title: Effect of Intraoperative Dexmedetomidine Infusion on Postoperative Bowel Movements in Patients Undergoing Laparoscopic Gastrectomy: A Prospective, Randomized, Placebo-Controlled Study.
abstract: Sympathetic hyperactivation is one of the causes of postoperative ileus, which occurs frequently after abdominal surgery and adversely influences the patient's prognosis. We aimed to investigate whether dexmedetomidine (DEX) could attenuate postoperative ileus in patients undergoing laparoscopic gastrectomy. Ninety-two patients were randomized to the control (n = 46) or DEX group (n = 46). DEX was administered at a loading dose of 0.5 μg/kg for 10 minutes, followed by an infusion rate of 0.4 μg/kg/h from insufflation of the pneumoperitoneum to the end of surgery. The primary goal was to compare postoperative bowel movements by evaluating the time to first flatus. The balance of the autonomic nervous system, duration of postoperative hospital stay, and pain scores were assessed. The time to first flatus was shorter in the DEX group compared with the control group (67.2 ± 16.8 hours vs 79.9 ± 15.9 hours, P < 0.001). The low-frequency/high-frequency power ratio during pneumoperitoneum increased in the control group, compared with baseline values and the DEX group. The length of postoperative hospital stay was shorter in the DEX group compared with the control group (5.4 ± 0.7 days vs 5.8 ± 1.1 days, P = 0.04). Patients in the DEX group had lower pain scores and required fewer analgesics at 1 hour postoperatively. DEX facilitated bowel movements and reduced the length of hospital stay in patients undergoing laparoscopic gastrectomy. This may be attributed to the sympatholytic and opioid-sparing effects of DEX.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine (JSC, K-YL, SJB, JYC, YCY); Department of Surgery (H-IK, JYA); and Anesthesia and Pain Research Institute (K-YL, SJB, YCY), Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Sun
authors.initials: JS
authors.lastname: Cho
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Ki-Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.forename: Sun Joon
authors.initials: SJ
authors.lastname: Bai
authors.forename: Ju Yeon
authors.initials: JY
authors.lastname: Cho
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Yoo
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D045823:Ileus / Q000188:drug therapy* / Q000209:etiology*; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine