IMPACTO DA DEXMEDETOMIDINA NO DESPERTAR DA ANESTESIA DE PACIENTES SUBMETIDOS A COLECISTECTOMIA VIDEOLAPAROSCÓPICA: ENSAIO CLÍNICO RANDOMIZADO
DOI:
https://doi.org/10.36557/2674-9432.2026v5n5p868-893Keywords:
Emergence delirium, Dexmedetomidine, Cholecystectomy, Laparoscopic.Abstract
Introduction: Pain, agitation and elevated blood pressure are common and difficult-to-control manifestations during recovery from anaesthesia. Dexmedetomidine, an alpha-2 agonist with sedative and analgesic properties, may show promise in mitigating these events. This study assessed its impact on the recovery from anaesthesia in patients undergoing laparoscopic cholecystectomy.
Methods: A randomised, single-blind clinical trial involving 50 patients undergoing elective laparoscopic cholecystectomy under balanced general anaesthesia. Participants were allocated to two groups: the dexmedetomidine group (DG; n = 25), which received an infusion of 0.5 mcg·kg⁻¹·h⁻¹, and the control group (CG; n = 25). Age, sex, BMI and ASA score were analysed. Sedation and agitation were assessed using the Riker scale on admission to the operating room (T0) and after extubation (T1). Following the intervention, mean arterial pressure (MAP), heart rate (HR), pain (VAS), nausea and vomiting, the need for rescue propofol, time to extubation and length of stay in the post-anaesthesia care unit (PACU) were assessed. A p-value < 0.05 was considered statistically significant.
Results: The groups were similar in terms of clinical and anthropometric characteristics, except for a higher proportion of ASA II patients in the CG (88% vs. 56%; p = 0.012). Following extubation, the CG had a higher number of agitated patients (68% vs 36%), with a statistically significant difference in the median Riker scale scores (5.00 [2.0] vs 4.00 [1.0]; p = 0.016). Only in the CG were there patients with a Riker score of 7 (4%), whilst 12% of patients in the CG had a Riker score of 3. Pain was more prevalent in the CG, both upon awakening and during the post-anaesthesia recovery period, although this was not statistically significant. A significant reduction in mean arterial pressure (MAP) was observed only in the CG (p = 0.008). HR remained stable in the GD group (p = 0.841), whilst there was an increase in the GC group (p = 0.196). There was no statistical significance regarding time to awakening or length of stay in the post-anaesthesia care unit.
Conclusion: Dexmedetomidine reduced agitation, pain and blood pressure levels upon emergence from anaesthesia, without significantly increasing the time to wake-up or the length of stay in the post-anaesthesia care unit.
Keywords: Emergence delirium; Dexmedetomidine; Cholecystectomy, Laparoscopic.
Downloads
References
1. Feng Z, Shi X, Yan X, Zhu Y, Gu J, Zhu H, et al. Comparing the effects of dexmedetomidine versus propofol on the treatment of emergence agitation in adult patients after general anesthesia: study protocol for a randomized, superiority, controlled trial (DP-TEA Trial). Trials. 2021;22(1):911. https://doi.org/10.1186/s13063-021-05743-2.
2. Zhang J, Yu Y, Miao S, Liu L, Gan S, Kang X, et al. Effects of peri-operative intravenous administration of dexmedetomidine on emergence agitation after general anesthesia in adults: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019;13:2853–64. https://doi.org/10.2147/DDDT.S207016.
3. Li J, Zhu H, Wang Y, Chen J, He K, Wang S. Remifentanil is superior to propofol for treating emergence agitation in adults after general anesthesia. Drug Des Devel Ther. 2024;18:341–50. https://doi.org/10.2147/DDDT.S433155.
4. Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol. 2020;73(6):471–85. https://doi.org/10.4097/kja.20097.
5. Rabie A, Abdelfattah MR. Outcome of intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy. Egypt J Anaesth. 2022;38(1):16–22. https://doi.org/10.1080/11101849.2021.2004501.
6. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999 Jul;27(7):1325–9. https://doi.org/10.1097/00003246-199907000-00022.
7. Choi JJ, Kim K, Park HY, Chang YJ, Lee KC, Kim KY, et al. The effect of a bolus dose of dexmedetomidine on postoperative pain, agitation, and quality of recovery after laparoscopic cholecystectomy: a randomized controlled trial. Medicine (Baltimore). 2021;100(3):e24353. https://doi.org/10.1097/MD.0000000000024353.
8. Kunikkakath S, Aboobacker CPS, Baby M, Kutty CSM. Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. Indian J Clin Anaesth. 2021;8(2):310–5. https://doi.org/10.18231/j.ijca.2021.057.
9. Miao M, Xu Y, Li B, Chang E, Zhang L, Zhang J. Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: a meta-analysis of randomized controlled trials. J Clin Anesth. 2020;65:109894. https://doi.org/10.1016/j.jclinane.2020.109849.
10. Govêia CS, Miranda DB, Oliveira LV, Praxedes FB, Moreira LG, Guimarães GMN. Dexmedetomidine reduces postoperative cognitive and behavioral dysfunction in adults submitted to general anesthesia for non-cardiac surgery: meta-analysis of randomized clinical trials. Braz J Anesthesiol. 2021;71(4):413–20. https://doi.org/10.1016/j.bjane.2021.02.020.
11. Abdel-Rahman KA, Abd-Elshafy SK, Sayed JA. Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial. Braz J Anesthesiol. 2018;68(6):571–6. https://doi.org/10.1016/j.bjan.2018.05.002.
12. Ye Q, Wang F, Xu H, Wu L, Gao X. Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiol. 2021;21(1):308. https://doi.org/10.1186/s12871-021-01283-z.
13. Zheng L, Fang T, Zhang W, Zhang X, Ren Z, Qin W, et al. Beneficial effects of low-dose intravenous dexmedetomidine premedication in patients undergoing laparoscopic cholecystectomy under general anesthesia: a prospective, double-blind, randomized controlled trial. Drug Des Devel Ther. 2024 Feb 13;18:443-452. https://doi.org/10.2147/DDDT.S452077.
14. Tian C, Malhan RS, Deng SX, Lee Y, Peachey J, Singh M, Hong D. Benefits of dexmedetomidine on postoperative analgesia after bariatric surgery: a meta-analysis. Minerva Anestesiol. 2022 Mar;88(3):173-183. Epub 2021 Oct 28. https://doi.org/10.23736/S0375-9393.21.15986-3 .
15. Cheuk Kin Sin J, Tabah A, Campher MJJ, Laupland KB, Eley VA. The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis.. Anesth Analg. 2022 Jun;134(6):1229-1244. Epub 2022 Jan 27. PMID: 35085107. https://doi.org/10.1213/ANE.0000000000005843
16. Agarwal M, Malliwal A. Effect of dexmedetomidine on hemodynamic responses during tracheal extubation. Indian J Clin Anaesth. 2019 Jan-Mar;6(1):23-29. https://doi.org/10.18231/2394-4994.2019.0006.
17. Gayathri B, Mirunalini G, Sundaram LN, Nivedita RK. A comparison of the recovery profile of dexmedetomidine when administered by different routes in patients undergoing laparoscopic cholecystectomy–a randomized controlled trial. Biomed Pharmacol J. 2021;14(4):1763-1770. https://doi.org/10.13005/bpj/2733.
18. Wei B, Feng Y, Chen W, Ren D, Xiao D, Chen B. Risk factors for emergence agitation in adults after general anesthesia: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2021;65(6):719-29. https://doi.org/10.1111/aas.13774.
19. Aouad MT, Zeeni C, Al Nawwar R, Siddik-Sayyid SM, Barakat HB, Elias S, Yazbeck Karam VG. Dexmedetomidine for improved quality of emergence from general anesthesia: a dose-finding study. Anesth Analg. 2019 Dec;129(6):1504-1511. https://doi.org/10.1213/ANE.0000000000002763.
20. Wegner GRM, Wegner BFM, Silva LS, Arias JA. Peri-operative dexmedetomidine and emergence agitation in adults undergoing nasal surgery: a systematic review and meta-analysis. Eur J Anaesthesiol. 2024;41(9):766-774. PMID: 40052487. https://doi.org/10.1097/EJA.0000000000002158 .
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ingrid Lilianne de Almeida Araujo, Marcius Vinícius Mulatinho Maranhão, Jane Auxiliadora Amorim, Priscila Evaristo de Carvalho Veiga, Leandro Ribeiro Novais de Sousa , Murilo Robson Fabrício do Nascimento
This work is licensed under a Creative Commons Attribution 4.0 International License.
Você tem o direito de:
- Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato para qualquer fim, mesmo que comercial.
- Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial.
- O licenciante não pode revogar estes direitos desde que você respeite os termos da licença.
De acordo com os termos seguintes:
- Atribuição — Você deve dar o crédito apropriado , prover um link para a licença e indicar se mudanças foram feitas . Você deve fazê-lo em qualquer circunstância razoável, mas de nenhuma maneira que sugira que o licenciante apoia você ou o seu uso.
- Sem restrições adicionais — Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.
