Clinical efficacy of remifentanil combined with dexmedetomidine for analgesia in bariatric surgery patients and its impact on postoperative recovery

Jiang Jianhua; Zhu Xuxian

doi:10.3969/j.issn.1672-8157.2025.04.022

Abstract：Objective To explore clinical efficacy of remifentanil combined with dexmedetomidine for analgesia in bariatric surgery patients and its impact on postoperative recovery.Methods A retrospective analysis was conducted on the clinical data of 92 obese patients who underwent laparoscopic weight loss surgery at Affiliated Baoji Hospital of Xi'an Medical University from March 2021 to September 2024.The patients were divided into the control group and the observation group according to the anesthe-sia methods,with 46 cases in each group.During anesthesia induction,the control group received propofol,cisatracurium,and sufen-tanil,while the observation group received an additional of dexmedetomidine on the basis of the control group's regimen.During intraoperative anesthesia maintenance,both groups intermittently received sufentanil and cisatracurium,with continuous infusion of propofol and remifentanil.The heart rate,mean arterial pressure(MAP),partial pressure of carbon dioxide(PaCO2),pH value and partial pressure of oxygen(PaO2)of the two groups were monitored before anesthesia(T0),10 min post-anesthesia intubation(T1),20 min post-anesthesia intubation(T2),and 30 min post-anesthesia intubation(T3).The recovery conditions of the two groups of pa-tients were recorded,including the duration of tracheal extubation,the duration of treatment in the post-anesthesia care unit(PACU),the duration of the first postoperative ambulation,the PaO2 level during postoperative hospitalization,the duration of preoperative transcutaneous oxygen saturation(SpO2)dropping to 92% after endotracheal intubation(T92),and the duration for SpO2 to recover to 96% after ventilation restoration(T96R).The visual analog scale(VAS)was used to assess the pain conditions of the two groups of patients immediately after extubation and at 6,12 and 24 hours postoperatively.The incidence of adverse reactions during the recovery period and the use of remedial analgesic drugs in the two groups of patients were also observed.Results The results of repeated measures analysis of variance showed that there were statistically significant differences in the time effect,intergroup ef-fect,and interaction effect of PaCO2 between the two groups of patients(all P<0.05).At the T1 and T2 time points,the PaCO2 in the observation group((48.53±7.31)mm Hg(1 mm Hg≈0.133 kPa)and(45.64±7.80)mm Hg)was higher than that of the control group((40.07±7.59)mm Hg and(39.95±7.73)mm Hg),and the differences were statistically significant(t=5.426,3.515,both P<0.05),and the levels of PaO2 in the observation group((76.22±6.73)mm Hg and(77.05±8.01)mm Hg)were lower than those of the control group((81.66±7.04)mm Hg and(81.67±7.92)mm Hg),and the differences were statistically significant(t=3.726,2.782,both P<0.05).The observation group had shorter duration for tracheal extubation,the treatment in PACU,first postoperative ambulation,and the postoperative hospital stay((6.33±2.13)min,(36.32±10.28)min,(242.36±20.70)min and(6.52±1.07)d)compared to the control group((7.92±2.26)min,(42.20±10.13)min,(283.15±19.35)min and(7.27±1.13)d),and the differences were statistically significant(t=3.472,2.763,9.763,3.269,all P<0.05).The T92 value of the observation group((295±90)s)was lower than that of the control group((355±92)s),and the difference was statistically significant(t=3.162,P=0.002).The T96R value of the observation group((48±11)s)was higher than that of the control group((33±9)s),and the difference was statistically significant(t=-7.158,P<0.001).The VAS scores of the patients of the observation group at 6,12,and 24 hours postoperative((4.61±1.65)points,(4.22±1.33)points and(3.57±1.16)points)were lower than those of the control group((5.83±1.78)points,(5.18±1.52)points and(4.61±1.38)points),and the differences were statistically significant(t=3.409,3.224,3.913,all P<0.05).The observation group showed significantly lower rates of hypoxemia and remedial anal-gesia(15.22% (7/46),17.39% (8/46))compared to the control group(34.78% (16/46),36.96% (17/46))(χ2=4.696,4.449,both P<0.05).Conclusion The combination of remifentanil and dexmedetomidine can effectively improve the degree of acute pain after laparo-scopic weight loss surgery in obese patients,stabilize hemodynamics,promote postoperative recovery and reduce adverse reactions.