Autonomic activity during dexmedetomidine or fentanyl infusion with desflurane anesthesia.
OBJECTIVE
To evaluate autonomic activity with dexmedetomidine or fentanyl infusion and desflurane anesthesia during laparoscopic gastric banding.


METHODS
Randomized, single-blinded, open-label study.


METHODS
Operating rooms at a university hospital.


METHODS
40 patients scheduled for laparoscopic gastric banding with a mean body mass index of 50 kg/m2.


METHODS
Patients received either dexmedetomidine (0.5 microg/kg given intravenously over 10 minutes, 0.4 microg.kg-1.h-1, n=20) or fentanyl (0.5 microg.kg-1 bolus, 1 microg.kg-1.h-1, n=20) during anesthesia. Response entropy of the electroencephalogram was maintained at 45+/-5 by adjusting end-tidal desflurane concentration.


METHODS
In the operating room, blood pressure, heart rate (HR), response entropy, end-tidal desflurane concentration, tone entropy, and power-spectral analysis of HR were measured with the patient awake; 20, 40, and 60 minutes from intubation and the start of drug infusion; and at extubation.


RESULTS
The mean end-tidal desflurane concentration during anesthesia was 4.0%+/-0.6% with dexmedetomidine and 4.1%+/-0.7% with fentanyl, indicating a similar anesthetic requirement in both groups. Autonomic activity, determined by tone entropy and spectral analysis of HR, decreased by 50% during anesthesia in both groups. The dexmedetomidine group showed a greater decrease in sympathovagal balance during anesthesia.


CONCLUSIONS
Both dexmedetomidine and fentanyl facilitated anesthesia and attenuated autonomic activity. Dexmedetomidine produced a greater decrease in sympathovagal balance than fentanyl.
Feld
James
J
Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA.
Hoffman
William E
WE
Paisansathan
Chanannait
C
Park
Hans
H
Ananda
Ranga C
RC
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000502:physiology; D000077335:Desflurane; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D015391:Gastroplasty / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D016037:Single-Blind Method
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D020927:Dexmedetomidine; D000077335:Desflurane; D007530:Isoflurane; D005283:Fentanyl