• James Feld, William E Hoffman, Chanannait Paisansathan, Hans Park, and Ranga C Ananda.
• Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA.
• J Clin Anesth. 2007 Feb 1;19(1):30-6.

Study ObjectiveTo evaluate autonomic activity with dexmedetomidine or fentanyl infusion and desflurane anesthesia during laparoscopic gastric banding.Study DesignRandomized, single-blinded, open-label study.SettingOperating rooms at a university hospital.Subjects40 patients scheduled for laparoscopic gastric banding with a mean body mass index of 50 kg/m2.InterventionsPatients received either dexmedetomidine (0.5 microg/kg given intravenously over 10 minutes, 0.4 microg.kg-1.h-1, n=20) or fentanyl (0.5 microg.kg-1 bolus, 1 microg.kg-1.h-1, n=20) during anesthesia. Response entropy of the electroencephalogram was maintained at 45+/-5 by adjusting end-tidal desflurane concentration.MeasurementsIn the operating room, blood pressure, heart rate (HR), response entropy, end-tidal desflurane concentration, tone entropy, and power-spectral analysis of HR were measured with the patient awake; 20, 40, and 60 minutes from intubation and the start of drug infusion; and at extubation.Main ResultsThe mean end-tidal desflurane concentration during anesthesia was 4.0%+/-0.6% with dexmedetomidine and 4.1%+/-0.7% with fentanyl, indicating a similar anesthetic requirement in both groups. Autonomic activity, determined by tone entropy and spectral analysis of HR, decreased by 50% during anesthesia in both groups. The dexmedetomidine group showed a greater decrease in sympathovagal balance during anesthesia.ConclusionBoth dexmedetomidine and fentanyl facilitated anesthesia and attenuated autonomic activity. Dexmedetomidine produced a greater decrease in sympathovagal balance than fentanyl.

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