• Sean Coeckelenbergh, Stefano Doria, Daniel Patricio, Laurent Perrin, Edgard Engelman, Alexandra Rodriguez, Livia Di Marco, Luc Van Obbergh, Jean-Pierre Estebe, Luc Barvais, and Panayota Kapessidou.
• From the Department of Anaesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (SC, SD, LP, EE, LVO, LB), Department of Anaesthesiology, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (SC, DP, LDM, PK), EW Data Analysis, Brussels, Belgium (EE), Department of Ear-Nose-Throat Surgery, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (AR) and Department of Anaesthesiology, CHU Rennes, Université de Rennes, Rennes, France (JP-E).
• Eur J Anaesthesiol. 2021 May 1; 38 (5): 524-533.

BackgroundThe effect of dexmedetomidine on Nociception Level Index-guided (Medasense, Israel) antinociception to reduce intra-operative opioid requirements has not been previously investigated.ObjectiveWe aimed to determine if low-dose dexmedetomidine would reduce remifentanil requirements during Nociception Level Index-guided antinociception without increasing complications associated with dexmedetomidine.DesignDouble-blind randomised controlled trial.SettingTwo university teaching hospitals in Brussels, Belgium.PatientsAmerican Society of Anesthesiologists 1 and 2 patients (n = 58) undergoing maxillofacial or cervicofacial surgery under propofol--remifentanil target-controlled infusion anaesthesia.InterventionsA 30 min infusion of dexmedetomidine, or equal volume of 0.9% NaCl, was infused at 1.2 μg kg-1 h-1 immediately preceding induction and then decreased to 0.6 μg kg-1 h-1 until 30 min before ending surgery. Nociception Level Index and frontal electroencephalogram guided the remifentanil and propofol infusions, respectively.Main OutcomesThe primary outcome was the remifentanil requirement. Other outcomes included the propofol requirement, cardiovascular status and postoperative outcome.ResultsMean ± SD remifentanil (3.96 ± 1.95 vs. 4.42 ± 2.04 ng ml-1; P = 0.0024) and propofol (2.78 ± 1.36 vs. 3.06 ± 1.29 μg ml-1; P = 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 ± 0.085 vs. 0.198 ± 0.086 μg kg-1 min-1; P = 0.0074) and propofol (5.7 ± 2.72 vs. 7.4 ± 2.80 mg kg-1 h-1; P = 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision.ConclusionIn ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia.Trial RegistrationsClinicaltrials.gov: NCT03912740, EudraCT: 2018-004512-22.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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