Dexmedetomidine Infusion During Laparoscopic Bariatric Surgery The Effect on Recovery Outcome

Anesthetic Pharmacology

Preclinical Pharmacology Section Editor:Marcel E.Durieux Clinical Pharmacology Section Editor:Tony Gin

Dexmedetomidine Infusion During Laparoscopic Bariatric Surgery:The Effect on Recovery Outcome Variables

Burcu Tufanogullari,MD* Paul F.White,PhD,MD* Mariana P.Peixoto,MD* Daniel Kianpour,MS*

Thomas Lacour,MD*

James Griffin,MD*

Gary Skrivanek,MD*

Amy Macaluso,MD*

Mary Shah,MD* David A.Provost,MD†BACKGROUND:Dexmedetomidine(Dex),an␣

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.

METHODS:Eighty consenting ASA II–III morbidly obese patients were randomly assigned to1of4treatment groups:(1)control group received a saline infusion during surgery,(2)Dex0.2group received an infusion of0.2␮g⅐kgϪ1⅐hϪ1IV,(3) Dex0.4group received an infusion of0.4␮g⅐kgϪ1⅐hϪ1IV,and(4)Dex0.8group received an infusion of0.8␮g⅐kgϪ1⅐hϪ1IV.Mean arterial blood pressure values were maintained withinϮ25%of the preinduction baseline values by varying the inspired desflurane concentration.Perioperative hemodynamic variables,postop-erative pain scores,and the need for“rescue”analgesics and antiemetics were recorded at specific intervals.Follow-up evaluations were performed on postop-erative days(PODs)1,2,and7to assess severity of pain,analgesic requirements, patient satisfaction with pain management,quality of recovery,as well as resump-tion of dietary intake and recovery of bowel function.

RESULTS:Dex infusion,0.2,0.4,and0.8␮g⅐kgϪ1⅐hϪ1,reduced the average end-tidal desflurane concentration by19,20,and22%,respectively.However,it failed to facilitate a significantly faster emergence from anesthesia.Although the intra-operative hemodynamic values were similar in the four groups,arterial blood pressure values were significantly reduced in the Dex0.2,0.4,and0.8groups compared with the control group on admission to the postanesthesia care unit (PACU)(PϽ0.05).The length of the PACU stay was significantly reduced in the Dex groups(81Ϯ31to87Ϯ24vs104Ϯ33min in the control group,PϽ0.05).The amount of rescue fentanyl administered in the PACU was significantly less in the Dex 0.2,0.4,and0.8groups versus control group(113Ϯ85,108Ϯ67,and120Ϯ78vs 187Ϯ99␮g,respectively,PϽ0.05).The percentage of patients requiring antiemetic therapy was also reduced in the Dex groups(30,30,and10%vs70%in the control group).However,the patient-controlled analgesia morphine require-ments on PODs1and2were not different among the four groups.Pain scores in the PACU,and on PODs1,2,and7,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. CONCLUSIONS:Adjunctive use of an intraoperative Dex infusion(0.2–0.8␮g⅐kgϪ1⅐hϪ1)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 of0.2␮g⅐kgϪ1⅐hϪ1is recommended to minimize the risk of adverse cardiovascular side effects.

(Anesth Analg2008;106:1741–8)

D exmedetomidine(Dex)is a highly selective␣2-adrenoreceptor agonist,which possesses hypnotic,sedative,anxiolytic,sympatholytic,and analgesic properties without producing significant respiratory depression.1–4Its sympatholytic effect decreases mean arterial blood pressure(MAP)and heart rate(HR)by reducing norepinephrine release.5,6In addition,Dex has the ability to reduce both the anesthetic and opioid analgesic requirements during the perioperative period.7–9 As a result of the prevalence of obesity in modern societies,bariatric surgery continues to grow throughout

From the Departments of*Surgery,†Anesthesiology and Pain Management,University of Texas Southwestern Medical Center at Dallas,Dallas,Texas.

Accepted for publication February8,2008.

This investigator–initiated,Food and Drug Administration-approved study was supported,in part,by an unrestricted educa-tional grant from Hospira,Inc.(Lake Forest,IL),endowment funds from the Margaret Milam McDermott Distinguished Chair in An-esthesiology,and the White Mountain Institute,a non-profit private

foundation(Paul F.White,President).

Address correspondence and reprint requests to Dr.Paul F. White,Professor and Holder of the Margaret Milam McDermott Distinguished Chair in Department of Anesthesiology and Pain Management,University of Texas Southwestern Medical Center at Dallas,5323Harry Hines Boulevard,Dallas,TX75390-9068.Ad-dress e-mail to paul.white@.

Copyright©2008International Anesthesia Research Society DOI:10.1213/ane.0b013e318172c47c