BACKGROUND

Dexmedetomidine having analgesic properties along with hypotensive effect seems advisable for multimodal general anesthesia in children with extrahepatic portal hypertension.

OBJECTIVE

To study the opioid-sparing effect of general combined anesthesia with dexmedetomidine in children with portal hypertension undergoing bypass surgery.

MATERIAL AND METHODS

A prospective open randomized study was conducted in 30 patients (3 groups) differing in the methods of intravenous administration of dexmedetomidine as one of the components of general combined anesthesia. All patients received dexmedetomidine 1 μg/kg for 10 minutes after induction of anesthesia (basic regimen). In the 1st group, only basic scheme was applied. In the 2nd group, basic regimen was supplemented by injection of dexmedetomidine 0.2 μg/kg/h, in the 3rd group — 1.4 μg/kg/h. In the 2nd and 3rd groups, dexmedetomidine was used before blood flow release through anastomosis. We assessed analgesic component of general anesthesia considering clinical, objective and laboratory parameters.

RESULTS

In all groups, hemodynamic parameters, serum cortisol, glucose and lactate indicated sufficient depth of anesthesia and effectiveness of analgesia. Fentanyl consumption was significantly higher in the 1st group (1.71 μg/kg/h) compared to the 2nd group (1.26 μg/kg/h, p=0.01) and the 3rd group (1.08 µg/kg/h, p=0.01). Doses of fentanyl were similar in the 2nd and 3rd groups.

CONCLUSIONS

Dexmedetomidine infusion 1 μg/kg at induction of anesthesia and subsequent infusion 1.4 μg/kg/h in children with portal hypertension significantly reduce the need for fentanyl to 37%. This approach provides effective and sufficient analgesia and hemodynamic stability.