Anesthesia For Abdominal Surgery Research Articles

Formation of professional competence in anesthesiology interns (sociological research data)

Background. A sociological study has been conducted among anesthesiology interns of the second year of study whose results make it possible to interpret the formation of a body of knowledge, abilities and skills in them, which are gained in the process of training on the specialty “Anesthesiology and intensive care”. Among the tasks in postgraduate medical education, those stand out that involve the training of competent specialists capable of quickly solving practical tasks in health care with the introduction of innovative technologies. The aim of the study: to establish trends in the formation of professional competence among anesthesiology interns through their sociological survey. Materials and methods. At the end of 2022, a sociological survey was conducted among anesthesiology interns (a total of 63 doctors of both sexes, average age was 24.2 years). Results. When choosing the future profession of an anesthesiologist, 49.20 % of respondents indicated that it was their own choice; 23.80 % of interns noted the influence of parents on the choice of future specialty, 15.87 % indicated their friends or acquaintances or other factors. The interns noted the presence of personal experience of working in health care institutions — 88.88 % answered positively (at the same time, 14.28 % of respondents mentioned previous experience of working in an intensive care unit as a nurse) and 11.12 % denied such experience. Most respondents said what attracts them to anesthesiology as a specialty: the possibility of obtaining a quick positive result of their activity — 85.71 % and the satisfaction of saving a human life — 57.14 %. A significant part of the interviewees noted such a factor as prestige (38.09 %) and a small number of interns noted “other” (6.34 %). Among the subjects and disciplines during training at a higher educational institution, the most important for anesthesiologists, according to the interns, are physiology and pathophysio­logy — 93.65 %, pharmacology — 80.95 %, normal or pathological anatomy — 46.03 %, physics — 28.57 %, chemistry — 25.39 %; 1.58 % of the respondents answered that all subjects are important at the same time or clinical pharmacology. When choosing a future specialty, interns chose from such medical specialties as surgery (39.6 %), neurology (9.52 %), emergency medicine (19.04 %), and others. Among the directions in anesthesiology, interns consider obstetric anesthesiology (47.62 % of respondents), cardiac anesthesiology (66.66 %), neuroanesthesiology (53.96 %), trauma anesthesia (68.25 %), pediatric anesthesiology (46.03 %), anesthesia in abdominal surgery (46.03 %), intensive care (3.17 %), and 4.76 % of respondents answered that all directions in anesthesiology are important. Intern doctors noted the following necessary personality traits and human values for successful work as an anesthesiologist: determination (74.60 %), leadership qualities (44.44 %), excellent health (33.33 %), the ability to quickly make the right decisions (90.47 %), other (11.11 %). The interns indicated which directions in anesthesiology they would like to thoroughly study during the face-to-face training at the department, namely: cardiopulmonary resuscitation (92.06 % of respondents), intensive care in emergency situations (85.71 %), ultrasound diagnosis in anesthesiology (71.42 %), acute poisonings (68.25 %), prevention and treatment of pain syndromes (80.95 %), features of providing assistance to the victims (39.68 %) and others: emergency medical care and mana­gement of patients with combat trauma in the intensive care unit (4.76 %), features of anesthesia in various pathological conditions, regional anesthesia, pharmacotherapy of emergencies, intensive care for acute pathologies (1.58 % of respondents). Conclusions. The conducted sociological research among anesthesiology interns of the second year of study allowed to detect the following trends in the formation of professional competence of anesthesiology interns: a significant amount of information and high professional requirements for anesthesiologists imply constant improvement of their knowledge and skills that is impossible without a sufficiently high level of motivation. The presence of previous work experien­ce of intern doctors in health care institutions emphasizes the meaning­fulness of the choice of future specialty, social and professional understanding of the essence of practical medicine, ensures communication skills with colleagues. Among the subjects and disciplines taught in higher education institutions, in the opinion of anesthesiology interns, the most important are: physiology and pathophysiology, pharmacology, normal or pathological anatomy, physics and chemistry. When choosing the future specialty “Anesthesiology and intensive care”, interns most often chose from such medical specialties as surgery, neurology, and emergency medicine. For successful work as an anesthesiologist, according to anesthesiology interns, the most relevant are: determination, leadership qualities, excellent health, the ability to quickly make the right decisions, etc. Among the directions in anesthesiology, interns of the second year of study expressed their desire to thoroughly study: cardiopulmonary resuscitation, intensive care in emergency situations, ultrasound diagnosis in anesthesiology, acute poisonings, prevention and treatment of pain syndromes, features of providing assistance to the victims, and others.

Epidural Anesthesia in Abdominal Surgery

The epidural anesthesia has found widespread application in abdominal surgical interventions. But the relevance of its use is the subject to some doubt and discussion in connection with developing surgical technologies and reduction of the degree of surgical aggression, and introduction of new approaches to the management of patients in the perioperative period. Often the risks of epidural anesthesia exceed expected benefits. This is a limiting factor for its use. Today, there is no uniform approach to the way epidural analgesia is administered in the intraoperative period. However, there is a correlation between the frequency of adverse events related to epidural block and the route of administration (speed of administration, volume, and concentration).Therefore, selecting the optimal method of epidural analgesia within the framework of combined anesthesia can minimize the risks and maximize its positive effects in abdominal surgery.

Intravenous versus Epidural Routes of Patient-Controlled Analgesia in Abdominal Surgery: Systematic Review with Meta-Analysis.

Objective: To compare the intravenous and epidural routes of patient-controlled anesthesia in abdominal surgery. Methods: We searched for randomized clinical trials that compared the intravenous and epidural modes of patient-controlled anesthesia in intra-abdominal surgery in adults. Data analysis was performed in RevMan 5.4. Heterogeneity was measured using I2 statistic. Risk of bias was assessed using the Jadad/Oxford quality scoring system. Results: Seven studies reporting 529 patients were included into the meta-analysis. For pain at rest, the mean difference with 95% confidence interval (CI) was −0.00 [−0.79, 0.78], p-value 0.99, while for pain on coughing, it was 0.43 [−0.02, 0.88], p-value 0.06, indicating that patient-controlled epidural analgesia (PCEA) was superior. For the sedation score, the mean difference with 95% CI was 0.26 [−0.37, 0.89], p-value 0.42, slightly favoring PCEA. For the length of hospital stay, the mean difference with 95% CI was 1.13 [0.29, 1.98], p-value 0.009, favoring PCEA. For postoperative complications, the risk ratio with 95% CI was 0.8 [0.62, 1.03], p-value 0.08, slightly favoring patient-controlled intravenous analgesia (PCIVA). A significant effect was observed for hypotension, favoring PCIVA. Conclusions: Patient-controlled intravenous analgesia compared with patient-controlled epidural analgesia was associated with fewer episodes of hypotension. PCEA, on other hand, was associated with a shorter length of hospital stay. Pain control and other side effects did not differ significantly. Only three studies out of seven had an acceptable methodological quality. Thus, these conclusions should be taken with caution.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial

BackgroundPostoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. MethodsA single-blinded prospective randomized clinical trial on 105 patients aged 18−65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24hours after the surgery. The use of a rescue antiemetic was also evaluated. Results50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p< 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p= 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p= 0.043). ConclusionThe incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós‐operatórios em laparotomia: estudo clínico randomizado

BackgroundPostoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients’ characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. MethodsA single‐blinded prospective randomized clinical trial on 105 patients aged 18−65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24hours after the surgery. The use of a rescue antiemetic was also evaluated. ResultsFifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p <0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p=0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p=0.043). ConclusionThe incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

BackgroundLimited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. MethodsA total of 98 patients aged ≥75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. ResultsSpinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. ConclusionIn a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

COMBINED MULTIMODAL ANESTHESIA FOR ABDOMINAL SURGERIES IN CHILDREN

Introduction. The article presents findings which may be useful for solving an urgent medical problem on the adequacy of anesthetic management during planned surgical interventions in children with abdominal pathology. Purpose. To compare the effectiveness of combined multimodal anesthesia and multicomponent neuroleptanalgesia in abdominal interventions in children by evaluating central and peripheral hemodynamics. Material and methods. 96 children, aged 1-17, who had various surgical pathologies and were operated on, were examined. In 52% of patients (n = 50), a combined multimodal anesthesia with Propofol, Fentanyl, epidural anesthesia and Sevoflurane was used (main group 1); and in 48% of patients (n = 46), a multicomponent neuroleptanalgesia with Droperidol and Fentanyl combined with epidural anesthesia was used (control group 2) . Results. Trial findings showed that hemodynamics stability is determined by a differential blockade of sympathetic fibers and by a gradual development of epidural block at the level of segmental innervation of surgical intervention zone, thus preventing disorders in parameters of central hemodynamics. Conclusion. The combined multimodal anesthesia as a part of epidural block and inhalation anesthesia with Sevoflurane contributes to a high controllability of anesthesia, to the smooth course of the most traumatic stage, early enteral nutrition, early activation and rehabilitation of patients, starting from the first hours in the intensive care unit, which is an important factor in the prevention of postoperative complications.

Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?

Epidural anesthesia has been considered the gold standard for perioperative analgesia, but the implementation of enhanced recovery after surgery (ERAS) protocols and a shift from open to laparoscopic surgery have diminished the advantage of epidural anesthesia. The authors summarize data from two newer meta-analyses and discuss the consequences for the role of epidural anesthesia (EA) in the perioperative setting. These meta-analyses enabled to distinguish between pre- and post-ERAS outcomes. Endpoints related to open and laparoscopic abdominal surgery were retrieved. General data, also applicable on abdominal surgery, were included. Data on other types of surgery were ignored. Two meta-analyses met the subject and inclusion criteria of the search. They demonstrate no difference between epidural analgesia and the control for most investigated endpoints. Analgesia employing epidural techniques is often not clinically superior to its alternatives; is associated with a small but relevant number of serious complications; and has a relatively high failure rate. Data show that the distinction between pre-ERAS and ERAS is essential for understanding the role of EA in intestinal surgery. Since ERAS was introduced, the advantages of epidural anesthesia vanished while the incidence of serious neurological complications is higher than previously thought. The authors conclude that epidural anesthesia in abdominal surgery has become less preferred and is limited to patients and types of surgery known to be accompanied with difficult pain management. This requires the use of other methods for analgesia, such as intravenous ketamine, peripheral nerve blocks, continuous wound infiltration, intrathecal morphine, and intravenous, and non-invasive PCA.

MODERN METHODS OF REGIONAL ANESTHESIA OF THE PERIOPERATIVE PERIOD IN CHILDREN IN ABDOMINAL SURGERY. A REVIEW

Perioperative anesthesia in abdominal surgery at present is a main problem in anesthesiologist practice. According to the literature regional methods of anesthesia are used for anesthesia in the perioperative period. The analgetic effectiveness of the QLB in pediatric practice is not sufficiently studied. Materials and methods: There were articles in English and Ukrainian languages for the period from 1996 to 2018, which are part of the PubMed, EMBASE, Cochrane, and Google Scholar research databases. Discussion: This article presents the results of the using of basic methods of regional analgesia that are used in surgery. More and more data from studies in adult patients indicate that QLB is an effective method of analgesia in abdominal surgery. It should be noted that in the literature there is a small amount of clinical applications of the QLB block in pediatric practice. Therefore, it is necessary to carry out further study of efficiency, safety, and improve the methodology for implementing the QLB unit, especially in pediatric practice.

Comparative Evaluation of I Gel and Cuffed ET Tube for Anesthesia in Abdominal Surgery

Comparative Evaluation of I Gel and Cuffed ET Tube for Anesthesia in Abdominal Surgery

Efficacy of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in abdominal surgery: A meta-analysis of randomised controlled trials.

To assess the efficacy and safety of dexmedetomidine (DEX) as an adjuvant to local wound infiltration anaesthesia in abdominal surgery, we conducted this meta-analysis. First, the systematic search strategy was performed on PubMed, Embase, and Cochrane Library and five randomised controlled trials (RCTs) involving 294 patients were included. Then, the outcome data were extracted from the studies and their effect sizes were calculated using Review Manager 5. As a result, the addition of DEX significantly reduced visual analogy scores at 6 hours after surgery (mean difference = -0.53[-0.82, -0.25], P < .001), 12 hours after surgery (mean difference = -0.39 [-0.73, -0.05]; P = .03), and 24 hours after surgery (mean difference = -0.20 [-0.29, -0.11], P < .001) and reduced total analgesic consumption within 24 hours after surgery (mean difference = -4.92 [-9.00, -0.84]; P = .02) compared with placebo groups. However, there was no difference in the incidence of postoperative nausea and vomiting (risk ratio = 0.68 [0.41, 1.14]; P = .14). In summary, DEX as a local anaesthetic adjuvant added for local wound infiltration anaesthesia in abdominal surgery could reduce visual analogy scores and postoperative analgesic consumption without changing incidence of postoperative nausea and vomiting.

Clinical case of postoperative anesthesia of a patient by using subanesthetic dose of ketamine in severe abdominal pathology

Pain is an inevitable consequence of surgical interventions in children, resulting in great stress and discomfort not only for patients but also for their parents. The intensity of the pain depends not only on the level of injury after the operation, but also on the localization and the nature of the procedure. Management of pain in children is best done through a multimodal approach: opioids, auxiliary drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, anti-neuroleptics such as gabapentin, and regional anesthetic methods. Postoperative anesthesia in abdominal surgery at present is a topical problem in anesthetic practice. In this clinical case, we would like to demonstrate the experience of applying post-operative anesthesia using subnormal dosages of ketamine. The patient was given anesthesia with prolonged infusion of a ketamine solution in a submorbid dose of 0.2 mg/kg/h IV. An assessment of the quality of anesthesia by assessing the level of stress markers, such as blood glucose, cortisol levels, and the assessment of the pain level on the NIPS scale was performed. Conclusion: The use of a ketamine solution in a dose of 0.2 mg/kg/h has a positive effect on treating postoperative pain in patients after severe abdominal surgical interventions. Applying a ketamine solution in a dose of 0.2 mg/kg/h reduces tolerance of the patient to opioid analgesics and the development of hyperalgesia and allodynia.

Effect of dexmedetomidine on tracheal intubation under general anesthesia for abdominal surgery

Objective To study the effect of dexmetomidine on tracheal intubation under abdominal anesthesia. Methods From January 2015 to January 2018, 100 patients were selected to perform tracheal intubation under abdominal anesthesia in Shanxi Provincial Hospital of Taiyuan.A total of 100 patients under abdominal surgery were randomly divided into two groups, with 50 patients in each group.The observation group was given dexmetomidine intravenous injection during the operation, while the control group was not given dexmetomidine during the operation.The blood pressure and heart rate of the two groups were compared before and after anesthesia.The recovery time of spontaneous respiration, eye opening time, extubation time, incidence of adverse events, cough score and restlessness score were compared between the two groups, and the cognitive function of the two groups was compared. Results After anesthesia, the systolic blood pressure[(103.75±2.26) mmHg], diastolic blood pressure[(71.92±1.95)mmHg], heart rate[(70.91±1.89)rpm]in the observation group were significantly higher than those in the control group[(100.37±2.91)mmHg, (70.27±1.84)mmHg, (69.08 ±1.63)](t=6.487, 4.532, 5.185, all P<0.05). The recovery time of spontaneous respiration[(7.14±1.37)min], eye opening time[(9.85±2.31)min]and extubation time[(20.57±2.94)min]in the observation group were significantly shorter than those in the control group[(8.75±1.89)min, (12.41±2.97)min, (24.06±3.42)min](t=4.877, 4.811, 5.472, all P<0.05). The incidence rate of adverse events in the observation group (8%) was lower than 24% in the control group (χ2=4.762, P<0.05). The score of cough and the score of restlessness in the observation group were (4.09±1.63) and (4.27±1.96), respectively, which were significantly lower than those in the control group[(6.24±2.18) and (6.51 ±2.32)](t=5.186, 5.215, all P<0.05). At 6 h after operation, the scores of MMSE, vocabulary memory, simple calculation and picture memory in the observation group were (23.95±2.13), (7.35±1.08), (7.14±1.12) and (7.26±1.17), respectively, which were higher than those in the control group[(20.47±1.91), (6.17±0.94), (5.89±1.04), (6.02±0.89)](t=8.601, 5.828, 5.783, 5.965, all P<0.05). Conclusion The application of dexmetomidine in patients under general anesthesia under tracheal intubation can effectively reduce the fluctuation of hemodynamic indicators after anesthesia, help to maintain the hemodynamic stability of patients, and promote the recovery of consciousness after operation.It can prevent adverse events during recovery of anesthesia and reduce the effect of anesthesia on cognitive function of patients. Key words: Anesthesia, general; Surgical procedures, operative; Abdomen; Hemodynamics; Cognitive function; Dexmetidine

Premedication effect of melatonin on propofol induction dose for anesthesia, anxiety, orientation and sedation after abdominal surgery: a double-blinded randomized trial.

The present study addressed the effect of melatonin premedication on propofol induction dose for anesthesia in abdominal surgery. This is a double-blinded clinical trial in which abdominal surgery patients admitted to the Valiasr Hospital, Iran (n = 88) were enrolled and individually randomized into two groups: melatonin and placebo groups sublingually administered 3 mg of melatonin and placebo, respectively, 50 minutes before surgery. Their anxiety, orientation, and sedation were recorded before melatonin administration, anesthesia induction, and recovery, while we also recorded the propofol induction dose required for general anesthesia. Anxiety was seen less in the melatonin group than the placebo group (P < 0.05), whereas orientation was significantly different before anesthesia induction (P = 0.044) and sedation was the same before the induction (P = 0.044) and recovery (P = 0.049) in both groups, with a better efficiency in the melatonin group in which a lower dose of propofol was used (P = 0.002). The sedation, anxiety, and propofol dose used were lower in the melatonin group than the placebo group. The recommended dosage was 3 mg of melatonin once to achieve an anesthetic depth index or a bispectral index of 40. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1395.432 code in July 2016, and the trial was registered in Iranian Registry of Clinical Trials with IRCT20141209020258N98 in September 2016.

Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications after abdominal surgery. Although the protective role of a more physiologic tidal volume has been established, the added protection afforded by positive end-expiratory pressure (PEEP) remains uncertain. The authors hypothesized that a low fixed PEEP might not fit all patients and that an individually titrated PEEP during anesthesia might improve lung function during and after surgery. Forty patients were studied in the operating room (20 laparoscopic and 20 open-abdominal). They underwent elective abdominal surgery and were randomized to institutional PEEP (4 cm H2O) or electrical impedance tomography-guided PEEP (applied after recruitment maneuvers and targeted at minimizing lung collapse and hyperdistension, simultaneously). Patients were extubated without changing selected PEEP or fractional inspired oxygen tension while under anesthesia and submitted to chest computed tomography after extubation. Our primary goal was to individually identify the electrical impedance tomography-guided PEEP value producing the best compromise of lung collapse and hyperdistention. Electrical impedance tomography-guided PEEP varied markedly across individuals (median, 12 cm H2O; range, 6 to 16 cm H2O; 95% CI, 10-14). Compared with PEEP of 4 cm H2O, patients randomized to the electrical impedance tomography-guided strategy had less postoperative atelectasis (6.2 ± 4.1 vs. 10.8 ± 7.1% of lung tissue mass; P = 0.017) and lower intraoperative driving pressures (mean values during surgery of 8.0 ± 1.7 vs. 11.6 ± 3.8 cm H2O; P < 0.001). The electrical impedance tomography-guided PEEP arm had higher intraoperative oxygenation (435 ± 62 vs. 266 ± 76 mmHg for laparoscopic group; P < 0.001), while presenting equivalent hemodynamics (mean arterial pressure during surgery of 80 ± 14 vs. 78 ± 15 mmHg; P = 0.821). PEEP requirements vary widely among patients receiving protective tidal volumes during anesthesia for abdominal surgery. Individualized PEEP settings could reduce postoperative atelectasis (measured by computed tomography) while improving intraoperative oxygenation and driving pressures, causing minimum side effects.

Subarachnoid anaesthesia plus general anaesthesia in abdominal surgery

Subarachnoid anaesthesia plus general anaesthesia in abdominal surgery

Proseal LMA vs. Endotracheal Intubation in General Anaesthesia for Abdominal Surgeries

Proseal LMA vs. Endotracheal Intubation in General Anaesthesia for Abdominal Surgeries

Comparison of cost effectiveness using low flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane versus using high flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane during 2 hours anesthesia in abdominal surgery

Comparison of cost effectiveness using low flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane versus using high flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane during 2 hours anesthesia in abdominal surgery

Intravenous lidocaine infusion in balanced anaesthesia for abdominal surgery: update and clinical experiences

Intravenous lidocaine infusion in balanced anaesthesia for abdominal surgery: update and clinical experiences

Can dexmedetomidine substitute sufentanil in anesthesia for abdominal surgery in elderly patients?

Can dexmedetomidine substitute sufentanil in anesthesia for abdominal surgery in elderly patients?