowel function) or improve the patients' overall quality of recovery. When used during bariatric surgery, a Dex infusion rate of 0.2 microg x kg(-1) x h(-1) is recommended to minimize the risk of adverse cardiovascular side effects.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 030896673

Download citation: RISBibTeXText

PMID: 18499604

DOI: 10.1213/ane.0b013e318172c47c

Related references

Dexmedetomidine versus morphine infusion following laparoscopic bariatric surgery: effect on supplemental narcotic requirement during the first 24 h. Surgical Endoscopy 30(8): 3368-3374, 2016

The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery. Journal of Gastrointestinal Surgery 11(11): 1556-1559, 2007

The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. Journal of Neurosurgical Anesthesiology 25(1): 16-24, 2013

Effect of dexmedetomidine infusion for intravenous patient-controlled analgesia on the quality of recovery after laparotomy surgery. Oncotarget 8(59): 100371-100383, 2017

Effect of dexmedetomidine infusion on postoperative recovery for patients undergoing major spinal surgery during propofol anesthesia. Beijing Da Xue Xue Bao. Yi Xue Ban 48(3): 529-533, 2016

Comparison of Dexmedetomidine or Remifentanil Infusion Combined With Sevoflurane Anesthesia in Craniotomy: Hemodynamic Variables and Recovery. Neurosurgery Quarterly 19(2): 116-119, 2009

Effect of intratracheal dexmedetomidine administration on recovery from general anaesthesia after gynaecological laparoscopic surgery: a randomised double-blinded study. Bmj Open 8(4): E020614, 2018

The impact of dexmedetomidine or xylocaine continuous infusion on opioid consumption and recovery after laparoscopic sleeve gastrectomy. Minerva Anestesiologica 83(12): 1274-1282, 2017

Standardized perioperative protocol with enhanced recovery after major laparoscopic bariatric surgery reduces length of stay, improves quality of care, and optimizes resources in high-volume bariatric unit. Surgery for Obesity and Related Diseases 6(2): 233-234, 2010

Effect of short-term ketorolac infusion on recovery following laparoscopic day surgery. Anaesthesia and Intensive Care 28(6): 654-659, 2000

Meta-analysis on safety of application of enhanced recovery after surgery to laparoscopic bariatric surgery. Zhonghua Wei Chang Wai Ke Za Zhi 21(10): 1167-1174, 2018

Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. British Journal of Anaesthesia 111(2): 222-228, 2013

Effects of dexmedetomidine on propofol dosage in target-controlled infusion and hemodynamics during laparoscopic surgery under general anesthesia. Nan Fang Yi Ke Da Xue Xue Bao 35(10): 1497-1500, 2015

Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surgical Endoscopy 27(12): 4539-4546, 2013

Factors associated with prolonged anesthesia recovery following laparoscopic bariatric surgery: a retrospective analysis. Obesity Surgery 25(6): 1024-1030, 2015