Details
Category: Volume 08 Issue 02 February 2020
Hits: 1004

Title: Comparitive study between Intravenous Dexmedetomidine and Esmolol for Hypotensive Anaesthesia in Middle Ear Surgeries

Authors: Sowdamini Teki, Y.Venu Gopala Rao, A.Satyanarayana

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.88

Abstract

   

Background and Aim: This study was done to compare the efficiency of Dexmedetomidine and Esmolol in inducing deliberate hypotension and providing a better surgical field exposure during middle ear surgery. Parameters like MAP,HR and blood loss are compared between both the drugs.

Materials and Methods: This present study included patients aged between 18 to 60 years of ASA physical status I or II, who are planned to undergo a microscopic operation in the middle ear with informed consent. These were divided into Dexmedetomidine(D) group of 30 patients and Esmolol (E) group of 30 patients. Patients in the dexmedetomidine group (D) received a loading dose of 1 μg/kg of dexmedetomidine in 200 ml of 0.9% normal saline, before induction over 10 mins and subsequent maintenance doses of 0.5 μg/kg/h after intubation throughout the surgery. Whereas, patients in esmolol group(E) received a loading dose of 1 mg/kg of esmolol, before induction over 1 min and subsequent maintenance doses at 0.5 mg/kg/h after intubation throughout the surgery. Then, patients are evaluated for  hemodynamics like MAP,HR at regular intervals and blood loss noted for both drugs.

Results: Mean arterial pressure values were significantly decreased in Group D compared to that in Group E, except for the baseline value (p < 0.05). Blood loss is 104.15 ml in Dexmedetomidine group and 113.24 ml in Magnesium sulfate group, that is significantly low in Dexmedetomidine, hence quality of the surgical field and surgeon satisfaction score was better with D group at all intervals.Heart rate is significantly low in the Dexmedetomidine group at all intervals. Bradycardia is more prominent with Dexmedetomidine, with no major differences between other side effects.

Conclusion: Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.

References

  1. Controlled hypotension: a guide to drug choice. Degoute CS.Drugs. 2007; 67(7): 1053-76.
  2. Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside-and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anesth 1995; 42:373–376.
  3. Hypotensive anesthesia for middle ear surgery: a comparison of propofol infusion and isoflurane.Valtonen M1, Kuttila K, Kanto J, Pakkanen A, Rosenberg P. 1992 Jun;14(5):383-8.
  4. Degoute CS, Ray MJ, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesthe 2001; 48:20–27.
  5. Elsharnouby NM, Elsharnouby MM. Magnesium sulfate as a technique of hypotensive anesthesia. Br J Anesth 2006; 96:727–731.
  6. Yashikawa F, Kohase H, Umino M, Fukayama H. Blood loss and endocrine responses in hypotensive anesthesia with sodium nitroprusside and nitroglycerin for mandibular osteotomy. Int J Oral Maxillofac Surg 2009; 38:1159–64.
  7. Newton MC, Chadd GD, O’donghue B, Sapsed-Byrne SM, Hall GM. Metabolic and hormonal responses to induced hypotension for middle ear surgery. Br J Anaesth.1996;76(3):352–7.
  8. Erdem AF, Kayabasoglu G, Tas Tuna A, Palabiyik O, Tomak Y, Beyaz SG. Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study. J Clin Monit Comput. 2016;30(5):655–60. DOI: 10.1007/s10877-015-9768-6.
  9. Guven DG, Demiraran Y , Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus su rgery. Ann Otol Rhinol Laryngol 2011;120:586 92.
  10. Yavascaoglu B, Kaya FN, Baykara M, Bozkurt M, Korkmaz S. A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. 2008;25(6):517–519.
  11. Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A. Nitr oglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol 2016;32:192--77
  12. Gogus N, Akan B, Serger N, Baydar M. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation. Braz J Anesthesiol. 2014;64(5):314–319.
  13. Cuneo BF, Zales VR, Blahumka PC, Benson DW. Pharmacodynamics and pharmacokinetics of esmolol, a short-acting beta-blocking agent, in children. Pediatr Cardiol. 1994;15(6):296–301.
  14. Shams T, El Bahnasawe NS, Abu Samra M, El Masry R. Induced hypotension fornfunctional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth 2013;7:175.

Corresponding Author

Sowdamini Teki

Post Graduate Student, Department of Anesthesiology, AMC, Visakhapatnam, Andhra Pradesh