Intraoperative dexmedetomidine significantly reduces the time to first flatus and first feces, as well as hospital length of stay, in older patients undergoing abdominal surgery, according to a study in JAMA Network Open.

The double-blind, placebo-controlled randomized trial was conducted at 13 sites in China from August 21, 2018, to December 9, 2019, and included participants aged 60 years or older who were scheduled to receive abdominal surgery with an expected surgical duration of 1 to 6 hours.

The patients were randomly assigned 1:1 to receive dexmedetomidine or normal saline placebo (control group) during surgery. Participants in the dexmedetomidine group received an infusion of dexmedetomidine 0.5 μg/kg for 15 minutes, followed by 0.2 μg/kg per hour through a continuous pump until about 30 minutes before the end of surgery. Control patients received an equivalent volume of saline at the same rates. The time to first flatus according to patient self-report was the primary outcome.


Continue Reading

A total of 675 patients (344 in the dexmedetomidine group and 331 in the placebo group) were included in the per-protocol analysis. The cohort had a mean age of 70.2 (SD, 6.1) years (65.9% men), and 485 patients (71.9%) had gastrointestinal (GI) surgery.

The median time to first flatus was significantly lower in the dexmedetomidine group compared with the control group: 65 hours (IQR, 48-78 hours) vs 78 hours (IQR, 62-93 hours), respectively (P <.001).

Among the dexmedetomidine and control participants, the proportion of patients with intake, feeling nauseated, emesis, physical examination, and duration of symptoms (I-FEED) scores that suggested normal postoperative GI function (248 patients [72.1%] vs 254 patients [76.7%]), postoperative GI intolerance (85 patients [24.7%] vs 69 patients [20.8%]), and postoperative ileus (11 patients [3.2%] vs 8 patients [2.4%], respectively) were similar.

The times to first feces (median, 85 hours [IQR, 68-115 hours] vs 98 hours [IQR, 74-121 hours]; P =.001) and first oral feeding (median, 76 hours [IQR, 52-112 hours] vs 90 hours [IQR, 72-115 hours]; P <.001) were shorter in the dexmedetomidine group vs the control group, respectively.

Significantly lower median hospital costs were observed in the dexmedetomidine group ($6018 [IQR, $5051-$7035]) vs the control group ($6481 [IQR, $5495-$7535]; P <.001). A shorter median length of stay also was observed in the dexmedetomidine group (13 days [IQR, 10-17 days]) vs the control group (15 days [IQR, 11-18 days]; P =.005).

The investigators noted that the precise effects of dexmedetomidine on GI function have not been fully explained. Additionally, during daily delirium assessments, the incidence of delirium may have been underestimated due to short-term fluctuations, and postoperative delirium was only assessed during the first 3 postoperative days.

“This study’s findings support the intraoperative use of dexmedetomidine for the recovery of [GI] function among older adults undergoing abdominal surgery,” stated the researchers.

Disclosure: One of the study authors declared an affiliation with a pharmaceutical company and previously owned a patent for dexmedetomidine. Please see the original reference for a full list of authors’ disclosures.

Reference

Lu Y, Fang P-P, Yu Y-Q, et al. Effect of intraoperative dexmedetomidine on recovery of gastrointestinal function after abdominal surgery in older adults: a randomized clinical trial. JAMA Netw Open. 2021;4(10):e2128886. doi: 10.1001/jamanetworkopen.2021.28886