Dexmedetomidine versus propofol on intestinal barrier function in patients undergoing major gastrointestinal tract surgery: A prospective randomized comparative trial protocol

Abstract

Background: Dexmedetomidine and propofol are recommended as sedatives for agitation management in critically ill adults. However, sedative agents always have a diversity of adverse effects, including gastrointestinal recovery. Delayed recovery of gastrointestinal motility results in prolonged hospital stays and increased medical costs for critically ill patients. The study is intended to compare the effects of dexmedetomidine and propofol on intestinal barrier function and clinical benefits in patients undergoing major gastrointestinal surgery. Methods: In an experimental prospective randomized comparative trial, 60 patients who undergo major gastrointestinal tract surgery will be randomized into the dexmedetomidine group (n=30) and the propofol group (n=30). In the dexmedetomidine group, dexmedetomidine will be commenced at an initial concentration of 0.3 to 0.7 mcg/kg/h. In the propofol group, propofol will be commenced at an initial dose of 1.0 mg/kg/h to 4.0 mg/kg/h. Sedation is targeted at RAAS (-1)-0. Epidural analgesia will be used for pain control in both groups. The blood pressure, mean arterial pressure, heart rate, length of stay in the intensive care unit, postoperative endotracheal intubation time, and time to postoperative first defecation will be recorded. Serum D-lactate levels will be detected before the start of sedation (0 hour) and after sedation at 12, 24 hours, respectively. Hypothesis: We hypothesize that dexmedetomidine and propofol, with optimal use for sedation, will have different effects on gastrointestinal recovery. Ethics and dissemination: This study protocol was developed by investigators and approved by the Institutional Review Board of Faculty of Medicine of Chulalongkorn University (COA No. 0139/2023) Trial registration: TCTR20230118002