Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial

Abstract

Purpose

Dexmedetomidine (Dex) is a potent and highly selective α2-adrenergic receptor agonist. Within an appropriate dose range, Dex can effectively attenuate the surgical stress response, provide intraoperative hemodynamic stability, and improve the patient recovery quality. High-dose Dex can delay patient awakening from anesthesia and increase the incidence of bradycardia. This randomized controlled trial aimed to investigate the effects of low-dose intravenous Dex premedication in patients undergoing laparoscopic cholecystectomy (LC).

Material and Methods

In total, 100 patients undergoing LC were equally randomized into Group C (premedication with saline) and Group D (premedication with 0.5 µg/kg Dex). The patients were premedicated with saline or Dex, depending on the group, before anesthesia induction. Following this, anesthesia induction and endotracheal intubation was performed, and anesthesia was maintained during surgery. Following the completion of the surgery, the patients were transferred the post-anesthesia care unit (PACU) and stayed there until they met the PACU discharge criteria. The hemodynamic parameters, consumption of anesthetics, surgical duration, postoperative awakening time, extubation time, postoperative pain, and complications were recorded.

Results

No significant differences were observed in the heart rate (HR) and mean arterial pressure (MAP) between the two groups before premedication (P>0.05). The MAP and HR immediately after endotracheal intubation and immediately after extubation were significantly lower in Group D than in Group C (P<0.05 for both). The incidence of bradycardia was significantly higher in Group D than in Group C (P<0.05), while atropine was used in neither group. Propofol and remifentanil consumption was significantly lower in Group D than in Group C (P<0.05). The postoperative awakening and extubation times were significantly shorter in Group D than in Group C (P<0.05). The postoperative visual analog scale scores for pain and incidence of nausea, vomiting, and cough were significantly lower in Group D than in Group C (P<0.05 for all).

Conclusion

Our data suggest that premedication with dexmedetomidine (0.5 µg/kg) before general anesthesia induction can effectively attenuate intraoperative stress response and postoperative pain, maintain perioperative hemodynamic stability, and decrease the incidence of adverse events, which might be an effective and safe anesthetic protocol during LC worthy of further clinical application.

Keywords:

• dexmedetomidine
• laparoscopic cholecystectomy
• general anesthesia
• premedication

Abbreviations

Dex, dexmedetomidine; LC, laparoscopic cholecystectomy; HR, heart rate; MAP, mean arterial pressure; VAS, visual analog score; BMI, body mass index; SpO₂, pulse oxygen saturation; BIS, bispectral index; PACU, post-anesthesia care unit; ASA, American Society of Anesthesiologists; GABA, γ-aminobutyric acid.

Data Sharing Statement

All data generated during the current study has been deidentified. Further inquiries about the datasets can be directed to the corresponding author: Professor Ning Yin on reasonable request.

Ethics

Clinical Trials Registration: ChiCTR2100054687.

Acknowledgments

Appreciate for the support from the department of general surgery of the Sir Run Run Hospital, Nanjing Medical University.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Nanjing Health Science and Technology Development Special Fund (No. YKK21259, YKK22208). University Natural Science Research of Jiangsu Province (No. 23KJB310004).