Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Abstract

Background: Rapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs.

Methods: Eighty-six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg^-1 hr^-1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg^-1 hr^-1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg^-1 hr^-1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery.

Results: Dexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days.

Conclusions: Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg^-1 hr^-1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.

Keywords: cerebral vasospasm; dexmedetomidine; endovascular interventional therapies; neuroanesthesia; nimodipine.

Figure 1

Patients enrollment flow diagram. This illustrates the flow of all patients screened, excluded, and randomized. ASA, American Society of Anesthesiology; BMI, body mass index

Figure 2

Hemodynamics was monitored in the three groups during the surgical procedure and postanesthesia care unit stay. (a) Comparison of the heart rate (HR; beats/min) in the three groups at different time points. (b) Comparison of mean arterial pressure (MAP; mmHg) in the three groups at different time points. Baseline vital signs were not significantly different between the two groups. *p < 0.05 versus Group RD1, ^# p < 0.05 versus Group RD2

Figure 3

Hemodynamics was monitored in the three groups during the first 48 hr after surgery. (a) Comparison of heart rate (HR; beats/min) in the three groups at different time points. (b) Comparison of mean arterial pressure (MAP; mmHg) in the three groups at different time points. *p < 0.05 versus Group RD1, ^# p < 0.05 versus Group RD2

Figure 4

Postoperative consumption of sufentanil in the three groups. The total dose of sufentanil was significantly lower in RD3 group than the other two groups. *p < 0.05 versus group RD1

Figure 5

Time‐course of postoperative pain expressed as scores on a Numerical rating scale (NRS) out of 10 in the three groups. *p < 0.05 versus group RD

Figure 6

Comparison of patient sedation using the level of sedation (LOS) among the three groups. The LOS was only significantly higher in the RD3 group at 0.5 hr after surgery. Level of sedation: 1, subject is anxious, agitated, or restless; 2, subject is cooperative, oriented, tranquil and responds to commands; 3, subject is asleep but has a brisk response to light glabellar tap or a loud auditory stimulus; 4, subject is asleep, has a sluggish response to a light glabellar tap or loud auditory stimulus; and 5, subject is asleep and unresponsive. *p < 0.05 versus Group RD1, ^# p < 0.05 versus Group RD2

Figure 7

Comparison of Glasgow Coma Scale (GCS) scores among the three groups. There were no significant differences in terms of GCS during the first 48 hr after surgery

Figure 8

Comparison of Bruggrmann Comfort Scale (BCS) scores among the three groups. Bruggrmann Comfort Scale: 0, persistent pain; 1, severe pain while deep breathing or coughing; 2, mild pain while deep breathing or coughing; 3, painless while deep breathing; and 4, painless while coughing. *p < 0.05 versus Group RD1, ^# p < 0.05 versus Group RD2