The use of dexmedetomidine for the multimodal low-opioid anesthesia during laparoscopic renal surgery

Background. Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic, and analgesic effects. These features make it a useful addition to the anesthesia protocol, especially in the context of providing adequate antinociceptive protection, anti-stress effect, hemodynamic stabilization and prevention of postoperative delirium. Our work was aimed to evaluate the effectiveness of dexmedetomidine for a multimodal low-opioid anesthesia program for laparoscopic renal surgery by comparing the effectiveness with general anesthesia, where traditional doses of opiates were used to provide an antinociceptive effect. Materials and methods. Fifty-five patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anes­thesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC — 1.44 ± 0.25 vol. %). In group 1 (control group of 26 patients), analgesia was provided with fentanyl 3.89 ± 2.10 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl at a dose of 2.38 ± 1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2 (29 patients). The efficacy of antinociceptive protection was assessed by the dynamics of the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations. Results. The total average doses of fentanyl used during the entire period of anesthesia were 369.23 ± 16.42 μg in group 1, 272.41 ± 10,98 μg in group 2 (p 0.05). Blood glucose concentrations in the early postoperative period in the study groups were 6.79 ± 0.31 and 6.29 ± 0.24 mmol/l, respectively (p > 0.05). Hemodynamic para­meters and BIS, which was maintained within 44.0 ± 6.4 %, indicated the adequacy of anesthesia and analgesia in all study groups. The indicators of the functional state of the kidneys were within the normal range in all patients. In group 1, in the p/o period 8 patients out of 26 (30.7 %) required additional analgesia with opioids (the level of pain on the VAS scale exceeded 4 points). In group 2, four patients (13.8 %) required opioid analgesia. In group 1, vomiting in the postoperative period occurred in 5 patients, in group 2 — in 3 patients. The standardized rate of postoperative nausea and vomi­ting in the control group was 19.2 %, in group 2 — 10.3 %. Conclusions. The use of dexmedetomidine for multimodal low-opioid anesthesia in laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery.