A comparison of dexmedetomidine and clonidine in attenuating the hemodynamic responses at various surgical stages in patients undergoing elective transnasal transsphenoidal resection of pituitary tumors

Background Transsphenoidal resection of pituitary tumors is the neurosurgical procedure of choice to excise most of the tumors of the sellar/suprasellar region. The main goals of anesthesia are maintenance of hemodynamic stability, provision of conditions that facilitate good surgical exposure, and a prompt and smooth emergence to allow neurological and visual assessment. Dexmedetomidine (Dex), a selective α-2 agonist, is known to maintain cardiovascular stability and anxiolysis and provide pain relief. Therefore, we hypothesized that intraoperative Dex will attenuate hemodynamic response to nasal speculum (NS) insertion, decrease analgesic requirement, and hasten postoperative recovery. Materials and Methods This prospective, randomized, double-blind, placebo-controlled study was conducted in 60 adult patients of either sex, American Society of Anesthesiologists status I or II undergoing elective pituitary surgery for excision of pituitary adenoma. Randomization was done into two groups; Group D ( n = 30) received Dex bolus 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h, and group control Group C ( n = 30) received normal saline (0.9%) in a similar manner. A standard anesthesia technique comprising fentanyl, propofol, rocuronium, sevoflurane, nitrous oxide, and oxygen was used. Intraoperative monitoring was uniform and standardized in all the patients; cardiovascular perturbations, if any, were noted and managed appropriately. After completion of surgery, tracheal extubation was performed, and emergence time, extubation time, modified Aldrete score, sedation, pain, time for first analgesic, nausea, vomiting, and shivering were recorded. Results In both the groups, an increase in heart rate and blood pressure occurred at the time of laryngoscopy and intubation, NS insertion, and extubation, but it was more in Group C ( p < 0.05). In Group D, intraoperative requirement of analgesic, neuromuscular relaxant, and inhalational anesthetic was lesser compared with Group C. Emergence time as well as visual analog scale at emergence was less in Group D. Conclusions Intraoperative Dex infusion is a reasonable choice in patients undergoing transsphenoidal pituitary surgery.

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“…Although hemodynamic fluctuations occurred in both groups, patients in the Dex group had better hemodynamic stability. 19…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery

Bala

Chaturvedi

Pandia

et al. 2019

JNRP

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“…To improve hemodynamic control, clonidine and dexmedetomidine have been used as anesthetic adjuvants in neurosurgery [14,15]. Jan [16] and Wu [17] have reported that the addition of dexmedetomidine improved hemodynamic control in patients undergoing surgeries for the removal of intracranial tumors.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine Attenuates Hemodynamic and Proinflammatory Responses During Craniotomy for Traumatic Brain Injury: A Randomized Controlled Trial Study

Hou

Cheng

Wei

et al. 2021

Preprint

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Trauma to the brain not only directly injures cerebral tissues, but also results in secondary damage. Neuroanesthesia should not only provide optimal conditions during surgery and ensure stable cerebral hemodynamics, but also attenuate proinflammatory reactions. Dexmedetomidine is a powerful α2-agonist that has been shown to be neuroprotective in animal models of stroke. In this work 70 patients with craniocerebral trauma were randomized into 2 groups with each 35 cases. We tested the effect of dexmedetomidine on hemodynamic response and serum inflammatory markers when administered perioperatively. Our results show that dexmedetomidine attenuated the hemodynamic responses to tracheal intubation and surgical stimulation, the MAP in patients with dexmedetomidine was maintained between 90 mmHg to 100 mmHg, and the HR was kept at lower than 80 bpm during the operation. However, in the control group, both the BP and HR showed a significant increase at the time of intubation and skin scission. Dexmedetomidine attenuate immune reaction during operation. The plasma concentrations of TNFα, IL6 and neuron specific enolase (NSE) was significantly lower than control group (P < 0.001). In conclusion, dexmedetomidine in craniotomy not only attenuated hemodynamic responses in the surgical operation, but also depressed neuroinflammation in patients with TBI without serious adverse effects. Trial registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000029501,28 Jan 2020༌Retrospectively registered༌http://www.chictr.org.cn

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“…It has the potential to reduce intraoperative anesthetic drug requirements and, thus, reduce hemodynamic instability intraoperatively. [2][3][4][5]10 Nevertheless, a conclusion has not been reached, especially regarding the appropriate dosage for its continuous intravenous infusion.…”

Section: Introductionmentioning

confidence: 99%

“…There are several intense noxious stimuli during these surgeries, including the use of sympathomimetic drug-soaked nasal packing, insertion of a nasal speculum, sphenoid drilling and cutting, and resection of the sellar and suprasellar regions. 2,3 Anesthesia for transsphenoidal sinus surgery of the pituitary gland aims to maintain hemodynamic stability, optimize cerebral oxygenation, promote a bloodless surgical field, prevent perioperative complications, and facilitate rapid smooth emergence for early neurological examination. 4,5 Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic properties, inducing anesthetic-and opioid-sparing effects.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 However, dexmedetomidine infusion doses vary from 0.2 to 0.7 mcg/kg/h. [2][3][4][5][6][7][8][9][10][11][12] Therefore, we aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate doses (0.5 mcg/kg/h) of dexmedetomidine during maintenance of anesthesia on the amount of blood loss (primary objective) and compare the hemodynamics and operative times (secondary objectives) of patients undergoing transsphenoidal pituitary tumor removal with the aforementioned doses.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study

Muangman

Raksakietisak

Akavipat

et al. 2023

J Neuroanaesth Crit Care

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Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg/kg, followed by 0.2 mcg/kg/h, and to group II at the same loading dose, followed by 0.5 mcg/kg/h. Comparative analyses were performed using the Student's t-test, repeated-measures analysis of variance, and Mann–Whitney U test; p-values < 0.05 were considered statistically significant. Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension (p = 0.034). Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg/kg/h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.

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A comparison of dexmedetomidine and clonidine in attenuating the hemodynamic responses at various surgical stages in patients undergoing elective transnasal transsphenoidal resection of pituitary tumors

Cited by 8 publications

References 12 publications

Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery

Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery

Dexmedetomidine Attenuates Hemodynamic and Proinflammatory Responses During Craniotomy for Traumatic Brain Injury: A Randomized Controlled Trial Study

Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study

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