Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanit in gynecologic videolaparoscopic surgery

Study Objective: To evaluate the capacity of dexmedetomidine (DEX), an alpha(2) adrenergic agonist drug, as a substitute for remifentanil (REM), a potent opioid, in total intravenous anesthesia (TIVA), in patient undergoing gynecologic videolaparoscopy. Design: Randomized, single-blinded study. Setting: University-affiliated hospital. Patients: 30 ASA physical status I and II women, patients (22-56 yrs), scheduled for gynecologic videolaparoscopy. Interventions: Patients were anesthetized with DEX or REM in continuous venous infusion, associated with propofol, in a target-controlled infusion. Measurements: Heart rate, mean blood pressure (MBP), systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma glucose, and cortisol were determined before anesthetic induction, 5 minutes after tracheal intubations and 30 minutes after initial surgical incision. Extubation and orientation times, and postanesthesia care unit (PACU) discharge times were noted. Main Results: Blood cortisol levels were higher in the DEX group than in the REM group at 30 minutes after surgical incision. Cortisol levels decreased as a function of time in the REM group, whereas in the DEX group they decreased in the second sample and returned to basal levels at 30 minutes. Hyperglycemia was higher in DEX than in REM during the second and third sample collection. However, glucose increased as a function of time in both groups. Analysis of MBP and DBP indicated a decrease in blood pressure at 5 minutes after tracheal intubations in both groups. At 30 minutes after incision, MBP and DBP returned to basal levels in the DEX group, whereas the variables were significantly lower in the REM group. There were significant differences between groups for SBP and heart rate at 5 and 30 minutes after incision, with a greater decrease in REM. The extubation and orientation times were significantly increased in the DEX group when compared with those of the REM group. There were no differences in PACU discharge times between groups. Conclusions: Dexmedetomidine was a clinically effective drug as a REM substitute in TIVA, during minimally invasive video gynecologic surgical procedures; however, patients anesthetized with DEX showed a more prolonged recovery time for some parameters such as orientation and extubation times. (c) 2007 Elsevier Inc. All rights reserved.