Introduction: Dexmedetomidine (Dex) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. Among the many possible clinical advantages to a drug with these characteristics in laparoscopic bariatric surgery is the potential for optimal pain control with fewer narcotics, less nausea and earlier discharge following surgery.
Methods: For 10 months (September 2005 to June 2006), patients undergoing a laparoscopic bariatric procedure (Lap Band [Band] and Gastric Bypass [GBP]) received a Dex infusion 30 minutes prior to the anticipated completion of the procedure. Dex was loaded at 1mcg/kg over 10 minutes and continued until end of surgery at 0.2-0.7mcg/kg/hr (to maintain systolic blood pressure>90). Narcotic dose, antiemetic use, patient self-assessed pain scores, and length of stay (LOS) were the variables of interest. These parameters were compared by retrospective chart review for patients to receive a Dex infusion vs. a similar number of patients to have surgery in the 4 months prior to this time period who did not receive Dex. All pathways and discharge criteria were identical for patients in each group.
Results Charts from 73 patients meeting the above criteria were reviewed. Two GBP patients were excluded for major complications (one intra-abdominal bleed and one leak), one in each group. Outcomes are compared in the table below based on procedure and Dex use. Demographics and BMI were similar for all groups.
Conclusions: Dex infusion peri-op is safe and may help to minimize narcotic requirements following laparoscopic bariatric procedures. This may result in discharge criteria being met earlier and less nausea after surgery. A well organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of Dex suggested by this study.

	GBP Dex (n=23)	GBP no Dex (n=19)	Band Dex (n=11)	Band no Dex (n=18)
MSO4 equiv total	66.1*	130.1*	19.1	32.8
LOS (days)	1.4*	1.9*	1.1	1.0
MSO4 equiv/day	47.3	67.3	17.9*	32.8*
Antiemetic doses	3.0	2.7	1.5*	2.2*
Mean Pain PACU (0-10)	3.5	2.7	4.1	3.6
Pain floor day#0	2.4	3.3	2.7	2.4
Mean HR PACU	74.6	71.6	69.2	68.9
Mean SBP PACU	120.8	123.7	113.7	125.1

*p<0.05 considered statistically significant; MSO4 equiv = Morphine equivalent doses; PACU = Post-Anesthesia Care Unit; SBP = Systolic Blood Pressure; HR = Heart Rate