Recovery Profiles after General Anesthesia in Patients undergoing Anterior Cervical Discectomy and Fusion (ACDF) Surgery with or without Dexmedetomidine as an Anesthetic Adjuvant: A Double Blinded Randomized Study
Busara Sirivanasandha MD1, Issada Jindawatthana MD1, Soraya Rodchour MD1, Porntip Mahatnirunkul BSN1, Arissara Iamaroon MD1, Manee Raksakietisak MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The purpose of the present study was to evaluate the effect of dexmedetomidine as an anesthetic adjuvant on
recovery profiles after general anesthesia for anterior cervical discectomy and fusion [ACDF] surgery.
Materials and Methods : Ninety-eight patients who scheduled for ACDF were randomized into 2 groups by computer-
generated random numbers. The dexmedetomidine group (group D, n = 49) received dexmedetomidine 0.5 mcg/kg loading in
30 min then 0.5 mcg/kg/h. The control group (group N, n = 48) received volume-matched 0.9% NaCl or normal saline [NSS].
General anesthesia was maintained with desflurane (bispectral index (BIS) around 40 to 60) and continuous intravenous
infusion of neuromuscular blocking agent and intravenous fentanyl. Study drug was started after positioning and stopped 30
minutes prior to the end of surgery. Desflurane was turned off at the time of suturing the last stitch and neuromuscular
reversal agent was given. The recovery profiles were evaluated by using Riker sedation agitation score (1 to 7) and respiratory
parameters. Riker sedation agitation score was reevaluated at 15 minutes post-extubation at PACU. The analgesic used and
pain scores were assessed in 24 hours postoperatively.
Results : The recovery profiles were not different between two groups. The incidences of emergence agitation (Riker score 5
to 7) were 13 (26.5%) in Group D vs. 20 (42.6%) in group N, p = 0.098. The intraoperative fentanyl, desflurane consumption
significantly decreased in group D. The extubation time was slightly longer in group D (8.3+5.3 min) compared to group N
(5.7+2.8 min) with statistical significance (p = 0.003). In group D, the incidence of severe pain (Numeric rating score >7) at
4 h was also lower. The incidence of intraoperative hypertension was lower in group D but higher incidence of hypotension.
Conclusion : Dexmedetomidine as an anesthetic adjuvant in ACDF surgery failed to demonstrate effect to reduce emergence
agitation, and had higher risk of adverse hemodynamic complications.
Keywords : Dexmedetomidine, Cervical spine surgery, Recovery, Riker sedation agitation score
