Title of article :
Deliberate hypotensive anesthesia during maxillofacialsurgery: a comparative study between dexmedetomidineand sodium nitroprusside
Author/Authors :
El-Kalla, Rehab S. Tanta University - Faculty of Medicine - Department of Anesthesia and Surgical Intensive Care, Egypt , El Mourad, Mona B. Tanta University - Faculty of Medicine - Anesthesia and Surgical Intensive Care Department, Egypt
Abstract :
BackgroundThe aim of the present study was to evaluate the anesthetic properties such as the onset of required hypotension, the quality of the surgical field, the percentage of inhaled anesthesia, intraoperative consumption of fentanyl, time to recovery, and adverse events of dexmedetomidine (DEX) as a hypotensive agent in comparison with sodium nitroprusside (SNP) in maxillofacial surgery.Patients and methodsA total of 70 ASA I or II patients, aged 20–60 years, scheduled for maxillofacial surgery were randomly assigned to receive either DEX 1 μg/kg before induction of anesthesia for over 10 min followed by 0.2–0.5 μg/kg/h infusion during maintenance (DEX group; n = 35 patients) or SNP0.25 μg/kg/min infusion after induction of anesthesia (SNP group; n = 35 patients) to maintain mean arterial blood pressure (MAP) between 50 and 65 mmHg. Hemodynamic variables and end-tidal isoflurane concentration were recorded, quality of surgical field was assessed by the same surgeon who was blinded of the selected hypotensive agent, and intraoperative fentanyl consumption and recovery time were recorded.ResultsHeart rate was significantly lower (P 0.05) in DEX group. Both drugs were effective in achieving the desired level of hypotension (MAP: 50–65 mmHg). However, the time needed to reach the target MAP was significantly shorter in the SNP group than in the DEX group. End-tidal isoflurane concentration and intraoperative fentanyl consumption were significantly lower in the DEX group than in the SNP group, and the quality of the surgical field was better in the DEX group compared with the SNP group, but the time for recovery was significantly longer in the DEX group than in the SNP group.ConclusionWe concluded that DEX is an effective and safe agent with anesthetic benefits for controlled hypotension, and that compared with SNP DEX offers the advantage of better quality of the surgical field and decreased anesthetic and fentanyl requirements intraoperatively. However, DEX was associated with significantly longer time to reach the target MAP and delayed recoveryfrom anesthesia compared with SNP.
Keywords :
dexmedetomidine , hypotensive anesthesia , maxillofacial surgery , sodium nitroprusside
Journal title :
Ain Shams Journal of Anesthesiology(ASJA)
Journal title :
Ain Shams Journal of Anesthesiology(ASJA)