Janelle D Vaughns1, Celeste Martin2, Jonathon Nelson2, Evan Nadler3, Zenaide M Quezado4. 1. Department of Anesthesiology, Pain and Perioperative Medicine and Pediatric Clinical Pharmacology, Children's Research Institute, Children's National Health System. Electronic address: jvaughns@childrensnational.org. 2. Department of Anesthesiology, Pain and Preoperative Medicine, Children's Research Institute, Children's National Health System. 3. Department of Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System. 4. Department of Anesthesiology, Pain and Preoperative Medicine, Children's Research Institute, Children's National Health System; Pain Neurobiology Laboratory, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System.
Abstract
BACKGROUND: The anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. OBJECTIVE: To determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. METHODS: An observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. RESULTS: While there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. DISCUSSION: These results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. STUDY TYPE: Therapeutic, Level III.
BACKGROUND: The anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. OBJECTIVE: To determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. METHODS: An observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. RESULTS: While there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. DISCUSSION: These results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. STUDY TYPE: Therapeutic, Level III.
Authors: Janelle D Vaughns; Elaine F Williams; Eleanor R Mackey; Jane C Muret; John van den Anker; Evan P Nadler; Zenaide M Quezado Journal: Obes Surg Date: 2019-05 Impact factor: 4.129