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Abstract Hemodynamic responses of laryngoscopy and laparoscopy should be attenuated by the appropriate premedication, smooth induction, and rapid intubation. Moreover, Postoperative pain is difficult to be managed with the use of opioids analgesia alone, so multimodal pain management is a method to improve postoperative analgesia with minimal side effects. Dexmedetomidine has sedative and anxiolytic effects and decrease the need for intraoperative analgesic drug requirement. It also decreases the need for analgesics in postoperative period. The present study evaluated the effect of dexemeditomedine infusion on recovery characteristics, post-operative pain relief, opioid sparing effect, and peri-operative stress response in the form of catecholamine serum levels during lumbar fixation. The present study was performed on 80 adult patients aged 18 to 60 years old with American Society of Anesthesiologist (ASA) physical status I and II of both sexes scheduled for elective lumbar fixation surgeries under general anesthesia. The dose of Dexmedetomidine that was used ranged from 0.2 to 0.8 μg / kg/hr IV. The patients were randomly divided into one of four groups, group1 received saline 4 ml/hr IV, group 2 received Dexmedetomidine 0.2 μg / kg/hr IV, group 3 received Dexmedetomidine 0.4 μg / kg/hr IV and group 4 received Dexmedetomidine 0.8 μg / kg/hr IV. Anesthetic technique was standardized and all groups were assessed for changes of heart rate and mean arterial pressure prior to premedication, before induction, after laryngoscopy and extubation. Intraoperative fentanyl requirement, catecholamine serum levels and any postoperative complications were also recorded. Patients were studied at 4h interval for 24 hour postoperatively for Visual Analogue Scale (VAS), and ketorolac and pethidine consumption. Significant increase in heart rate and mean arterial pressure was observed in Groups 1 after airway instrumentation, while statistically significant attenuation of mean arterial pressure and hemodynamic responses to laryngoscopy and endotracheal intubation, but with increased the incidence of bradycardia. The incidence of postoperative nausea and vomiting was statistically decreased in the premedicated groups. The incidence of postoperative shivering also decreased in the premedicated groups. The VAS scores of the Dex groups were significantly lower than the control group. The total ketolac and pethidine consumption at 24 h postoperatively of premedicated groups were significantly lower than the control group. Adjunctive use of an intraoperative Dexmedetomidine infusion (0.2– 0.8 μg/kg/h infusion) decreased intraoperative fentanyl use. Dexmedetomidine also helped to maintain intraoperative hemodynamic stability and to decrease the stress response to laryngoscopy and endotracheal intubation. It decreased incidence of PONV, shivering and the length of stay in the PACU. It also reduced the requirement for postoperative analgesia in patients undergoing lumbar fixation. |