The Indian Anaesthetists' Forum (Jan 2021)
Effect of dexmedetomidine on hemodynamics and recovery profile in children undergoing laparoscopic Stephen–Fowler's Stage-2 orchidopexy under general anesthesia: A prospective randomized controlled study
Abstract
Background: Stephen–Fowler's Stage-2 (SF-2) orchidopexy for high intra-abdominal testes poses the challenge of both laparoscopic and open urogenital surgery to the pediatric anesthesiologist. Balanced anesthesia supplemented with regional analgesia remains the standard technique adopted. Studies involving intravenous (IV) dexmedetomidine as an adjuvant anesthetic in children are sparse. Aims and Objectives: The aim and objective was to study the effect of IV dexmedetomidine on intraoperative hemodynamic stability, airway reflexes, and hemodynamic responses to extubation and postoperative analgesia. Materials and Methods: This prospective randomized controlled study was conducted on thirty children undergoing laparoscopic SF-2 repair to receive balanced anesthesia with isoflurane. Group D patients received IV dexmedetomidine 1 μg/kg bolus over 10 min after induction followed by an infusion at 0.5 μg/kg/h and Group C patients received regional analgesia. Hemodynamic parameters, sedation, agitation, pain scores, time to rescue analgesia, and time to discharge were documented. Results: A significant change was discernible in the heart rate and systolic blood pressure with intraoperative hemodynamic stability in Group D patients, which was comparable to baseline values. Smoother extubation with better hemodynamic stability (P < 0.001) and decreased agitation (P < 0.05) were noted in Group D patients. Children in Group C were observed to have lower sedation scores postoperatively (P < 0.05). Time to rescue analgesia was statistically significantly prolonged in Group D (P < 0.001) without any change in time to discharge from hospital. Conclusion: IV dexmedetomidine 1 μg/kg bolus followed by an infusion of 0.5 μg/kg/h gives better intraoperative hemodynamic stability with smoother extubation and prolonged postoperative analgesia without undue side effects in children undergoing SF-2 orchidopexy.
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