Propofol or dexmedetomidine which is better for anesthesia maintenance in laparoscopic cholecystectomy?

Iran: Anesthesia maintenance by dexmedetomidine in comparison with propofol showed a significant difference in hemodynamic parameters in a recent study published in the journal Anesthesiology & Pain Medicine. Dexmedetomidine, however, had better effects on controlling hemodynamic parameters, and propofol was found to have better effects on decreasing stress hormones and thus can be suggested for laparoscopic cholecystectomy (LC) surgery. 

General anesthesia induces immunologic, endocrine, and metabolic responses. Anesthetic drugs affect the endocrine system by modifying the level of stress hormones and hemodynamic variables of the patient. Ali Ghomeishi, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, and colleagues aimed to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy surgery.

The study included seventy patients of elective LC. They were randomly assigned in the ratio of 1:1 to receive propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), serum epinephrine, and blood sugar level were monitored and recorded from the pre-anesthesia period to 10 min after entry to the post-anesthesia care unit (PACU) according to a planned method. 

"Although epinephrine level was low in the propofol group, there was a significant difference in hemodynamic parameters," wrote the authors. This suggests future studding on the combination of dexmedetomidine propofol. Consistent hemodynamic and lack of significant difference in important factors could refer to monitoring depth anesthesia by BIS."

Reference:

Ghomeishi A, Mohtadi A R, Behaeen K, Nesioonpour S, Bakhtiari N, et al. Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery. Anesth Pain Med. 2021;11(5):e119446. doi: 10.5812/aapm.119446.