The analysis had several limitations, Maze and colleagues acknowledged, including that the effects of dexmedetomidine on gastrointestinal function are not entirely clear, and that more research is needed on dosing. A similar proportion of patients in the two groups were back to eating solid foods (93%), and no significant differences were seen for incidence of abdominal distension, constipation, and nausea or vomiting. One dexmedetomidine patient died within 28 postoperative days.įollow-up evaluating diet, gastrointestinal symptoms, and complications occurred by phone 28 days after surgery. No cardiac-related complications were reported. Incidence of bradycardia not needing treatment was 8.1% in the dexmedetomidine group and 6% in the placebo group. About two-thirds of patients in each arm had American Society of Anesthesiologists (ASA) class 2 status.Īdverse events requiring treatment were similar between the investigational arm and control arm, respectively: hypotension (8.7% vs 13.6%), hypertension (4.1% vs 4.5%), bradycardia (6.4% vs 3.6%). Little difference was seen in mean surgical time between the dexmedetomidine and placebo groups (183 vs 190 minutes, respectively). Most of the abdominal surgeries were open (53-59%), consisting of either gastric (41-43%), intestinal (30%), or other sites (27-29% including appendectomies, or pancreatic and hepatobiliary surgeries). Prior research has suggested its use during cardiac surgery could reduce the incidence of postoperative delirium as well as mortality, the authors explained.įor their study, Maze and colleagues conducted a per-protocol analysis on 675 patients (from a total of 808) randomized 1:1 to receive intraoperative dexmedetomidine (n=344 0.5 μg/kg loading dose intravenously for 15 minutes followed by 0.2 μg/kg every hour) or a saline placebo (n=331). However, the study found no significant differences between the dexmedetomidine and placebo groups for delirium at 3 days post-surgery (5.2% vs 3.6%, respectively) or when gastrointestinal function was measured by the I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) scoring system, with 72% reporting normal I-FEED scores in the dexmedetomidine group versus 77% in the placebo group.ĭexmedetomidine is a highly selective alpha-2 receptor agonist used as a sedative for intensive care unit (ICU) patients, and as a perioperative anesthetic adjuvant. "This well-done study contributes to a growing body of literature examining the use of IV dexmedetomidine to accelerate post-operative GI function, and application of its findings may be worth considering in combination with existing enhanced recovery after surgery protocols," added Asfaw, who was not involved in the study. These findings "may correlate with increased patient satisfaction," Sofya Asfaw, MD, of the Cleveland Clinic in Ohio, told MedPage Today. Patients who received dexmedetomidine also had reduced hospital costs (median $6,018 vs $6,481, P<0.001), improved sleep quality, and lower pain scores on the first and fourth postoperative days compared to those who received placebo. "Postoperative recovery of gastrointestinal function is often a decisive factor in length of stay after abdominal surgery, especially gastrointestinal surgery," the authors wrote in JAMA Network Open. Length of hospital stay: 13 vs 15 days ( P=0.005).Time to first oral feeding: 76 vs 90 hours ( PTime to first bowel movement: 85 vs 98 hours ( P=0.001).Several secondary endpoints also favored the investigational arm:
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