A randomised controlled trial to evaluate the peri-operative role of intraoperative dexmedetomidine infusion in robotic-assisted laparoscopic oncosurgeries

Abstract

Background: Robotic and minimal invasive surgeries pose challenges to the anaesthesiologists. Dexmedetomidine (dexmed), with distinct properties of sedation and analgesia has emerged as a promising drug. Our primary aim, in this double-blinded study, was to evaluate reduction in the intraoperative opioid requirement with the use of intravenous dexmed infusion. Secondary objectives included effect on intraoperative anaesthetic and postoperative analgesic requirement. Methodology: After approval from Ethics board and registration of the trial, 46 eligible patients planned for robotic oncosurgeries (abdomen) were included. As per computer generated randomisation chart, patients were randomised into either dexmed or saline group. Five minutes after insufflation of the abdomen, the study drug bolus—saline or dexmed (1 μg/kg) was given over 10 min and was followed by maintenance infusion (0.2 μg/kg/h) until release of pneumoperitoneum. Study drug titration, fentanyl boluses, and changes in minimum alveolar concentration (MAC) of inhalational agent were protocolised. Results: The mean intraoperative fentanyl requirement was significantly lower in the dexmed group 192.6 μg (±66.4) versus the saline group 260.7 μg (±88.6), P = 0.013. The MAC requirement of inhalational agent was significantly lower in the dexmed group. Intraoperative episodes of hypotension and bradycardia were similar in both groups. First analgesic request, 24 h postoperative pain scores and side effects profile were comparable in both groups. Conclusion: Intraoperative dexmed (bolus of 1 μg/kg followed by 0.2 μg/kg/h infusion) has an opioid and inhalational anaesthetic sparing role during robotic oncosurgeries. However, no benefit of the infusion is seen in the postoperative period.

Assessment of the effect of two different doses of intranasal nitroglycerine spray on attenuation of haemodynamic stress response to pneumoperitoneum in laparoscopic surgeries: A randomised, double-blinded study

“…To reduce the haemodynamic changes and pathophysiologic influences due to pneumoperitoneum, proper maintenance of preload and systemic vascular resistance is required and agents including vasodilators, high dose opioids, calcium channel blockers, beta blockers and alpha-2 agonists have been selectively used. [ 2 3 4 ]…”

Opioid-free anaesthesia: The conundrum and the solutions

“…This wonder drug labelled as an anti-anxiety, sedative-analgesic drug of the 21 st century in both paediatric and adult anaesthesia, has replaced perioperative opioid utilisation to a large extent. [ 11 ] The spectrum has further widened to include labour analgesia, preeclampsia and neuraxial analgesia in the parturient, with negligible effects on foetal APGAR scores and well-being. [ 12 ] In children, dexmedetomidine is used perioperatively as a pre-medicant, analgesic and adjunct for airway procedures.…”