Mohammad Abusaoud, RN, DNP, CRNA

DNP Nurse Anesthesia 

Effects of Intraoperative Dexmedetomidine in Abdominal Surgery: An Integrative Review

Project Category: Evidence Implementation

Project Team: Mohammad Abusaoud, DNP, CRNA, Ahmad Ahmad, DNP, CRNA  Jennifer Greenwood, DNP, CRNA (Advisor)

Abstract

Background: Postoperative gastrointestinal complications are common sequelae that affect many people in the United States. The complications are associated with interference with gastrointestinal function due to autonomic regulation, inflammatory responses, gastrointestinal hormones, and postoperative use of opioid drugs (Huang et al., 2021). One of the common postoperative complications affecting patients in the United States is postoperative ileus, characterized by the inability to resume a regular diet, vomiting, constipation, nausea, and abdominal distension (Lu et al., 2021). The disease manifests as the absence of flatus and defecation, with patients unable to tolerate normal eating. The incidence of postoperative ileus in patients who undergo abdominal surgery is approximately 10-27% making it an important issue for several healthcare professionals and patients (Somer et al., 2021). Surgeons and other healthcare providers need to understand the best approaches to improve gastrointestinal motility and prevent postoperative ileus among other problems. 

Methods: The integrative review will be conducted according to the Joanna Briggs Institute (JBI) guidelines for systematic reviews of effectiveness since the review aims at determining the effectiveness of dexmedetomidine in managing postoperative complications and pain in patients undergoing abdominal surgery. Conducting an integrative review concerned with analyzing effectiveness requires the development of a review protocol that outlines the objectives and the methods that are intended to be used in achieving the objectives (Joanna Briggs Institute, 2022). The protocol provides a framework containing all the important sections that must be incorporated in the integrative review to ensure effective search and utilization of evidence to answer the PICO question.

Results: After completing and analyzing the data matrix constructed, it is becoming evident that a common theme has emerged. For example, amongst the groups that received DEX vs. those that received the placebo drugs (normal saline), time to first flatus and length of stay significantly decreased.

Conclusion: Patients undergoing abdominal surgery would significantly benefit from the administration of DEX, which improves the postoperative experience by regaining normal gastrointestinal functioning without further impairment. The medication would help reduce the incidence of postoperative ileus by shortening the time to first flatus, time to first eating, and time to first eating. The effectiveness of DEX would help improve patient outcomes in terms of length of hospital stay, quality of recovery, and 30-day readmission rates. Such improvements would translate to reduced healthcare costs and postoperative morbidity and mortality resulting from postoperative gastrointestinal complications. For all patients undergoing abdominal surgery, intraoperative and postoperative use of DEX for improved gastrointestinal integrity should be recommended. The study is vital in anesthesia since DEX would minimize the use of intraoperative opioids and other anesthetics during abdominal surgery. The study would also improve anesthesia practice by providing a better alternative to minimize postoperative complications and pain without adverse effects on the patient's gastrointestinal motility. The integrative review is expected to inform practice for anesthesia providers, surgeons, and other healthcare professionals by determining the effectiveness of DEX in managing postoperative complications and pain after different types of abdominal surgery.

Full Manuscript