Medical Student Research Fellowship for Summer 2006

Mentor: James D. Griffin, MD
Department: Anesthesiology & Pain Management
Room number: F2.208
Mail Code: 9068
Phone number: 214-648-6424
E-mail: dolly.tutton@utsouthwestern.edu
Project title: A randomized, double-blind, controlled study of dexmedetomidine (Precedex®) infusion for improving control of acute autonomic response during laparoscopic bariatric surgery

Human subjects IRB approved project number (where applicable): 072005-020

Animal subjects IRB approved project number (where applicable): N/A

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects): Patient-based research

Brief Description of Project:

Dexmedetomidine (Precedex ) is a relatively selective alpha2-adrenoceptor agonist with sedative and analgesic properties with associated reduction in opioid and anesthetic requirements. One significant advantage of dexmedetomidine is that in the clinical dose range there is no respiratory depression. Precedex is indicated for sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting. Previous studies have shown that when dexmedetomidine is used, the percentage of patients requiring morphine after surgery and the mean quantity of morphine used when required were significantly reduced. However, intraoperative dexmedetomidine infusion for controlling the hemodynamic response during the surgery has not been reported. The objective of this study is to test the different doses of dexmedetomidine infusion for improving control of acute autonomic responses during surgery in a patient population at increased risk to opioid-induced ventilatory depression in the postoperative period.

After obtaining informed consent, 80 morbidly obese ASA II-III patients undergoing laparoscopic bariatric surgery procedures would be randomly assigned to one of four study groups (n=20/each) at UT Southwestern Medical Center at Dallas. Recovery times, postoperative pain scores, the need for "rescue" analgesics, and side effects will be recorded at 5 to 15 min intervals prior to discharge from the recovery room. The overall duration of the study is one week. Subject will be asked if he/she suffers from any nausea, vomiting and pain until the time of discharge from the recovery unit. Follow-up evaluations will be performed at 24 h, 36h, 72 h if the patient remains in the hospital. In addition, the subject will be called on Day 7 and the subject's pain score and pain medication requirements, as well as time to resumption of normal activities will be assessed.

Previous Research Activities or Publications with Medical Students:

Song D, Singh H, White PF, Gadhiali M, Griffin, JD, Klein KW: Optimal dose of nicardipine for maintenance of hemodynamic stability after tracheal intubation and skin incision. Anesth Analg 1997; 85: 1247-51.

Song D, Heise DA, White PF: Facial electromyography correlates with the level of sedation and pain in outpatients undergoing lithotripsy. Anesthesiology 1998; 89: A928.

Fredman B, d'Etienne BA, Taylor E, Smith I, White PF: Use of low-dose propofol vs methohexital for electroconvulsive therapy. Anesth Analg 1994; 78: S120.

Zarate E, Watcha MF, White PF, Klein KW, Sá Rêgo M, Stewart DG: A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis. Anesth Analg 2000 90: 1352-8.

Shao X, Li H, White PF, Klein KW, Kulstad C, Owens A: Bisulfite-containing propofol: is it a cost-effective alternative to Diprivan for induction of anesthesia?. Anesth Analg 2000; 91: 871-5.

Coloma M, Markowitz SD, White PF, Whitten CW, Berrisford SB: Effect of dexamethasone on the prophylactic antiemetic activity of dolasetron. Anesthesiology 2001; 95: A-40.

Kadar AG, Ing CH, White PF, Wakefield CA, Kramer BA, Clark K: Anesthesia for electroconvulsive therapy in obese patients. Anesth Analg 2002; 94: 360-1.

Issioui T, Klein KW, White PF, Watcha MF, Skrivanek GD, Jones SB, Hu J, Marple BF, Ing C: Cost-efficacy of rofecoxib versus acetaminophen for preventing pain after ambulatory surgery. Anesthesiology 2002; 97: 931-7.

Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso A, Berrisford S, Thornton K: Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anesthesiology 2002; 97: 1387-92.

White PF, Issioui T, Hu J, Jones SB, Coleman JE, Waddle JP, Markowitz SD, Coloma M, Macalusco AD, Ing CH: Comparative efficacy of acustimulation (ReliefBand ) and ondansetron (Zofran ) in combination with droperidol for preventing nausea and vomiting. Anesthesiology 2002; 97: 1075-81.

Coloma M, White PF, Ogunnaike BO, Markowitz SD, Brown PM, Lee AQ, Berrisford SB, Wakefield CA, Jones SB, Jones DB: Comparison of acustimulation and ondansetron for the treatment of established postoperative nausea and vomiting. Anesthesiology 2002; 97: 1387-92.

Issioui S, Jones B, White PF, Hu J, Rawal S, Ing C: Comparative efficacy of ondansetron and the Reliefband for antiemetic prophylaxis in outpatients undergoing plastic surgery. Anesth Analg 2002; 94: S3.
Issioui T, Klein KW, White PF, Rawal S, Skrivanek GD, Ing C: Comparison of ibuprofen, celecoxib and rofecoxib as premedication prior to outpatient orthopedic surgery. Anesth Analg 2002; 94: S4.
Coloma M, White PF, Markowitz SD, Jones SB, Wakefield CA, Berrisford SB: Comparison of the acustimulation ReliefBand device to ondansetron for treatment of PONV after ambulatory surgery. Anesth Analg 2002; 94: S12.

Coloma M, Ogunnaike BO, White PF, Lee AQ, Brown PM, Wakefield CA: Comparative analgesic efficacy of ibuprofen, ketorolac and rofecoxib in preventing pain after ambulatory surgery. SAMBA annual meeting May, 2002, poster 10.

White PF, Rawal S, Latham P, Markowitz S, Issioui T, Chi L, Dellaria S, Shi C, Morse L, Ing C: Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 2003; 99: 918-23.

White PF, Issioui T, Skrivanek GD, Early JS, Wakefield C: The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve quality of recovery? Anesth Analg 2003; 97: 1303-9.

Recart A, White PF, Wang A, Gasanova I, Byerly S, Jones SB: Effect of evoked potential index monitoring on anesthetic drug requirements and recovery profile after laparoscopic surgery: A clinical utility study. Anesthesiology 2003; 99: 813-8.

Recart A, Gasanova I, White PF, Thomas T, Ogunnaike B, Hamza M, Wang A: Effect of cerebral monitoring on recovery after general anesthesia: comparison of AEP vs BIS devices vs standard practice. Anesth Analg 2003; 97: 1667-74.

Recart A, Duchene D, White PF, Thomas T, Johnson DB: Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 2005; 19: 1165-9.

White PF, Song D, Abrao J, Klein KW, Navarette B: Effect of low-dose droperidol on the QT interval during general anesthesia: a placebo-controlled study. Anesthesiology 2005; 102:1101-5.

Return to Medical Student Research Page