COMPARISON OF TWO DEXMEDETOMIDINE MAINTENANCE-INFUSION DOSES FOR EMERGENCE AGITATION AND QUALITY OF RECOVERY AFTER LAPAROSCOPIC SURGERY: A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL

Abstract

Objectives: The purpose of this study was to compare dexmedetomidine maintenance infusions of 0.3 μg/kg/h and 0.5 μg/kg/h for preventing emergence agitation and improving post-operative quality of recovery after elective laparoscopic surgery. Methods: This randomized, double-blind, parallel-group trial included 132 adults with American Society of Anesthesiologists physical status I–II. After a dexmedetomidine loading dose of 0.5 μg/kg, participants received maintenance infusions of either 0.3 μg/kg/h (Group A, n=66) or 0.5 μg/kg/h (Group B, n=66). The primary outcome was emergence agitation, defined as a Richmond Agitation–Sedation Scale score ≥+1 within 30 min after extubation. Covariate-adjusted analysis was used as a sensitivity assessment for baseline imbalances in sex, weight, and body mass index. Results: Emergence agitation occurred in 25 (37.9%) patients in Group A and 12 (18.2%) in Group B (relative risk, 0.48; 95% confidence interval, 0.26–0.87; p=0.020). The adjusted odds ratio was 0.39 (95% confidence interval, 0.17–0.88). Group B had a higher 24-h quality of recovery-15 score (129.4±9.9 vs. 116.5±9.5; p<0.001) and greater satisfaction, although eye opening, verbal response, and extubation were modestly delayed. Bradycardia (36.4% vs. 7.6%; p<0.001) and hypotension (10.6% vs. 0%; p=0.013) were more frequent in Group B. No respiratory depression occurred. Conclusion: Dexmedetomidine 0.5 μg/kg/h reduced emergence agitation and improved patient-reported recovery compared with 0.3 μg/kg/h, but required closer surveillance for bradycardia and hypotension.