Table 2.
Studies on the applications and efficacy of dexmedetomidine in surgery and recovery from surgery
| Reference | Study design | Application | Dosage | Outcomes | Hemodynamic changes |
|---|---|---|---|---|---|
| [69] | Double blind, randomized, controlled | Postoperative recovery | Single preinduction dose of 0.5 μg kg−1 DEX via IV vs. normal saline |
-60% reduction in postop pain -Reduction in MAC (0.6 (0.2) vs. 0.9 (0.1), p = 0.037) |
At 15 min, p < 0.05 -Lower SBP 104.3 (12.8) vs.114.2 (21.2) -Lower DBP 62.3 (11.8) vs.72.2 (19.2) -Lower HR 62.6 (10.5) vs. 69.7 (12.1) |
| [70] | Double blind, randomized, controlled | Controlling stress response during surgery | 1 μg/kg bolus over 10 min and 0.5 μg/kg/h intraoperatively as maintenance vs. normal saline |
-Time to rescue analgesia: DEX group (360 min) vs. control group (50 min) -24-h analgesic need: DEX group (90 mg) vs. the NS control group (195 mg) |
MAP in DEX group was significantly less after 10 min of drug infusion and after laryngoscopy, tracheal intubation, pneumoperitoneum, and extubation |
| [59] | Prospective, comparative, randomized, controlled | Opioid-free total intravenous anesthesia | DEX (0.6 μg/kg loading and 0.2 μg/kg/h maintenance) with propofol vs. fentanyl (1 μg/kg loading and 0.5 μg/kg/h maintenance) with propofol |
-8.5% improvement in quality of recovery score at 24 h (from 175 to 190) -Time to first analgesic dose (min): DEX 40.5 (8.25) vs. opioid 35.6 (6.7) p < 0.004 |
Significant fall in HR and BP |
| [71] | Double blind, randomized, control | Ilioinguinal-iliohypogastric nerve blocks for hernia repair in children | 0.2 ml/kg ropivacaine 0.2% vs. ropivacaine 0.2% with adjunct DEX 1 μg/kg |
-Postop analgesia duration: DEX+ropivacaine (970.23 ± 46.71 min) vs. control (419.56 ± 60.6 min) -DEX+ropivacaine had decreased CHIIPPS score vs. control |
Decreased HR at 5 min in the DEX group |
| [72] | Prospective, randomized double blinded | Epidural anesthesia | 15 ml bupivacaine 0.20% + 50 μg of DEX vs. 15 ml bupivacaine 0.20% + 50 μg fentanyl |
-Increased time to first analgesic: DEX 392.7 ± 34.8 min vs. control 296.9 ± 24.5 min (p < 0.001) -Decreased opioid requirement: DEX 18.9 ± 3.4 vs. control 23.3 ± 3.2 (p < 0.001) |
Incidence of bradycardia and hypotension was significantly higher in DEX group vs. control (p = 0.003, 0.012, respectively) |
| [73] | Comparative, Randomized | Intraperitoneal local anesthetic | 30 ml of 0.2% ropivacaine + 1 μg/kg DEX vs. 30 ml of 0.2% ropivacaine + with 1 μg/kg fentanyl |
-VAS pain score decreased: (DEX 1.68 ± 0.46 vs. control 4.47 ± 0.94) -Time to first analgesia (min): (DEX 122.7 ± 24.5 vs. control 89.3 ± 13.2) -Total analgesic consumption (mg): (DEX 95.3 ± 15.6 vs. control 135.7 ± 75.1) |
None reported |
| [8] | Consort-prospective, randomized, controlled | PCA after surgery | DEX 0.25 μg/kg/h diluted to 100 ml in 0.9% saline vs. fentanyl 20 μg/kg diluted to 100 ml in 0.9% saline |
-VAS pain score postop was not significantly different between the groups (p > 0.05) -10% of DEX group experienced PONV vs. 31.2% of fentanyl group -Decreased time to first flatus and bowel movement |
No significant differences |
| [57] | Randomized, controlled | PCA after surgery | DEX 0.5 μg kg−1 IV vs. 0.9% normal saline 30 min before completion of surgery |
-DEX group experienced less nausea 1 to 3 h postoperatively (p = 0.019) -DEX group had lower incidence of severe nausea (p < 0.003) |
DEX group experienced higher incidences of hypotension and bradycardia, however not statistically significant |
| [58] | Double blind, randomized, controlled | Prevention of postoperative delirium | DEX (0.5 μg/kg) 20 min preop followed by continuous intravenous infusion of 0.1 μg/kg/h intraop vs. normal saline | -Dex group experienced lower incidence and severity of delirium from POD 1 to POD 5 |
-Bradycardia: DEX (10.4%) vs. control (7.5%) -Hypotension: DEX (6.9%) vs. control (5.2%) |
| [26] | Double blind, randomized, controlled | Prevention of emergence delirium in pediatric patients | DEX 0.5 μg/kg vs. normal saline over 10 min intraoperatively | DEX decreased the incidence of emergence delirium (31.1% vs 53.3%; p = 0.033) | HR and SBP were significantly decreased in the DEX group at the 15-min mark and at extubation, but did not require intervention |
| [74] | Prospective, randomized, controlled | Postop recovery after pediatric tonsillectomy | DEX 1 μg/kg vs. volume-matched saline 10 min before anesthesia | DEX group agitation score was 9.37 ± 1.33; median 9.5 vs. 13.84 ± 1.39; median 14 in control (p < 0.001) | Significant decrease in HR and MBP in DEX group without bradycardia or hypotension |
| [76] | Randomized, controlled | DEX for prevention of postop anxiety in pediatrics | DEX 0.5 μg/kg vs. midazolam 0.08 mg/kg in 20 ml of NS 10 min preop | DEX group had lower anxiety at 2 h (mean difference [95% CI], 1.89 [0.52–3.26]; p = 0.01) and 4 h (mean difference [95% CI], 3.32 [1.98–4.66], p < 0.001) | Decrease in SBP, DBP, and HR in DEX group, all p values p < 0.001 |
| [77] | Randomized, controlled | DEX for sedation during ankle surgery under spinal anesthesia | DEX group receiving loading dose of 1 mcg kg−1 over 10 min, maintenance dose of 0.2–0.7 μg kg−1 h−1 vs. propofol group receiving effective site concentration of 0.5–2.0 μg ml−1 | Less postop morphine requirement in DEX group 14.5 mg (0.75–31.75 mg) compared with 48.0 mg (31.5–92.5 mg) in the propofol group (median difference, 33.2 mg; 95% confidence interval, 21.0–54.8 mg; p < 0.001). | Higher incidence of bradycardia in DEX group (31.8%) vs. (4.8%) in the propofol group, p = 0.046 |
| [75] | Randomized, controlled | DEX as adjuvant to lidocaine in spinal anesthesia | 0.5 μg/kg DEX vs. 25 μg fentanyl added to lidocaine 5% |
-Shorter postop analgesia in DEX group (h) 1.2 ± 57.3 vs. 4.40 ± 1.4 (p = 0.01) -More opioid requirement in DEX group (mg) 148.26 ± 8.3 vs. 119.04 ± 23.3 (p = 0.01) |
No significant difference in HR or BP both after spinal anesthesia or in recovery |
DEX, dexmedetomidine