Older adults who received a low-dose of intravenous dexmedetomidine (Precedex) while undergoing abdominal surgery saw a quicker return to normal gastrointestinal function and shorter hospital stays, a randomized trial conducted in China found.
The study met its primary endpoint, with those administered intraoperative dexmedetomidine during anesthesia reporting a shorter time to first flatus versus those given placebo (median 65 vs 78 hours, respectively; P<0.001), reported Mervyn Maze, MB, ChB, of the University of California San Francisco, and colleagues.
Several secondary endpoints also favored the investigational arm:
- Time to first bowel movement: 85 vs 98 hours (P=0.001)
- Time to first oral feeding: 76 vs 90 hours (P<0.001)
- Length of hospital stay: 13 vs 15 days (P=0.005)
“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.
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.
These findings “may correlate with increased patient satisfaction,” Sofya Asfaw, MD, of the Cleveland Clinic in Ohio, told MedPage Today.
“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.
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.
Dexmedetomidine is a highly selective alpha-2 receptor agonist used as a sedative for intensive care unit (ICU) patients, and as a perioperative anesthetic adjuvant. Prior research has suggested its use during cardiac surgery could reduce the incidence of postoperative delirium as well as mortality, the authors explained.
For 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).
Patients were enrolled in the double-blind multicenter study from August 2018 to December 2019, and the study was conducted at 13 centers in China. Participants had a minimum age of 60, and were awaiting elective abdominal surgery that was expected to last at least 1 hour (up to 6 hours). Baseline characteristics were similar between groups: two-thirds were men, the average age was 70 years, and mean body mass index was 22.
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). Little difference was seen in mean surgical time between the dexmedetomidine and placebo groups (183 vs 190 minutes, respectively). About two-thirds of patients in each arm had American Society of Anesthesiologists (ASA) class 2 status.
Adverse 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%). Incidence of bradycardia not needing treatment was 8.1% in the dexmedetomidine group and 6% in the placebo group. No cardiac-related complications were reported. One dexmedetomidine patient died within 28 postoperative days.
Follow-up evaluating diet, gastrointestinal symptoms, and complications occurred by phone 28 days after surgery. 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.
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. They also noted that inflammatory markers and ischemia-reperfusion injury were not compared in the study.
Last Updated October 14, 2021
This study was supported by the National Natural Science Foundation of China.
Maze disclosed affiliations with the Foundation for Anesthesia Education and Research, stock ownership in NeuroproteXeon, and a dexmedetomidine patent sold to Stanford University in the 1980s.
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