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The effects of remifentanil and dexmedetomidine on recovery in ambulatory gynecologic laparoscopies: A-45

Salman, N.; Coskun, F.; Salman, M. A.; Salman, A. E.; Aypar, U.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 12
Ambulatory Anaesthesia

Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background and Goal of Study: Facilitating recovery after ambulatory anesthesia is still contentious (1,2,3). We aimed to compare dexmedetomidine with remifentanil with regards to their effects on recovery and postoperative side effects in ambulatory gynecologic laparoscopic surgeries.

Materials and Methods: After obtaining ethical approval we recruited 20-40 aged, 60 ASA I-II patients and randomized them into two groups. After induction with 2 mg · kg−1 propofol, 0.05 mcg · kg−1 · min−1 remifentanil infusion was started following 1 mcg · kg−1 bolus, in Group R. In Group D, 0.4 mcg · kg−1 ·h−1 dexmedetomidine infusion was started following 1 mcg · kg−1 bolus. 1 MAC desflurane in 35% N2O-65% O2 was used for maintenance. Infusions were titrated to keep BIS ≤ 50. Postoperative pain, nausea and vomiting were evaluated using VAS. First analgesic requirement, severity of pain, satisfaction with anesthesia and recovery were asked on phone 24 hours after discharge. Data were analyzed using Kolmogorov-Smirnov, t-test, Mann-Whitney U test, analysis of variance and p-values of <0.05 were considered to be significant.

Results and Discussions: Among all groups demographic and hemodynamic data were similar. Extubation (6.1-7.3 min.), recovery (9.1-10.5 min.), and orientation times (16.1-21.2 min.) were lower in group R. Patients in Group R were in hospitalized for a shorter time (88-124 min.). Postoperative pain scores were similar, but nausea scores were higher in Group R. In Group D, antiemetic requirements were lower compared to Group R. The patients in Group R needed more analgesics at home.

Conclusion(s): Although faster recovery is obtained with remifentanil infusion, dexmedetomidine infusion may be an alternative since it provides similar haemodynamics and lower incidences of postoperative nausea and vomiting and a decrease in analgesic requirements.

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1 Coloma M, Chiu JW, White PF, et al. Anesth Analg 2001; 92: 352-7.
2 White PF. Anesth Analg 2000; 90: 1234-5.
3 Song D, Vlymen JV, White PF, et al. Anesth Analg 1998; 87: 1245-8.
© 2005 European Society of Anaesthesiology