Dexmedetomidine in Non-intubated VATS

Study Overview
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Brief Summary
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This prospective study aims to evaluate the effectiveness of intraoperative DEX for postoperative analgesia and recovery after non-intubated VATS. In addition, the investigators observe the impact of DEX on anesthetic requirements, hemodynamic parameters, and adverse events during non-intubated VATS.

Detailed Description
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The non-intubated thoracoscopic approach has been adapted for use with major lung resections. The non-intubated VATS tries to minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. An adequate analgesia allows VATS to be performed in sedated patients and the potential adverse effects related to general anesthesia and selective ventilation can be avoided. Dexmedetomidine (DEX), a highly selective alpha-2 receptor agonist, is increasingly used in anesthesia with sedative, hypnotic, anxiolytic, sympatholytic, and analgesic effects. It can also attenuate perioperative stress and inflammation and preserve the immunity of surgical patients, which may contribute to reduced postoperative complications and improved clinical outcomes. This study aims to evaluate the effectiveness of intraoperative DEX for postoperative analgesia and recovery after non-intubated VATS. In addition, the investigators observe the impact of DEX on anesthetic requirements, hemodynamic parameters, and adverse events during non-intubated VATS.

Official Title
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Adjunctive Dexmedetomidine Infusion in Non-intubated Video-assisted Thoracoscopic Surgery

Conditions
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Dexmedetomidine, Thoracoscopy, Analgesia

Intervention / Treatment
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* Drug: Dexmedetomidine infusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists (ASA) score of I-III patients receiving video-assisted thoracoscopic surgery Exclusion Criteria: Age < 18 or > 80 years ASA classifications > III Pregnancy Known allergies to any drugs used in the study Emergency surgery Patient refusal Chronic pain history

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group Saline<br>Propofol-based total intravenous anesthesia with saline infusion | Drug: Dexmedetomidine infusion<br>* Intraoperative dexmedetomidine infusion<br>|
| Experimental: Group Dexmedetomidine<br>Propofol-based total intravenous anesthesia with dexmedetomidine infusion | Drug: Dexmedetomidine infusion<br>* Intraoperative dexmedetomidine infusion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cough | The incidence of cough reflex during surgery and severity Cough severity: 1=none, 2=slight, 3=moderate, 4=severe | Intraoperative period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative fentanyl consumption | Fentanyl bolus for cough reflex and limb movement | Intraoperative period | 
| Total fentanyl consumption | Total fentanyl requirement during surgery | Intraoperative period | 
| Total propofol consumption | Total propofol requirement during surgery | Intraoperative period | 
| Intraoperative adverse events | The incidence of hypotension, bradycardia and hypoxia | Intraoperative period | 
| Postoperative numeric rating scale | Numeric rating scale within postoperative 48 hours NRS scores is labeled from zero to ten, with zero being an example of someone with no pain and ten being the worst pain possible. | Postoperative 48 hours | 
| Postoperative opioid requirement | Postoperative opioid requirement within postoperative 48 hours | Postoperative 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dexmedetomidine, Thoracoscopy, Analgesia