Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis

Singh, Preet Mohinder; Panwar, Rajesh; Borle, Anuradha; Mulier, J. P.; Sinha, Ashish; Goudra, Basavana

doi:10.1016/j.soard.2017.02.025

Cited by 61 publications

(39 citation statements)

References 27 publications

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“…The frequency of delayed discharge from the PACU exceeding 90 minutes did not differ between the groups (p>0.05). (10) 30.00 (9) 36.67 (11) 30.00 (9) Values expressed in % (n). *Chi-square test.…”

Section: Resultsmentioning

confidence: 99%

“…The analgesic effects influenced the pain scores on the first postoperative day and reduced the need for rescue opioids in this period 10 . A published meta-analysis on the effects of dexmedetomidine on the perioperative period in obese patients showed a reduction in the need for postoperative analgesics and found it to be a safe and effective adjunct in obese patients 11 . In spite of a reduction in the incidence of PONV with the use of dexmedetomidine determined in the meta-analysis, this effect was not observed in our study.…”

Section: Discussionmentioning

confidence: 99%

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Comparative analysis of remifentanil versus dexmedetomidine in the incidence of pain in a post-anesthesia care unit after bariatric surgery

Silva¹,

Silveira²,

Abib³

et al. 2018

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Compare anesthesia techniques with sufentanil and intraoperative infusion of remifentanil or dexmedetomidine, and to then analyze their associations with the incidence of pain and other complications in the post-anesthesia care unit. METHODS: A retrospective analytical observational study conducted in a reference center for bariatric surgery in São Paulo, São Paulo State, Brazil. Patients (n=120) included in the study were randomly selected using this site's anesthesia records for bariatric surgery. Four 30-patient groups were established: G1-induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G2-induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G3-induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine; and G4-induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine. Significance was set at p<0.05. RESULTS: The incidence of pain in the post-anesthesia care unit was 52.5% (n=63). It was considered intense in 36.11% of these cases. The incidence of pain in the post-anesthesia care unit was lower in patients receiving a continuous infusion of dexmedetomidine relative to those who received remifentanil infusion. Sufentanil dosage in anesthesia induction did not influence the incidence of pain (G1=G2>G3=G4; p<0.05). The occurrence of respiratory complications did not differ significantly between the groups. CONCLUSION: The use of dexmedetomidine proved to be better for analgesia in the post-anesthesia care unit, and it did not increase the risk of respiratory complications when compared to the continuous infusion of remifentanil, regardless of the sufentanil dose used for induction.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative analysis of remifentanil versus dexmedetomidine in the incidence of pain in a post-anesthesia care unit after bariatric surgery

Silva¹,

Silveira²,

Abib³

et al. 2018

Brazilian Journal of Pain

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“…In an observational study by Vaughns et al of 26 consecutive adolescent patients undergoing bariatric surgery, the intraoperative use of dexmedetomidine, 1.62 μg/kg (0.89 to 2.032; median total dose and interquartile range), as initial bolus and then continuous infusion was associated with lower opioid requirements intraoperatively and in the first 48 hours postoperatively. These results were affirmed in a meta‐analysis involving a broader range of patients having bariatric surgery and a guideline implementation study demonstrating feasibility and significant cost avoidance . Of note, adolescents with severe obesity have increased fentanyl clearance, underscoring the need for more pharmacologic data on this population .…”

Section: Executive Summarymentioning

confidence: 90%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

339

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“…Among patients with morbid obesity, substitution of intraoperative opioids with an intraoperative Dexmedetomidine infusion resulted in reduced perioperative opioid requirements [55]. Also, perioperative Dexmedetomidine infusion were found to significantly reduce postoperative opioid consumption (24-hours) as compared to conventional perioperative analgesic regimens [56]. Alpha 2 agonists can cause sedation which could interfere with arousal in OSA patients.…”

Section: Alpha 2 Agonistsmentioning

confidence: 99%

Management of Acute Pain in Obese Patients with Sleep Apnea

Rahman¹,

Zaghw²,

Elazzouny³

et al. 2018

Pain Management in Special Circumstances

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Perioperative pain management for obese patients is daily challenges for anesthesiologists especially if complex comorbidities such as Obstructive Sleep Apnea and cardiovascular disease coexist. Limitations to effective pain management in this group are multifactorial, that includes technical difficulty with regional techniques, limited expertise, unavailability of standardized guidelines and lack of familiarity with recent multimodal analgesic regimens. Opioid-related complications such as narcotic-induced ventilatory depression in these group of patients poses another critical concern for both trainees and the experienced anesthesiologists. This chapter is intended for residents, fellows, as well as senior perioperative physicians, and will explore various regional and pharmacological options for acute pain management in this special population based on recent advances and available evidence.

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Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis

Cited by 61 publications

References 27 publications

Comparative analysis of remifentanil versus dexmedetomidine in the incidence of pain in a post-anesthesia care unit after bariatric surgery

Comparative analysis of remifentanil versus dexmedetomidine in the incidence of pain in a post-anesthesia care unit after bariatric surgery

Management of Acute Pain in Obese Patients with Sleep Apnea

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