Dexmedetomidine versus propofol on intestinal barrier function in patients undergoing major gastrointestinal tract surgery: A prospective randomized comparative trial protocol

The effect of non benzodiazepine sedation on post-operative bowel function

Authors

  • Jantarat Wisawachaiwat Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Pimpisa Assawaroongsakul Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Titipon Payongsri Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Pongpol Sirilaksanamanon Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Nalin Chokengarmwong Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Thammasak Thawitsri Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400

DOI:

https://doi.org/10.54205/ccc.v32.267521

Keywords:

Dexmedetomidine, Propofol, Major gastrointestinal surgery, Intestinal barrier function, D-lactate, Randomized controlled clinical trial

Abstract

Background: Dexmedetomidine and propofol are recommended as  sedatives for agitation management in critically ill adults. However, sedative agents always have a diversity of adverse effects, including gastrointestinal recovery. Delayed recovery of gastrointestinal motility results in prolonged hospital stays and increased medical costs for critically ill patients. The study is intended to compare the effects of dexmedetomidine and propofol on intestinal barrier function and clinical benefits in patients undergoing major gastrointestinal surgery.

Methods: In an experimental prospective randomized comparative trial, 60 patients who undergo major gastrointestinal tract surgery will be randomized into the dexmedetomidine group (n=30) and the propofol group (n=30). In the dexmedetomidine group, dexmedetomidine will be commenced at an initial concentration of 0.3 to 0.7 mcg/kg/h. In the propofol group, propofol will be commenced at an initial dose of 1.0 mg/kg/h to 4.0 mg/kg/h. Sedation is targeted at RAAS (-1)-0. Epidural analgesia will be used for pain control in both groups. The blood pressure, mean arterial pressure, heart rate, length of stay in the intensive care unit, postoperative endotracheal intubation time, and time to postoperative first defecation will be recorded. Serum D-lactate levels will be detected before the start of sedation (0 hour) and after sedation at 12, 24 hours, respectively.

Hypothesis: We hypothesize that dexmedetomidine and propofol, with optimal use for sedation, will have different effects on gastrointestinal recovery.

Ethics and dissemination: This study protocol was developed by investigators and approved by the Institutional Review Board of Faculty of Medicine of Chulalongkorn University (COA No. 0139/2023).

Trial registration: TCTR20230118002

References

Namba Y, Hirata Y, Mukai S, Okimoto S, Fujisaki S, Takahashi M, et al. Clinical indicators for the incidence of postoperative ileus after elective surgery for colorectal cancer. BMC Surg. 2021;21(1):80.

Barletta JF, Senagore AJ. Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy. World J Surg. 2014;38(8):1966-77.

Moghadamyeghaneh Z, Hwang GS, Hanna MH, Phelan M, Carmichael JC, Mills S, et al. Risk factors for prolonged ileus following colon surgery. Surg Endosc. 2016;30(2):603-609.

Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin. 2007;45(2):27-37.

Brenda A, Bucklin MD, Alan C,Santos MD, MPH. Local anesthetics and opioids. Chestnut's Obstetric Anesthesia, 13, 271-311.

Kurz A, Sessler DI. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003;63(7):649-71.

Ahmed A, Latif N, Khan R. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2013;29(4):472-7.

Jafarzadeh A, Hadavi M, Hassanshahi G, Rezaeian M, Vazirinejad R. General anesthetics on immune system cytokines: A narrative review article. Anesth Pain Med. 2020;10(4):e103033.

Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123(6):777-794.

Qi YP, Ma WJ, Cao YY, Chen Q, Xu QC, Xiao S, et al. Effect of dexmedetomidine on intestinal barrier in patients undergoing gastrointestinal surgery-A single-center randomized clinical trial. J Surg Res. 2022;277:181-188.

Tang J, Jiang Y, Tang Y, Chen B, Sun X, Su L, et al. Effects of propofol on damage of rat intestinal epithelial cells induced by heat stress and lipopolysaccharides. Braz J Med Biol Res. 2013;46(6):507–12.

Kowlgi NG, Chhabra L. D-lactic acidosis: An underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215.

Ewaschuk J, Naylor J, Zello G. D-lactate in human and ruminant metabolism. J Nutr. 2005;135:1619-25.

Downloads

Published

2024-05-30

How to Cite

1.
Wisawachaiwat J, Assawaroongsakul P, Payongsri T, Sirilaksanamanon P, Chokengarmwong N, Thawitsri T. Dexmedetomidine versus propofol on intestinal barrier function in patients undergoing major gastrointestinal tract surgery: A prospective randomized comparative trial protocol: The effect of non benzodiazepine sedation on post-operative bowel function. Clin Crit Care [Internet]. 2024 May 30 [cited 2024 Jun. 22];32(1):e240011. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/267521

Issue

Section

Research Protocol