Recovery profiles after general anesthesia in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery with or without dexmedetomidine as an anesthetic adjuvant: A double blinded randomized study

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: The purpose of the present study was to evaluate the effect of dexmedetomidine as an anesthetic adjuvant on recovery profiles after general anesthesia for anterior cervical discectomy and fusion [ACDF] surgery. Materials and Methods: Ninety-eight patients who scheduled for ACDF were randomized into 2 groups by computergenerated random numbers. The dexmedetomidine group (group D, n = 49) received dexmedetomidine 0.5 mcg/kg loading in 30 min then 0.5 mcg/kg/h. The control group (group N, n = 48) received volume-matched 0.9%NaCl or normal saline [NSS]. General anesthesia was maintained with desflurane (bispectral index (BIS) around 40 to 60) and continuous intravenous infusion of neuromuscular blocking agent and intravenous fentanyl. Study drug was started after positioning and stopped 30 minutes prior to the end of surgery. Desflurane was turned off at the time of suturing the last stitch and neuromuscular reversal agent was given. The recovery profiles were evaluated by using Riker sedation agitation score (1 to 7) and respiratory parameters. Riker sedation agitation score was reevaluated at 15 minutes post-extubation at PACU. The analgesic used and pain scores were assessed in 24 hours postoperatively. Results: The recovery profiles were not different between two groups. The incidences of emergence agitation (Riker score 5 to 7) were 13 (26.5%) in Group D vs. 20 (42.6%) in group N, p = 0.098. The intraoperative fentanyl, desflurane consumption significantly decreased in group D. The extubation time was slightly longer in group D (8.3±5.3 min) compared to group N (5.7±2.8 min) with statistical significance (p = 0.003). In group D, the incidence of severe pain (Numeric rating score ≥7) at 4 h was also lower. The incidence of intraoperative hypertension was lower in group D but higher incidence of hypotension. Conclusion: Dexmedetomidine as an anesthetic adjuvant in ACDF surgery failed to demonstrate effect to reduce emergence agitation, and had higher risk of adverse hemodynamic complications.