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Dexmedetomidine Reduces Propofol and Remifentanil Requirements During Bispectral Index-Guided Closed-Loop Anesthesia: A Double-Blind, Placebo-Controlled Trial

Le Guen, Morgan MD*†; Liu, Ngai MD, PhD*†‡; Tounou, Felix MD§; Augé, Marion MD*; Tuil, Olivier MD*; Chazot, Thierry MD*; Dardelle, Dominique Pharm D; Laloë, Pierre-Antoine MD; Bonnet, Francis MD§#; Sessler, Daniel I. MD**; Fischler, Marc MD*†

doi: 10.1213/ANE.0000000000000185
Anesthetic Pharmacology: Research Report

BACKGROUND: The α2-adrenergic agonist dexmedetomidine is a sedative and can be used as an adjunct to anesthetics. Our primary goal was thus to determine the extent to which dexmedetomidine reduces the requirement for propofol and remifentanil.

METHODS: This double-blinded, randomized study (NCT00921284) used an automated dual closed-loop administration to maintain the Bispectral Index between 40 and 60. Sixty-6 ASA physical status I and II patients were given either dexmedetomidine (1 μg/kg over 10 minutes followed by a continuous infusion of 0.5 μg/kg/h throughout surgery) or comparable volumes of saline as a placebo. Propofol and remifentanil requirements were compared using nonparametric tests and expressed as medians (interquartile ranges).

RESULTS: Twenty-eight patients in each group completed the study. Patients given dexmedetomidine required less propofol (1.0 [0.7–1.3] vs 1.3 [1.0–1.7] mg/kg, P = 0.002) and remifentanil (1.2 [1.0–1.4] vs 1.6 [1.1–2.8] μg/kg, P = 0.02) for anesthetic induction. The propofol dosage required for anesthetic maintenance was 29% (with a 95% confidence interval, 18–40) lower in patients given dexmedetomidine (2.2 [1.5–3.0] vs 3.1 [2.4–4.5] mg/kg/h, P = 0.005), whereas the remifentanil dosage was not significantly different (0.16 [0.09–0.17] vs 0.14 [0.13–0.21] μg/kg/h with P = 0.3). The incidence of adverse events, including hemodynamic instability and delayed recovery, was comparable with and without dexmedetomidine. The first postoperative request for morphine analgesia was delayed in patients given dexmedetomidine (median fourth hour vs first hour, P = 0.008).

CONCLUSIONS: Dexmedetomidine administration significantly reduced the requirement for both propofol and remifentanil during anesthetic induction and reduced propofol use during maintenance of anesthesia. Dexmedetomidine also delayed postoperative analgesic use. Dexmedetomidine is a useful adjuvant that reduces anesthetic requirement and provides postoperative analgesia.

From the *Department of Anesthesiology, Hôpital Foch, Suresnes, France; UVSQ—UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France; Outcomes Research Consortium, Cleveland, Ohio; §Department of Anesthesiology and Intensive Care, Hôpital Tenon, Paris, France; Pharmacy, Hôpital Foch, Suresnes, France; Department of Anesthesiology, Leeds General Infirmary, Leeds, United Kingdom; #UPMC, Paris, France; and **Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

Funding: Support was provided by the Service d’Anesthésie, Hôpital Foch, Suresnes, France.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Marc Fischler, MD, Department of Anesthesiology, Hôpital Foch, 40 Rue Worth, 92151 Suresnes, France. Address e-mail to

© 2014 International Anesthesia Research Society