Title: Dexmedetomidine Versus Nitroglycerine for Controlled Hypotension in Head & Neck Surgery: A Prospective Randomised Clinical Study
Authors: Sanjeev Kumar, Chandrakant Prasad, Saurav Shekhar, Ranjeet Rana De, Rakesh Kumar Singh, K. H. Raghwendra
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.221
Abstract
Aim: Present study is aimed to compare Dexmedetomidine with Nitroglycerine for controlled hypotension in head & neck surgeries in terms of intra-operative blood loss, clearity of surgical field, haemodynamic parameters, post-operative sedation and any adverse events noted.
Materials and Methods: After written informed consent and Institutional Ethical Committee approval, 50 patients were randomly allocated into two groups: Dexmedetomidine (Group D) and Nitroglycerine (Group N). After induction of anesthesia, All patients were initially given loading dose of dexmedetomidine (1 µg kg−1) in group-D and equal volume NS in group-N over a period of 10 minutes. Mean arterial pressure (MAP) of all patients were controlled and maintained between 60-65 mm of Hg by titrated dose of dexmedetomidine (0.4-0.6 µg kg−1h−1) in Group D and Nitroglycerine (0.5-10 µg kg−1) in Group N. Intraoperative blood loss were assessed by surgeon visual bleeding scale and sedation was assessed post operatively in both the groups using Ramsay Sedation score.
Results: Average blood loss in Group D (196.76ml) was significantly less than Group N (232.67ml). Nausea vomiting, tachycardia and shivering were significantly higher in group N where as dryness of mouth and bradycardia was significantly higher in Group D. Sedation score was significantly higher in Group D at 15 mins, 30 mins, 60 mins and 90 mins post-operatively.
Conclusion: Controlled hypotension with dexmedetomidine results in significantly lesser blood loss than with Nitroglycerine, and is associated with prolonged post operative sedation which can be desirable in few patients but leads to increased emergence time.
Keywords- Dexmedetomidine, Nitroglycerine, Head & Neck Surgery, Controlled Hypotension.
References
1. 1. Van Aken H, Miller D. Delibrate hypotension. In: Miller RD, editor. Anesthesia. New York, USA: Churchill Livingstone Inc; 2000. pp. 1470–90.
2. Degoute CS, Ray MJ, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth. 2001; 48:20–7.
3. Srivastava U, Dupargude AB, Kumar D, Joshi K, Gupta A. Controlled hypotension for functional endoscopic sinus surgery: Comparison of esmolol and nitroglycerine. Indian J Otolaryngol Head Neck Surg. 2013; 65:440–4.
4. Mandal P. Isofluraneanaesthesia for functional endoscopis sinus surgery. Indian J. Anaesth. 2003; 47:37–40.
5. Degoute CS. Controlled hypotension: A guide to drug choice. Drugs. 2007; 67:1053–76.
6. Shams T, El Bahnasawe NS, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth. 2013; 7:175–80.
7. Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S, et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. EAJM. 2012; 44:99–105.
8. Turan G, Dincer E, Ozgultekin A, Uslu C, Akgun N. Comparison of dexmedeto-midine, remifentanyl and esmolol in controlled hypotensive anaesthesia. Eur J Anaesthesiol. 2008;25:65–6.
9. Erbesler ZA, Bakan N, Karaoren GY, Erkmen MA. A comparison of the effects of esmolol and dexmedetomidine on the clinical course and cost for controlled hypotensive anaesthesia. Turk J AnaesthReanim. 2013; 41:156–61.
10. Tobias JD. Controlled hypotension in children: A critical review of available agents. Paediatr Drugs.2002; 4:439–53.
11. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000; 90:699–705.
12. Kol IO, Kaygusuz K, Yildirim A, Dogan M, Gursoy S, Yucel E, et al. Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: A double-blind, randomized, controlled trial. Curr Ther Res Clin Exp. 2009; 70:197-208.
13. Testa LD, Tobias JD, Pharmacologic drugs for controlled hypotension, J of ClinAnesth, 7, 1995, 326-337.
14. Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology. 1996; 84:873–81
15. Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S. Reduction in the incidence of shivering with perioperative dexmedet-omidine: A randomized prospective study. J Anaesthesiol Clin Pharmacol. 2012; 28:86–91.