Effect of a low-dose dexmedetomidine infusion on intraoperative hemodynamics, anesthetic requirements and recovery profile in patients undergoing lumbar spine surgery

Abstract

Background and Aims: Dexmedetomidine has been used as an anesthetic adjuvant; however, hypotension is a concern especially in prone patients. The aim of the study was to evaluate the effect of a low-dose dexmedetomidine infusion on intraoperative hemodynamics, blood loss, anesthetic requirements, and recovery profile in patients undergoing lumbar spine surgery in the prone position. Material and Methods: The study was conducted in a randomized double-blinded manner in 60 patients scheduled for one- or two-level lumbar laminectomy. After administration of general anesthesia, patients were placed in prone position and allocated to either of two groups of 30 patients each. Patients in Group A received dexmedetomidine infusion at the rate of 0.3 μg kg -1 hr -1 , whereas, group B patients received a saline infusion. The depth of anesthesia was guided by Bispectral index (BIS) monitoring, maintaining BIS between 40 and 60. Results: The demographic profile and duration of surgery in both groups were similar. Mean heart rate was statistically similar in both the groups. Mean blood pressure was lower in group A, though the difference was significant only for the initial 30 min. The mean end-tidal sevoflurane requirement in group A was significantly less than that in group B ( P = 0.003). Patients in group A had better recovery profile with mean emergence, extubation, and recovery times of 8.08 ± 3.48 min, 9.37 ± 3.64 min, and 11.65 ± 4.03 min, respectively, as compared with 11.27 ± 3.05 min, 12.24 ± 2.39 min, and 14.90 ± 2.63 min, respectively, in group B ( P < 0.001). Mean intraoperative blood loss in group A of 263.47 ± 58.66 mL was significantly lower than 347.67 ± 72.90 ml in group B ( P = 0.0001). Conclusion: Group A patients had stable hemodynamic parameters, reduced intraoperative blood loss, less anesthetic requirement, and could be extubated earlier as compared with group B patients.

The Effects of Prophylactic Dexmedetomidine Administration on General Anesthesia Recovery Quality in Healthy Dogs Anesthetized With Sevoflurane and a Fentanyl Constant Rate Infusion Undergoing Elective Orthopedic Procedures

“…In adult and pediatric human patients, dexmedetomidine has been reported to reduce dysphoria (10,(22)(23)(24). In those studies, various protocols have been studied including administration of dexmedetomidine at varying doses and time points (at the start of general anesthesia, as a bolus following extubation and as a CRI 15 min before the anticipated end of surgery) (23,25,26). All of these studies reported smoother extubation, lower incidence of postanesthesia dysphoria and minimum effect on cardiovascular parameters.…”

Use of Dexmedetomidine During an Emergent Exploratory Laparotomy in a High-Risk Cardiac Patient With an Intra-aortic Balloon Pump

“…With the addition of DEX to a sevoflurane maintenance anesthetic targeting BIS levels 40-60, the mean sevoflurane end-tidal concentration was statistically significantly lower at 0.8% end-tidal concentration versus 1% end-tidal concentration. In addition, lumbar spine surgery patients receiving DEX had more hemodynamic stability, reduced intraoperative blood loss, and earlier extubation than patients who did not receive DEX [ 14 ]. DEX has also been shown to reduce BIS more than volatile anesthetics with more hemodynamic stability [ 15 ], which is especially important in a patient with an IABP.…”

The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial

“…Dexmedetomidine is a highly selective alpha-2 (α 2 ) agonist. 2 Several studies have found that dexmedetomidine is used as an anaesthetic adjuvant due its desirable properties (e.g., providing sedation without respiratory depression and its opioid-sparing effects 3 ). The perioperative use of dexmedetomidine has also been confirmed to reduce the need for intraoperative and postoperative opioids.…”