Dexmedetomidine reduces pulmonary complications in older patients undergoing abdominal laparoscopic surgery: a prospective, single-blinded, randomized controlled trial

Citation:

Gao Z-Z, Sun Z-L, He Z-J, Zhao H-S, Song H, Sun D-F, Yang L. Dexmedetomidine reduces pulmonary complications in older patients undergoing abdominal laparoscopic surgery: a prospective, single-blinded, randomized controlled trial. BMC Anesthesiol. 2026. doi:10.1186/s12871-026-03633-1

Single-centre randomized data in older adults undergoing major abdominal laparoscopy suggest that adding an intraoperative dexmedetomidine infusion to standard anesthesia probably reduces clinically important postoperative pulmonary complications over the first week and improves short-term lung mechanics and oxygenation, without a clear safety penalty. However, unclear randomization methods, post-randomization exclusions, and modest sample size mean the certainty of evidence is moderate rather than definitive, and applicability is best to similar elective laparoscopic populations within structured perioperative pathways.

Study at a glance

- Design and setting: Prospective, single-blinded randomized controlled trial at a tertiary academic hospital in China, enrolling older adults undergoing elective major abdominal laparoscopic surgery and assigning them to intraoperative dexmedetomidine infusion versus volume-matched saline, with 106 of 120 randomized patients analysed; overall risk of bias was judged as having some concerns due to limited reporting of randomization and complete-case analysis after post-randomization exclusions.

- Primary outcome: postoperative pulmonary complications: The primary outcome was grade at least 2 postoperative pulmonary complications within 7 days, defined by a prespecified clinical grading system. Clinically important pulmonary complications occurred in 16 of 53 patients in the dexmedetomidine group versus 28 of 53 in the control group, corresponding to a risk ratio of 0.68 (95% confidence interval 0.47 to 0.94; p value 0.018). Adjusted logistic models and inverse probability weighting analyses showed similar direction and magnitude of effect, and certainty of evidence for this outcome was rated moderate.

- Key secondary pulmonary outcome: hypoxemia: Hypoxemia within 7 days, defined as arterial oxygen saturation below 90 percent on room air for at least 30 seconds, occurred in 7 of 53 dexmedetomidine patients and 17 of 53 control patients, giving a risk ratio of 0.78 (95% confidence interval 0.62 to 0.96; p value 0.02). This supports a modest reduction in clinically relevant desaturation events with dexmedetomidine, with moderate certainty of evidence.

- Other efficacy outcomes: Dexmedetomidine was associated with higher perioperative oxygenation index values, lower intrapulmonary shunt fraction, lower peak inspiratory and driving pressures, and higher dynamic lung compliance at key intraoperative timepoints, as well as higher vital capacity on postoperative days 1, 3, and 7. These physiological and spirometric benefits were consistent in direction and statistically significant, generally with moderate certainty, but postoperative hospital stay differed little between groups (median 12 vs 13 days; estimated difference 1 day, 95% confidence interval minus 1 to 2; p value 0.289, low certainty).

- Safety and adverse events: Postoperative agitation and nausea and vomiting were less frequent with dexmedetomidine, while delirium, ileus, anastomotic fistula, heart failure, reoperation, second admission, unplanned intensive care admission, and death were all rare and similar between groups. The trial was not powered for uncommon harms, and certainty for specific adverse events is generally low to very low, but there was no signal that dexmedetomidine increased serious postoperative complications.

- Applicability and key caveats: Findings apply best to older, relatively fit adults (physical status classes I to III, moderate body mass index) undergoing elective laparoscopic colorectal, gastric, hepatic, or pancreatic surgery within a standardized ventilation and recovery pathway. Evidence that dexmedetomidine probably reduces short-term clinically important pulmonary complications and hypoxemia is of moderate certainty, but limitations include unclear details of sequence generation and allocation concealment, approximately 12 percent post-randomization exclusions handled with complete-case analysis, and single-centre conduct with only 7 days of follow up.