The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery.

Dexmedetomidine (Precedex, Hospira, Lake Forest, IL) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. For 10 months, all patients undergoing a laparoscopic bariatric procedure received a dexmedetomidine infusion 30 min before the anticipated completion of the procedure (n = 34). A control group was comprised of a similar number of patients to have had laparoscopic bariatric surgery in the time period immediately before these 10 months (n = 37). All pathways and discharge criteria were identical for patients in each group. A total of 73 patients were included in this retrospective chart review. Two gastric bypass patients were excluded for complications requiring additional surgery (one bleed and one leak). Gastric bypass patients who received a dexmedetomidine infusion required fewer narcotics (66 vs 130 mg of morphine equivalents) than control patients and met discharge criteria on post-op day (POD) 1 more often (61% discharged POD 1 vs 26% discharged POD 1, p = 0.02). Vital signs and pain scores were similar in all groups. Dexmedetomidine infusion perioperatively is safe and may help to minimize narcotic requirements and decrease duration of stay after laparoscopic bariatric procedures. This may have important patient safety ramifications in a patient population with a high prevalence of obstructive sleep apnea. A well-organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of dexmedetomidine suggested by this study.

Drug interactions in epilepsy care: perspective on the newer generation antiepileptic drugs.

Pharmacokinetic interactions involving the antiepileptic drugs have long been considered to be an unavoidable component of epilepsy treatment. Many of the 'older' generation of antiepileptic drugs, including carbamazepine, phenytoin and phenobarbital, are recognized to cause hepatic induction of drug-metabolizing enzyme systems, such as the cytochrome P450 and UDP-gluculronyltransferase. Such interactions are not uncommonly implicated in resulting in clinically significant treatment complications. During the latter half of 1990s, a number of new antiepileptic drugs have become available to clinicians. Generally speaking, a common feature of these 'newer' generation medications are improved pharmacokinetic characteristics, including an improved drug interaction profile. The aim of this review is to summarize the data, both experimental and clinical, regarding pharmacokinetic interactions with the newer antiepileptic drugs.