A comparative study of dexmedetomidine–propofol and fentanyl-propofol on perioperative haemodynamics, propofol requirement and post-operative recovery profile in patients undergoing elective abdominal surgeries - A prospective randomised double-blind study

Abstract

Background: Dexmedetomidine is gaining popularity for its sympatholytic, sedative and haemodynamic stabilising properties, without significant respiratory depression.Methods: A prospective randomised double-blind study was conducted on 60 patients belonging to American Society of Anesthesiologists (ASA) Grade I and II undergoing elective abdominal surgeries who were randomised to receive either dexmedetomidine (Group D-P) or fentanyl (Group F-P) 10 Min prior to induction. Induction was done with midazolam along with propofol in 20 mg aliquots until bispectral index (BIS) value drops below 60. Infusion of one of the study drugs was continued along with propofol infusion which was titrated to maintain BIS around 40–60. Vecuronium to provide muscle relaxation and bolus doses of fentanyl were given whenever additional analgesia was needed. Intra-operative propofol, vecuronium and additional fentanyl requirement, time from discontinuation of anaesthetic drugs to extubation, time from the end of surgery to achieve a Ramsay sedation score of 2 and to the first post-operative analgesic request were recorded. Post-operatively, patients were monitored till 24 h for any adverse events.Results: A significant decrement in heart rate was observed in the D-P group in comparison to the fentanyl group. The D-P group was found to have required less propofol for induction, limited additional fentanyl requirement, less time required for extubation and a delay in request for first post-operative analgesia which was statistically significant.Conclusions: Propofol–dexmedetomidine provides better haemodynamic stability with lesser intraoperative propofol and fentanyl requirement, early cognitive recovery and longer postoperative analgesia when compared to propofol–fentanyl.