What is the clinical evidence from this study?

Study design: RCT. Population: Robot-assisted laparoscopic prostatectomy (n=50). Intervention: Dexmedetomidine vs. Normal saline. Primary outcome: QTc interval prolongation of >20 ms from baseline during surgery (p=0.001).

What question did this study set out to answer?

To determine whether intraoperative dexmedetomidine infusion attenuates prolongation of heart rate-corrected QT (QTc) and Tpeak–Tend (Tp-e) intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg positioning.

May 1, 2016MedicineOpen Access

Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak–Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position

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Key result

Continuous infusion of dexmedetomidine significantly attenuated QTc interval prolongation during robot-assisted laparoscopic prostatectomy, reducing the incidence of >20 ms prolongation from 96% to 54% compared to placebo.

Why the study?

Does dexmedetomidine reduce QTc and Tp-e interval prolongation in patients undergoing robot-assisted laparoscopic prostatectomy?

Population

50 patients scheduled for robot-assisted laparoscopic prostatectomy with steep Trendelenburg position

Comparison

Continuous infusion of dexmedetomidine at a rate… vs Same volume of normal saline. Both groups…

Design

RCT, randomized, double-blinded

Follow-up

during surgery

Authors

NKNa Young KimYonsei University DHDong Woo HanKyung Hee University JKJae Chul KohKorea University

Discussion

Member takes

Implication

Dexmedetomidine may lower arrhythmia risk during prostatectomy; extends QTc safety data in anesthesia RCTs.

Key Points

To determine whether intraoperative dexmedetomidine infusion attenuates prolongation of heart rate-corrected QT (QTc) and Tpeak–Tend (Tp-e) intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg positioning.
In a prospective, randomized, double-blind trial, 50 patients undergoing robot-assisted laparoscopic prostatectomy were allocated to receive either continuous dexmedetomidine (0.3 μg/kg/h; n = 25) or normal saline control (n = 25) from induction until the end of steep Trendelenburg positioning.
Anesthesia was maintained with sevoflurane and remifentanil, while QTc intervals, Tp-e intervals, hemodynamics, and end-tidal concentrations were recorded across surgical time points (47 patients completed the protocol).
Dexmedetomidine significantly attenuated QTc prolongation and reduced Tp-e intervals compared to control throughout surgery (PGroup × Time = 0.001 and 0.014, respectively).
QTc interval prolongation exceeding 20 ms occurred in 54% (13/24) of the dexmedetomidine group versus 96% (22/23) of the control group (P = 0.001).
The maximum QTc prolongation from baseline was significantly lower in the dexmedetomidine group than in the control group (24 ± 21 ms vs 46 ± 21 ms; mean ± SD, P = 0.001).

Study Design

Type

RCT (n=50)

Blinding

Double-blind

Randomization

Computer-generated random numbers

Multicenter

Structured PICO

Does dexmedetomidine reduce QTc and Tp-e interval prolongation in patients undergoing robot-assisted laparoscopic prostatectomy?

Population

50 male patients with ASA physical status I/II undergoing robot-assisted laparoscopic prostatectomy, evaluated for electrocardiographic changes during surgery.

Intervention

Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position

Comparator

Same volume of normal saline. Both groups maintained anesthesia with sevoflurane and remifentanil.

Outcome

QTc and Tp-e interval changessurrogate

Main Result

Absolute Event Rate: 54% vs 96%

p-value: p=0.001

Continuous infusion of dexmedetomidine during robot-assisted laparoscopic prostatectomy significantly attenuates QTc prolongation and reduces Tp-e intervals, potentially lowering ventricular arrhythmia risk.

Limitations

Dose-dependent effects remain unclear as only a single continuous infusion rate without a loading dose was used.
Baseline sympathetic activity was not directly assessed via heart rate variability or plasma catecholamines.
High prevalence of hypertension and diabetes mellitus among participants may influence ECG changes.

Cite This Study

Kim et al. (2016) conducted an RCT in Robot-assisted laparoscopic prostatectomy (n=50). Dexmedetomidine vs. Normal saline was evaluated on QTc interval prolongation of >20 ms from baseline during surgery (p=0.001). Continuous infusion of dexmedetomidine significantly attenuated QTc interval prolongation during robot-assisted laparoscopic prostatectomy, reducing the incidence of >20 ms prolongation from 96% to 54% compared to placebo.

synapsesocial.com/papers/6a9022114aebf474cb340f8e https://doi.org/10.1097/md.0000000000003645

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Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak–Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak–Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider