Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic videolaparoscopic surgery.
OBJECTIVE
To evaluate the capacity of dexmedetomidine (DEX), an alpha(2) adrenergic agonist drug, as a substitute for remifentanil (REM), a potent opioid, in total intravenous anesthesia (TIVA), in patient undergoing gynecologic videolaparoscopy.


METHODS
Randomized, single-blinded study.


METHODS
University-affiliated hospital.


METHODS
30 ASA physical status I and II women, patients (22-56 yrs), scheduled for gynecologic videolaparoscopy.


METHODS
Patients were anesthetized with DEX or REM in continuous venous infusion, associated with propofol, in a target-controlled infusion.


METHODS
Heart rate, mean blood pressure (MBP), systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma glucose, and cortisol were determined before anesthetic induction, 5 minutes after tracheal intubations and 30 minutes after initial surgical incision. Extubation and orientation times, and postanesthesia care unit (PACU) discharge times were noted.


RESULTS
Blood cortisol levels were higher in the DEX group than in the REM group at 30minutes after surgical incision. Cortisol levels decreased as a function of time in the REM group, whereas intheDEX group they decreased in the second sample and returned to basal levels at 30 minutes. Hyperglycemia was higher in DEX than in REM during the second and third sample collection. However, glucose increased as a function of time in both groups. Analysis of MBP and DBP indicated adecrease in blood pressure at 5 minutes after tracheal intubations in both groups. At 30 minutes afterincision, MBP and DBP returned to basal levels in the DEX group, whereas the variables were significantly lower in the REM group. There were significant differences between groups for systolic blood pressure and heart rate at 5 and 30 minutes after incision with a greater decrease in REM. The extubation and orientation times were significantly increased in the DEX group, when compared with those of the REM group. There were no differences in postanesthesia care unit discharge times between groups.


CONCLUSIONS
Dexmedetomidine was a clinically effective drug as a REM substitute in TIVA, during minimally invasive video gynecologic surgical procedures; however, patients anesthetized with DEX showed a more prolonged recovery time for some parameters such as orientation and extubation times.
Bulow
Neusa Maria H
NM
Department of Surgery, Centro de Ensino e Treinamento de Anestesiologia, Hospital Universitário de Santa Maria, Centro de Ciencias da Saude, Santa Maria, CEP 97105-900 RS, Brazil. jbtrocha1@yahoo.com.br
Barbosa
Nilda Vargas
NV
Rocha
Joao Batista Teixeira
JB
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000771:Anesthesia, Intravenous; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010535:Laparoscopy; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D016037:Single-Blind Method
D000701:Analgesics, Opioid; D001786:Blood Glucose; D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil; D006854:Hydrocortisone; D015742:Propofol