The Impact of Perioperative Dexmedetomidine Infusion on Postoperative Narcotic Use and Duration of Stay after Laparoscopic Bariatric Surgery

Abstract

Dexmedetomidine (Precedex, Hospira, Lake Forest, IL) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. For 10 months, all patients undergoing a laparoscopic bariatric procedure received a dexmedetomidine infusion 30 min before the anticipated completion of the procedure (n = 34). A control group was comprised of a similar number of patients to have had laparoscopic bariatric surgery in the time period immediately before these 10 months (n = 37). All pathways and discharge criteria were identical for patients in each group. A total of 73 patients were included in this retrospective chart review. Two gastric bypass patients were excluded for complications requiring additional surgery (one bleed and one leak). Gastric bypass patients who received a dexmedetomidine infusion required fewer narcotics (66 vs 130 mg of morphine equivalents) than control patients and met discharge criteria on post-op day (POD) 1 more often (61% discharged POD 1 vs 26% discharged POD 1, p = 0.02). Vital signs and pain scores were similar in all groups. Dexmedetomidine infusion perioperatively is safe and may help to minimize narcotic requirements and decrease duration of stay after laparoscopic bariatric procedures. This may have important patient safety ramifications in a patient population with a high prevalence of obstructive sleep apnea. A well-organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of dexmedetomidine suggested by this study.

Dexmedetomidine pharmacokinetics in the obese

“…Although dexmedetomidine is commonly used as an adjunct anesthetic in bariatric surgery, no previous studies have assessed dexmedetomidine pharmacokinetic profile in the obese population. Dexmedetomidine loading doses and infusion rates are currently calculated on a milligram per kilogram (mcg/kg) TBW basis in both nonobese and obese patients [10].…”

Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

“…Th e patient with compromised pulmonary function may be at an increased risk for an adverse event. Dexmedetomidine, an alpha 2-adrenoceptor agonist, has been used to provide sedation in critical care patients and has been demonstrated to reduce opioid requirements, cause minimal respiratory depression, and improve outcomes (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). We hypothesized that the addition of a dexmedetomidine infusion to the postoperative pain management protocol would reduce the amount of morphine delivered by a PCA pump, reduce the opioid-induced adverse drug eff ects, and provide adequate analgesia for postthoracotomy patients.…”

Effect of intravenous dexmedetomidine on haemodynamic responses to laryngoscopy, tracheal intubation and anaesthetic and analgesic requirements: a randomized double-blind clinical efficacy study

“…One retrospective 16 study and two prospective, randomized controlled trials [17][18][19] in bariatric surgical patients have found that a balanced anaesthetic with desflurane or propofol plus dexmedetomidine reduces postoperative morphine consumption, and improves haemodynamics compared with desfluranefentanyl or propofol-fentanyl anesthetics. In our study, we have used morphine for analgesia in both groups but the requirement of additional dose of morphine was decreased in patients who received dexmedetomidine compared to those who received saline.…”