Comparing remifentanil, magnesium sulfate, and dexmedetomidine for intraoperative hypotension and bleeding and postoperative recovery in endoscopic sinus surgery and tympanomastoidectomy

Abstract

The study aimed to compare remifentanil, magnesium sulfate, and dexmedetomidine for intraoperative hypotension, bleeding volume, and recovery time in endoscopic sinus surgery and tympanomastoidectomy (TM). A double-blind clinical trial enrolled the patients undergoing endoscopic nasal sinus surgery and TM at Amirkabir Hospital (Arak, Iran), who were randomly assigned into three groups dexmedetomidine (DEX), remifentanil (REM), and magnesium sulfate (MgSO4) to which we intravenously administered 1 μg/kg DEX, an intravenous dose of 1 μg/kg REM, and 40 mg/kg of intravenous MgSO4, respectively. The blood loss, blood pressure (BP), heart ratio (HR), oxygen saturation (SaO2), and recovery time were recorded. Significant differences were found statistically in bleeding rates among all groups (P = 0.0001). The least amount of blood loss (very mild bleeding) was observed at 82.85% in the DEX group. BP and HR were lower in this group than those in the other groups. While recovery score was significantly different in the three groups (P = 0.007), the recovery time was the highest in the DEX group, while the least in the REM group. Based on the present results Dexmedetomidine seems to better prevent from bleeding than the others. Moreover, DEX can cause lower BP and HR in subjects with lower propofol administration, but the recovery time is longer. This study was registered by IRCT2017021114056N11 in Iranian Registry Clinical Center.

Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials

“…And then 4 studies were excluded by full-text review for they were performed in pediatric patients. At last, 10 RCTs were enrolled in further meta-analysis [14][15][16][17][18][19][20][21][22][23]. The identification procedure of these eligible articles is described in Fig 1. The enrolled studies were published from 2011 to 2018, and all of them were published in English.…”

“…A total of 663 patients were randomized to receive two drugs. In 10 included RCTs, 5 were researches about head and neck surgery [14][15][16][17][18], 3 were researches about spinal surgery [19][20][21], and the rest two trials were researches about pituitary adenoma surgery [22] and laparoscopic colorectal resection surgery [23]. All enrolled studies reported the hemodynamic parameters (MAP, HR), and 6 studies reported the evaluation of surgical field bleeding by using 6-point scale [14][15][16][17][18]22].…”

“…In 10 included RCTs, 5 were researches about head and neck surgery [14][15][16][17][18], 3 were researches about spinal surgery [19][20][21], and the rest two trials were researches about pituitary adenoma surgery [22] and laparoscopic colorectal resection surgery [23]. All enrolled studies reported the hemodynamic parameters (MAP, HR), and 6 studies reported the evaluation of surgical field bleeding by using 6-point scale [14][15][16][17][18]22]. Duration of surgery was reported in 8 studies [14][15][16][17][18][21][22][23], and the number of patients requiring opioid/analgesia administration was reported in 3 studies [14,16,18].…”

“…All enrolled studies reported the hemodynamic parameters (MAP, HR), and 6 studies reported the evaluation of surgical field bleeding by using 6-point scale [14][15][16][17][18]22]. Duration of surgery was reported in 8 studies [14][15][16][17][18][21][22][23], and the number of patients requiring opioid/analgesia administration was reported in 3 studies [14,16,18]. The recovery profile of patients was measured by the time till reaching Aldrete score �9 in 5 studies [14,[16][17][18]23].…”

“…Duration of surgery was reported in 8 studies [14][15][16][17][18][21][22][23], and the number of patients requiring opioid/analgesia administration was reported in 3 studies [14,16,18]. The recovery profile of patients was measured by the time till reaching Aldrete score �9 in 5 studies [14,[16][17][18]23]. The general characteristics and information of enrolled studies are described in Table 1.…”