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

Burcu Tufanogullari, Paul F. White, Mariana P. Peixoto, Daniel Kianpour, Thomas Lacour, James Griffin, Gary Skrivanek, Amy Macaluso, Mary Shah, David A. Provost

Research output: Contribution to journalArticle

188 Citations (Scopus)

Abstract

BACKGROUND: Dexmedetomidine (Dex), an α 2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, doubleblind, 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 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 μg · kg -1 · h -1 IV, (3) Dex 0.4 group received an infusion of 0.4 μg · kg -1 · h -1 IV, and (4) Dex 0.8 group received an infusion of 0.8 μg · kg -1 · 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. RESULTS: Dex infusion, 0.2, 0.4, and 0.8 μg · kg -1 · h -1, reduced the average endtidal 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 μg, 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. CONCLUSIONS: Adjunctive use of an intraoperative Dex infusion (0.2- 0.8 μg · kg -1 · 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 μg · kg -1 · h -1 is recommended to minimize the risk of adverse cardiovascular side effects.

Original languageEnglish (US)
Pages (from-to)1741-1748
Number of pages8
JournalAnesthesia and Analgesia
Volume106
Issue number6
DOIs
StatePublished - Jun 2008

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Dexmedetomidine
Bariatric Surgery
Laparoscopy
Control Groups
Antiemetics
Analgesics
Arterial Pressure
Recovery of Function
Fentanyl
Hemodynamics
Pain
Patient-Controlled Analgesia
Pain Management
Postoperative Pain
Patient Satisfaction
Morphine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Tufanogullari, B., White, P. F., Peixoto, M. P., Kianpour, D., Lacour, T., Griffin, J., ... Provost, D. A. (2008). Dexmedetomidine infusion during laparoscopic bariatric surgery: The effect on recovery outcome variables. Anesthesia and Analgesia, 106(6), 1741-1748. https://doi.org/10.1213/ane.0b013e318172c47c

Dexmedetomidine infusion during laparoscopic bariatric surgery : The effect on recovery outcome variables. / Tufanogullari, Burcu; White, Paul F.; Peixoto, Mariana P.; Kianpour, Daniel; Lacour, Thomas; Griffin, James; Skrivanek, Gary; Macaluso, Amy; Shah, Mary; Provost, David A.

In: Anesthesia and Analgesia, Vol. 106, No. 6, 06.2008, p. 1741-1748.

Research output: Contribution to journalArticle

Tufanogullari, Burcu ; White, Paul F. ; Peixoto, Mariana P. ; Kianpour, Daniel ; Lacour, Thomas ; Griffin, James ; Skrivanek, Gary ; Macaluso, Amy ; Shah, Mary ; Provost, David A. / Dexmedetomidine infusion during laparoscopic bariatric surgery : The effect on recovery outcome variables. In: Anesthesia and Analgesia. 2008 ; Vol. 106, No. 6. pp. 1741-1748.
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abstract = "BACKGROUND: Dexmedetomidine (Dex), an α 2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, doubleblind, 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 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 μg · kg -1 · h -1 IV, (3) Dex 0.4 group received an infusion of 0.4 μg · kg -1 · h -1 IV, and (4) Dex 0.8 group received an infusion of 0.8 μg · kg -1 · 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. RESULTS: Dex infusion, 0.2, 0.4, and 0.8 μg · kg -1 · h -1, reduced the average endtidal 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 μg, 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. CONCLUSIONS: Adjunctive use of an intraoperative Dex infusion (0.2- 0.8 μg · kg -1 · 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 μg · kg -1 · h -1 is recommended to minimize the risk of adverse cardiovascular side effects.",
author = "Burcu Tufanogullari and White, {Paul F.} and Peixoto, {Mariana P.} and Daniel Kianpour and Thomas Lacour and James Griffin and Gary Skrivanek and Amy Macaluso and Mary Shah and Provost, {David A.}",
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TY - JOUR

T1 - Dexmedetomidine infusion during laparoscopic bariatric surgery

T2 - The effect on recovery outcome variables

AU - Tufanogullari, Burcu

AU - White, Paul F.

AU - Peixoto, Mariana P.

AU - Kianpour, Daniel

AU - Lacour, Thomas

AU - Griffin, James

AU - Skrivanek, Gary

AU - Macaluso, Amy

AU - Shah, Mary

AU - Provost, David A.

PY - 2008/6

Y1 - 2008/6

N2 - BACKGROUND: Dexmedetomidine (Dex), an α 2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, doubleblind, 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 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 μg · kg -1 · h -1 IV, (3) Dex 0.4 group received an infusion of 0.4 μg · kg -1 · h -1 IV, and (4) Dex 0.8 group received an infusion of 0.8 μg · kg -1 · 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. RESULTS: Dex infusion, 0.2, 0.4, and 0.8 μg · kg -1 · h -1, reduced the average endtidal 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 μg, 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. CONCLUSIONS: Adjunctive use of an intraoperative Dex infusion (0.2- 0.8 μg · kg -1 · 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 μg · kg -1 · h -1 is recommended to minimize the risk of adverse cardiovascular side effects.

AB - BACKGROUND: Dexmedetomidine (Dex), an α 2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, doubleblind, 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 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 μg · kg -1 · h -1 IV, (3) Dex 0.4 group received an infusion of 0.4 μg · kg -1 · h -1 IV, and (4) Dex 0.8 group received an infusion of 0.8 μg · kg -1 · 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. RESULTS: Dex infusion, 0.2, 0.4, and 0.8 μg · kg -1 · h -1, reduced the average endtidal 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 μg, 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. CONCLUSIONS: Adjunctive use of an intraoperative Dex infusion (0.2- 0.8 μg · kg -1 · 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 μg · kg -1 · h -1 is recommended to minimize the risk of adverse cardiovascular side effects.

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