The impact of dexmedetomidine on intraoperative anesthesia, stress response, and perioperative outcomes in elderly patients undergoing laparoscopic-assisted radical gastrectomy for gastric cancer

Gastric cancer is a leading global health burden, with laparoscopic-assisted radical gastrectomy increasingly preferred for elderly patients. However, anesthesia management in this population remains challenging due to age-related physiological decline and surgical stress. This study evaluated dexmedetomidine's impact on anesthesia quality, surgical stress, and recovery in elderly gastric cancer patients who received laparoscopic-assisted radical gastrectomy. In this retrospective cohort study, after propensity score matching, 192 patients (≥ 65 years) were divided into conventional anesthesia (CA, n = 96) and (Dex, n = 96) groups. Hemodynamics, stress biomarkers (cortisol, epinephrine, IL-6, TNF-α), recovery parameters, complications, and pain scores were compared. Statistical analysis used SPSS 29.0 with t -tests and Chi-square tests. Hemodynamic parameters were assessed at four predefined perioperative time points: immediately prior to anesthetic induction (T0), following induction (T1), 30 min after surgical initiation (T2), and upon completion of the procedure (T3). The Dex group showed better hemodynamic stability than the CA group, with substantially lower mean arterial pressure (MAP) and heart rate (HR) observed at T1, T2, and T3. MAP (T1: P = 0.040; T2: P = 0.028; T3: P = 0.034) and HR (T1: P = 0.007; T2: P = 0.013; T3: P = 0.045). Postoperative epinephrine, the cytokine interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were substantially lower in the Dex group (all P < 0.05). In contrast, postoperative cortisol levels were numerically lower, although the difference observed between the groups was not significant according to statistical analysis ( P = 0.061). Postoperative recovery analysis indicated that the groups did not differ significantly with respect to the time to resumption of bowel sounds ( p = 0.126), whereas the time to first bowel movement was significantly shorter in the Dex group ( p = 0.033). Pain scores at 72 h ( p = 0.028) and 7 days ( p = 0.028) were lower with dexmedetomidine. The overall incidence of complications was lower ( p = 0.019), including less delirium and respiratory depression. In this propensity score-matched retrospective cohort, dexmedetomidine use was linked to more favorable perioperative outcomes. However, these findings demonstrate associations rather than causality and should be confirmed in prospective randomized controlled studies.