Abstract
BACKGROUND: Elderly patients undergoing laparoscopic cholecystectomy (LC) are at increased risk for postoperative complications. AIM: To investigate the impact of dexmedetomidine (DEX) preconditioning on postoperative analgesia and recovery in elderly patients undergoing LC. METHODS: A retrospective analysis was conducted involving elderly patients (aged ≥ 60 years), who underwent LC between May 2023 and April 2024. Patients were categorized into two groups based on DEX administration protocols: (1) DEX preconditioning anesthesia (DEX-PA) group; and (2) DEX conventional anesthesia group. Postoperative assessments included pain (Visual Analog Scale), sedation (Ramsay Sedation Scale), oxidative stress and inflammation at 6 hours, recovery from anesthesia, gastrointestinal function recovery, cognitive scores (mini-mental state examination), and incidence of adverse events. RESULTS: Among 182 patients (DEX-PA = 87, DEX conventional anesthesia = 95), the DEX-PA group showed significantly lower Visual Analog Scale scores (6 hours: 3.86 ± 1.23 vs 4.46 ± 1.38, P = 0.002), reduced oxidative stress (malondialdehyde: 3.17 ± 0.56 μmol/L vs 3.39 ± 0.61 μmol/L, P = 0.013) and inflammation (C-reactive protein: 5.24 ± 1.35 mg/L vs 5.77 ± 1.62 mg/L, P = 0.018), shorter awakening times (14.87 ± 2.67 minutes vs 15.75 ± 2.82 minutes, P = 0.032), shorter stays in the post-anesthesia care unit (58.24 ± 10.85 minutes vs 62.38 ± 12.47 minutes, P = 0.018), accelerated gastrointestinal recovery (time to first defecation: 36.82 ± 7.63 hours vs 39.95 ± 8.24 hours, P = 0.009), better cognitive performance at 6 hours (25.53 ± 1.87 vs 24.72 ± 2.15, P = 0.008), and fewer adverse events (agitation: 4.60% vs 14.74%, P = 0.022). CONCLUSION: DEX preconditioning prior to anesthesia induction significantly enhances postoperative analgesia, reduces oxidative stress and inflammatory responses, accelerates gastrointestinal and cognitive recovery, and decreases adverse events in elderly patients undergoing LC.