Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy

The present study was designed to show the effects of dexmedetomidine infusion with loading dosage on perioperative hemodynamics, propofol consumption, and postoperative recovery when used for general anesthesia in patients undergoing spinal laminectomy.

Fifty American Society of Anesthesiologists (ASA) I-II patients were randomised into two groups. Group D received dexmedetomidine 0.6 microg kg(-1) as bolus before induction and 0.2 microg kg(-1) h(-1) by infusion. Group F received fentanyl 1 microg kg(-1) as bolus before induction and 0.5 microg kg(-1) h(-1) by infusion. Signs of inadequate analgesia, defined as an increase in heart rate and mean arterial pressure (MAP) 20% above the baseline, were managed by increasing or decreasing the dosage of dexmedetomidine and fentanyl. Statistical analysis was performed with student t, chi-squared and Fisher's exact tests.

The maintenance dosage was 0.64+/-0.06 microg kg(-1) h(-1) for fentanyl in Group F and 0.31+/-0.08 microg kg(-1) h(-1) for dexmedetomidine in Group D. MAP values in Group D were significantly higher than in Group F only after intubation. Before and after extubation, MAP values in Group F were significantly higher than those in Group D. There was no statistical difference in heart rate between the groups. Propofol dosages for induction (1.40+/-0.48 mgkg(-1)) and maintenance of anesthesia (2.03+/-0.41 mg kg(-1)) were lower with dexmedetomidine. Extubation time and postanesthesia care unit discharge time were similar in both groups. The fentanyl group patients required supplemental analgesia earlier than the dexmedetomidine group (34.8+/-1.35 min vs 60.4+/-1.04 min). Postoperative nausea and vomiting were significantly higher in Group F.

In conclusion, propofol-dexmedetomidine is suitable for patients undergoing elective spinal laminectomy and provides stable perioperative hemodynamic responses. Propofol-fentanyl medication requires a higher dosage of postoperative analgesics and causes frequent postoperative nausea and vomiting compared with propofol-dexmedetomidine.