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Effect of Different Doses of Dexmedetomidine on Stress Response and Emergence Agitation after Laparoscopic Cholecystectomy: Randomized Controlled Double-Blind Study

Mohamed Fathy Mostafa, Ragaa Herdan, Mohammed Yahia Farrag Aly and Azza Abo Elfadle

Background: Emergence agitation (EA) may develops during recovery from general anesthesia. It causes confusion, disorientation, and unpredictable behaviours. Surgical stress response activates the sympathetic nervous system and increase the release of catabolic hormones leading to prolonged hospital stay.

Objectives: We designed this study to assess the effect of different doses of intra-operative dexmedetomidine infusion on surgical stress response, emergence agitation and postoperative outcome.

Study design: A controlled double-blind study was conducted using a computer-generated randomization scheme.

Setting: The study was conducted in Assiut University Hospitals, Assiut, Egypt.

Methods: 90 patients scheduled for laparoscopic cholecystectomy were randomly assigned into three equal groups to receive intraoperative dexmedetomidine infusion over 20 minutes before end of surgery. Group I received 1 μg/kg, group II received 0.75 μg/kg and group III received 0.5 μg/kg.

Results: We found that dexmedetomidine (0.5, 0.75 or 1 μg/kg) can decrease the incidence of EA when infused 20 minutes before skin closure in laparoscopic cholecystectomy in adults. Lower agitation scores, pain scores, cortisol and glucose levels were observed during the first 2 hours postoperatively with no serious complications.

Limitations: First, we think a larger number of patients may be needed to detect better comparison between different doses of dexmedetomidine in preventing EA and monitor possible complications. Second, we did not take in mind any other preoperative predisposing factors that may affect the incidence of EA especially anxiety or smoking. Finally, we did not use any monitoring for depth of anesthesia which has an important factor in the incidence of emergence agitation.

Conclusion: We conclude that low doses of dexmedetomidine infusion (0.5 μg/kg) over 20 minutes before skin closure are effective as higher doses (0.75 and 1 μg/kg) to decrease stress response and incidence of emergence agitation in laparoscopic cholecystectomy in adults with less adverse effects.