Dexmedetomidine reduces sevoflurane EC₅₀ for supraglottic airway device insertion in spontaneously breathing morbidly obese patients

Abstract

Purpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC₅₀ for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients.

Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40–57 kg/m² who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ET_sev) was adjusted to a target value as to the modified Dixon’s up-and-down method. Patients’ response to SAD insertion was classified as “movement” or “no movement”. The average of the midpoints of all crossover points was defined as calculated sevoflurane EC₅₀ for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC₅₀) and 95% (EC₉₅) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD.

Results: The calculated sevoflurane EC₅₀ for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p<0.001). By the probit regression analysis, EC₅₀ and EC₉₅ of sevoflurane for successful SAD insertion were 1.59% (95% CI, 1.22–1.90%) and 2.15% (95% CI, 1.86–3.84%) in group D, respectively, and 2.81% (95% CI, 2.35–3.29%) and 3.32% (3.02–6.74%) in group S.

Conclusion: When sevoflurane inhalational induction is performed in spontaneous breathing morbidly obese patients, intravenous DEX can reduce sevoflurane EC₅₀ for successful SAD insertion by about 40%.

Chinese Clinical Trial Registry: No. ChiCTR1800016868

Keywords:

• obesity
• inhalational induction
• sevoflurane
• dexmedetomidine
• supraglottic airway device

Ethics approval

This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of the Beijing Friendship Hospital. All patients provided written informed consent.

Data sharing statement

Data will be available upon reasonable request, which also needs to be reviewed and approved by the ethics committee.

Author contributions

Lei Wan, Liu-Jia-Zi Shao, Yang Liu, Hai-Xia Wang, Fu-Shan Xue and Ming Tian were study investigators and participated in study design, patient recruitment, acquisition of data, and/or analysis and interpretation of the findings. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.