Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass.
BACKGROUND
Obese patients may be sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for management of bariatric surgery. We evaluated the effect of dexmedetomidine on anesthetic requirements during surgery, hemodynamic, recovery profile and morphine use in the postoperative period.


METHODS
Eighty adult patients scheduled for elective laparoscopic Roux-en-Y gastric bypass surgery were randomly assigned to one of two study groups; Group D (40 patients) received dexmedetomidine (0.8-microg/kg bolus, 0,4 microg kg(-1) h) and Group P (40 patients) received normal saline (placebo) in the same volume and rate. Intraoperative and postoperative mean blood pressure and heart rate were recorded. The total amount of intraoperative fentanyl and propofol required to maintain anesthesia were measured. Recovery profile, pain score and total amount of morphine used via patient controlled analgesia (PCA) were assessed.


RESULTS
During surgery, dexmedetomidine decreased the total amount of intraoperative fentanyl and propofol required for maintenance of anesthesia compared to placebo. Patients who received dexmedetomidine showed significant decrease of intraoperative and postoperative mean blood pressure, heart rate. In the postoperative period, dexmedetomidine decreased pain scores and PCA morphine use significantly and showed better recovery profile as compared to the placebo Group. There was no difference in the incidence of postoperative nausea and vomiting (PONV) between both groups.


CONCLUSIONS
The intraoperative infusion of dexmedetomidine decreased the total amount of propofol and fentanyl required to maintain anesthesia, offered better control of intraoperative and postoperative hemodynamics, decreased postoperative pain level, decreased the total amount of morphine used and showed better recovery profile compared with placebo.
Saad Specialist Hospital.
Hassan S
HS
Bakhamees
Yasser M
YM
El-Halafawy
Hala M
HM
El-Kerdawy
Nevien M
NM
Gouda
Sultan
S
Altemyatt
D000316:Adrenergic alpha-Agonists; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000713:Anastomosis, Roux-en-Y; D000771:Anesthesia, Intravenous; D000777:Anesthetics / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D020927:Dexmedetomidine; D005260:Female; D015390:Gastric Bypass; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000627:therapeutic use; D009767:Obesity, Morbid / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D000777:Anesthetics; D018686:Anesthetics, Intravenous; D020927:Dexmedetomidine; D009020:Morphine; D015742:Propofol