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Janipour M, Bastaninejad S, Mohebbi A, Amali A, Owji SH, Jazi K, Mirali RA, Moshfeghinia R. Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:194. [PMID: 38816731 PMCID: PMC11138079 DOI: 10.1186/s12871-024-02563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. RESULTS Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. CONCLUSION In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.
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Affiliation(s)
- Masoud Janipour
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeni Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Owji
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kimia Jazi
- Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
| | | | - Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
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Calim M, Karaaslan K, Yilmaz S, Senturk E, Deniz H, Akbas S. The Effects of Hypocapnia and Hypercapnia on Intraoperative Bleeding, Surgical Field Quality, and Surgeon Satisfaction Level in Septorhinoplasty: A Prospective Randomized Clinical Study. Aesthetic Plast Surg 2024; 48:167-176. [PMID: 37407709 DOI: 10.1007/s00266-023-03433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Septorhinoplasty (SRP) is one of the most commonly performed procedures in the world for functional and aesthetic purposes. The present study was aimed to compare the effects of hypocapnia and hypercapnia regarding the total amount of intraoperative bleeding, surgical field quality, and surgeon satisfaction level. METHODS In this randomized prospective clinical study, eighty patients with American Society of Anesthesiologists I-II and were 18-45 years old scheduled for septorhinoplasty were randomly allocated to group hypocapnia [end-tidal carbon dioxide (EtCO2) 30 ± 2 mmHg] and group hypercapnia (EtCO2 40 ± 2 mmHg). We evaluated the total amount of intraoperative bleeding, the surgical field quality, surgeon satisfaction level, hemodynamics and peri- and postoperative adverse events. RESULTS Group hypocapnia significantly reduced the total amount of intraoperative bleeding (p < 0.001). The surgical field quality and surgeon satisfaction level in group hypocapnia were significantly better than group hypercapnia (p < 0.001). EtCO2 levels of group hypocapnia were significantly lower than group hypercapnia at all time points (p < 0.001 for all time points). There were no significant differences between the groups in terms of heart rate and mean arterial pressure at all time points. There were no significant differences between the groups in terms of adverse events CONCLUSIONS: The results of this double-blind randomized clinical trial showed that reducing the amount of intraoperative bleeding for patients with hypocapnia undergoing SRP through known methods (e.g., reverse Trendelenburg head-up position, positive end-expiratory pressure limiting, controlled hypotension, and use of topical vasoconstrictors, corticosteroids, and tranexamic acid) would improve the quality of the surgical field and raise the surgeon satisfaction level. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sinan Yilmaz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hilal Deniz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Khetpal S, Dahoud F, Partownavid P, Roostaeian J. Permissive Hypotension in Rhinoplasty: A Literature Review of Therapeutics and Associated Outcomes. Aesthetic Plast Surg 2023; 47:2632-2638. [PMID: 36877227 DOI: 10.1007/s00266-023-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND/PURPOSE Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty. METHODS A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature. RESULTS Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled. CONCLUSION Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sumun Khetpal
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA
| | - Fadi Dahoud
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA
| | - Parisa Partownavid
- Department of Anesthesiology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jason Roostaeian
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA.
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Dehghanpisheh L, Sahmeddini MA, Kaboodkhani R, Samadi K, Khademi S, Rafati Z, Abbasi S, Abbasi R. Efficacy of Isoflurane-Remifentanil versus Propofol-Remifentanil on Controlled Hypotension and Surgeon Satisfaction in Rhinoplasty: A Single-Blind Clinical Trial Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:379-384. [PMID: 37456209 PMCID: PMC10349152 DOI: 10.30476/ijms.2022.94781.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/15/2022] [Accepted: 07/10/2022] [Indexed: 07/18/2023]
Abstract
Background Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Results Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Conclusion Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.
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Affiliation(s)
- Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Kaboodkhani
- Otolaryngology Research Center, Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Samadi
- Department of Anesthesiology, Shahid Dastgheib Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Khademi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rafati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Djalali Motlagh S, Rokhtabnak F, Ghodraty MR, Maleki Delarestaghi M, Saadat S, Araghi Z. Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial. Anesth Pain Med 2021; 11:e118857. [PMID: 34692447 PMCID: PMC8520684 DOI: 10.5812/aapm.118857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022] Open
Abstract
Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg - 70 mmHg, provides a bloodless and visible surgical field during rhinoplasty. It has been shown that dexmedetomidine, an α2-adrenoreceptor agonist, is a suitable choice in this regard. One of the disadvantages of this drug is the possibility of severe bradycardia during infusion. Therefore, we compared lower intravenous (IV) loading doses to determine whether the hypotensive effect of the drug was preserved and the bradycardia incidence decreased. In this randomized, double-blinded clinical trial, 81 patients aged 18 to 50 years with the American Society of Anesthesiologists physical status (ASA-PS) class I and II, scheduled for rhinoplasty randomly received 1.0, 0.9, and 0.8 µg/kg (named as groups 1.0, 0.9, and 0.8, respectively) of IV dexmedetomidine before the induction of anesthesia followed by infusion (0.3 - 0.7 µg/kg/h) during operation. The patients' heart rate (HR), MAP, the requirements for nitroglycerin (NTG) and extra fentanyl, as well as the incidence of bradycardia, were recorded. Bleeding and visibility of the surgical field were scored by the surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG and extra fentanyl were similar in the studied groups. The surgical field was more visible and bloodless in group 1.0 compared to group 0.8 (P < 0.001); the differences were not significant between groups 1.0 and 0.9 (P = 0.605). The incidence (P = 0.027) and the severity of bradycardia (P = 0.017) were higher in the groups with higher loading doses. We concluded that dexmedetomidine is an acceptable agent to provide controlled hypotension. A loading dose of 0.9 µg/kg, but not 0.8 µg/kg, provides similar surgical field conditions as the dose of 1 µg/kg. Furthermore, despite the decrease in the incidence of bradycardia, the hypotensive effect of the drug is preserved.
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Affiliation(s)
- Soudabeh Djalali Motlagh
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghodraty
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Maleki Delarestaghi
- Department of Otolaryngology Head and Neck Surgery, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of ENT and Head and Neck Research and the Five Senses Institute, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Saadat
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Araghi
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
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J N S, Kumar S, Vijay T. To Compare the Efficacy of Dexmedetomidine Versus Labetalol in Providing Controlled Hypotension in Functional Endoscopic Sinus Surgery. Anesth Pain Med 2021; 11:e108915. [PMID: 34221935 PMCID: PMC8241463 DOI: 10.5812/aapm.108915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Functional endoscopic sinus surgery (FESS) is a surgical intervention for sinus diseases. Bleeding is a common concern during FESS. Hemodynamic stability and quality surgical field visibility help to achieve the best outcomes. Objectives The present study primarily intended to compare the effectiveness of dexmedetomidine versus labetalol in providing controlled hypotension during FESS and then to assess the quality of the surgical field. Methods The current research was conducted as a prospective randomized double-blinded clinical study. Sixty patients of the American Society of Anesthesiologists grade I or II status undergoing FESS under general anesthesia were divided into two groups, each with 30 members. Patients receiving dexmedetomidine and labetalol were named as group D and L, respectively. The study intended to manage mean arterial pressure (MAP) between 65 - 75 mmHg. The visibility of the operative field was evaluated using Fromme and Boezaart scoring system. Total intraoperative fentanyl consumption and postoperative first analgesic request time were recorded. Results The MAP target was achieved in both groups. Intergroup differences concerning MAP were observed in both D (75.0 ± 2.0) and L (82.4 ± 5.2) groups (P-value < 0.05). Scores for blood loss were significantly lower in the D group (1.3 ± 0.3) compared to the L group (2.1 ± 0.3) (P-value < 0.05). There was no intergroup difference concerning the mean heart rate (group D; 70.8 ± 4.2, and group L; 73.4 ± 4.4). The total dose of fentanyl consumed was found to be significantly lower in the group D (41.9 ± 5.8) compared to group L (59.9 ± 5.3) (P-value < 0.05). The first analgesic request time was significantly longer in the group D (50.2 ± 9.1) compared to group L (24.8 ± 5.1) (P-value < 0.05). Conclusions Dexmedetomidine provided better hemodynamic stability and operative field visibility as compared to labetalol during FESS.
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Affiliation(s)
- Sujay J N
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
| | - Shiva Kumar
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
- Corresponding Author: Department of Anesthesiology Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India.
| | - Tanushree Vijay
- Department of Anesthesiology, Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India
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Lang B, Zhang L, Lin Y, Zhang W, Li FS, Chen S. Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0227410. [PMID: 31914454 PMCID: PMC6949117 DOI: 10.1371/journal.pone.0227410] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
Background Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications. Methods Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries. Results Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting. Conclusion Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.
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Affiliation(s)
- Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- * E-mail:
| | - Yunzhu Lin
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Wensheng Zhang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Feng-shan Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Shouming Chen
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
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Ruku R, Jamwal A, Bhadrala N, Gulati S. Randomized Open-Labelled Comparative Evaluation of the Efficacy of Nitroglycerine, Esmolol and Dexmedetomidine in Producing Controlled Hypotension in Spine Surgeries. Anesth Essays Res 2019; 13:486-491. [PMID: 31602066 PMCID: PMC6775846 DOI: 10.4103/aer.aer_78_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study was designed to evaluate the efficacy of nitroglycerine (NTG), esmolol, and dexmedetomidine (DEX) as hypotensive agents in decreasing intraoperative blood loss by producing controlled hypotension in posterior spine surgeries. Materials and Methods: Sixty patients aged 18–60 years, the American Society of Anesthesiologists physical status Classes I and II of either gender, were randomly assigned into three groups to receive either: NTG (0.01%) at the rate of 3–10 μg.kg-1.min-1 after positioning without a prior loading dose in Group N, esmolol 500 μg.kg-1 loading dose over 1 min before induction of anesthesia followed by 50–300 μg.kg-1.min-1 infusion in Group E, and DEX 1 μg.kg-1 over 10 min before induction followed by 0.2–0.7 μg.kg-1.h-1. infusion in Group D to maintain mean arterial blood pressure (MAP) between 60 and 65 mmHg. The three groups were compared for the achievement of target MAP, intraoperative blood loss, reversibility of hypotensive state, quality of surgical field, emergence time, and postextubation sedation score. Statistical Analysis: Analysis of variance was used for intergroup analysis, and for multiple comparisons, Bonferroni post hoc test was applied. P < 0.05 was considered statistically significant. Results: Patients in Group D and Group E achieved the target MAP with better heart rate control as compared to Group N. The intraoperative blood loss was significantly lesser in Group D (P < 0.001). The time to hypotension reversal and emergence time was prolonged in Group D (P < 0.001). The mean quality of surgical field score was statistically insignificant among the three groups. The mean Ramsay Sedation Scores were significantly higher in Group D compared to Groups N and E at 20th and 40th min postextubation (P < 0.001) with no significant intergroup difference at 60th min postextubation (P = 0.130). Conclusion: Continuous infusion of DEX is an effective and safe method of producing controlled hypotension by achieving the target MAP, minimizing blood loss, and maintaining superior hemodynamics in comparison with NTG and esmolol in posterior spine surgeries.
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Affiliation(s)
- Rumani Ruku
- Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Anju Jamwal
- Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Naine Bhadrala
- Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Smriti Gulati
- Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu, Jammu and Kashmir, India
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Khademi SH. Letter to Editor: "A Comparative Study of the Amount of Bleeding and Hemodynamic Changes between Dexmedetomidine Infusion and Remifentanil Infusion for Controlled Hypotensive Anesthesia in Lumbar Discopathy Surgery; A Double-Blind, Randomized, Clinical Trial". Anesth Pain Med 2018; 8:e78871. [PMID: 30214890 PMCID: PMC6119236 DOI: 10.5812/aapm.78871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Seyed Hossein Khademi
- Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Seyed Hossein Khademi, Department of Anesthesiology and Pain Research Center, Tehran, Iran. E-mail:
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