Effects of dexmedetomidine on post-operative recovery and mental status in patients receiving robotic-assisted thoracic surgery

Abstract

Background: This study aimed to investigate the effects of dexmedetomidine on the post-operative recovery and mental status in patients receiving robotic-assisted thoracic surgery (RATS).Methods: One hundred patients who received selective RATS under general anesthesia were recruited and assigned into control group (C) and dexmedetomidine group (D). The anesthesia induction and maintenance were consistent between groups. Midazolam, sufentanil, propofol and rocuronium were intravenously injected for anesthesia induction, followed by mechanical ventilation after endotracheal intubation.Sevoflurane inhalation at a minimum alveolar concentration (MAC) of 0.5 was administered, propofol and remifentanil were intravenously injected to maintain the bispectral index (BIS) at 40-60, and rocuronium was intravenously injected once every 30 min. In the D group, dexmedetomidine was intravenously injected after endotracheal intubation, and then it was injected before the end of surgery. In the C group, normal saline of equal volume was injected. The hemodynamic parameters, blood loss, urine volume, time of surgery, time of anesthesia, total dose of propofol, time of thoracic tube indwelling, hospital stay and pulmonary complications were recorded; blood gas analysis was performed after extubation; the QoR-15 and minimental state examination (MMSE) questionnaires were employed for the assessment of mental status at 1 and 3 days after surgery.Results: The mean arterial pressure (MAP), heart rate (HR) and brain oxygenation were similar between groups at different time points (P>0.05). There were no significant differences in the operation time, time of anesthesia and intra-operative urine volume between groups. As compared to the C group, the blood loss and dose of propofol reduced significantly (P<0.05). After extubation, the respiratory frequency reduced and PaO2 increased markedly (P<0.05). After surgery, the time of thoracic tube indwelling and hospital stay reduced dramatically in the D group as compared to the C group (P<0.05). The QoR-15 score and MMSE score in the D group were markedly higher than in the C group (P<0.05).Conclusions: Dexmedetomidine can improve the post-operative recovery and mental status after RATS.

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

“…In 2017, Xue Li [17] found that the incidence of PPCs (including pulmonary infection, pneumothorax and pleural effusion) tended to be lower in the DEX group than in the control group (OR 0.51, 95% CI 0.26 to 1.00; p = 0.050) in elderly patients after cardiac surgery. In 2019, Li-Yun Zhang [18] indicated that there were no significant differences in PPCs(including atelectasis, pneumonia and air leak) between DEX and control groups (P > 0.05) in patients receiving roboticassisted thoracic surgery.…”

“…Studies have proved that DEX could attenuate perioperative stress, inflammation, and protect the immune function of surgical patients [12], and can provide clinically postoperative pulmonary relevant benefits by improving oxygenation and lung mechanics [13,14], all of which may contribute to decreased postoperative complications and improved clinical outcomes. In the last few years, a few clinical trials have evaluated the effect of DEX on PPCs [13][14][15][16][17][18][19]. However, the results of these studies are markedly variable and appear to be underpowered.…”

Effects of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients: a double-blind randomized controlled trial

“…In present study, when etomidate was combined with dexmedetomidine, the time to spontaneous respiration, time to recovery and tracheal extubation time were prolonged. However, intraoperative intravenous infusion of dexmedetomidine (0.4 μ/kg/h) did not affect postoperative anesthesia recovery in patients undergoing thoracic surgery 27 , or provided faster recovery in patients undergoing tympanoplasty surgery 28 . It was suggested that the administeration of dexmedetomidine in long-term surgery rather than short-term surgery could provide faster recovery.…”

A randomised controlled trial to evaluate the peri-operative role of intraoperative dexmedetomidine infusion in robotic-assisted laparoscopic oncosurgeries

“…[ 9 10 ] The use of dexmed has been studied extensively in laparoscopic surgeries;[ 11 12 13 ] however there is limited but growing data with the use of dexmed in robotic surgeries. [ 14 15 ] Though one may argue that the principles of laparoscopic surgery can be extrapolated to robotic surgery, one must understand that there remains a difference in the two surgical approaches. Literature has shown in addition to the need of steeper positions,[ 16 ] robotic surgeries have prolonged duration and more opioid use when compared to their laparoscopic counterparts.…”