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

Abstract

Background Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications. Methods Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries. Results Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.

Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

“…It has been reported that ischemic damage due to hypoperfusion may develop in some surgeries where hypotensive anaesthesia is applied. [19][20][21][22] Some studies have used organ-specific biomarkers 23,24 to demonstrate ischemia at the cellular level, while others have used oxidative stress markers. 25 We did not expect ischemia at the organ level because ASA I and II patients without diabetes and similar chronic diseases were included in our study.…”

“…It has been reported that ischemic damage due to hypoperfusion may develop in some surgeries where hypotensive anaesthesia is applied 19‐22 . Some studies have used organ‐specific biomarkers 23,24 to demonstrate ischemia at the cellular level, while others have used oxidative stress markers 25 …”

Uses of magnesium sulfate in anesthesiology

“…It has been used as a drug in controlled hypotension. It has also been used during neuraxial block, where "it prolongs the duration of motor block and sensory block, increases the onset interval of motor block and sensory block when administered via the subarachnoid route and reduces it when administered via the epidural route" 7,[12][13][14][15][16][17][18] .…”

Comparative study of the effect of two different doses of remifentanil on bleeding control in lumbar fusion surgery: A randomized clinical trial

“…By defining a reduction in blood pressure and heart rate, the goal of clearing the surgical field can be achieved [ 14 ]. Excessive bleeding during surgery, in addition to reducing the surgeon's view of the surgical field, causes more trauma to the surrounding tissues, and the longer the period, the better the recovery period [ 15 ]. Controlled hypotension reduces bleeding from the surgical incision, thereby providing technical freedom and better vision for the surgeon in terms of operating more accurately [ 16 , 17 ].…”

“…Required Sample size was calculated with using the sample size estimation formula to compare the means with considering the 95% confidence level, 80% test power, standard deviation of mean blood pressure in controlled hypotension which was about 1.5 [ 15 ] and the effect size was 0.8 in 55 patients in each group. Also, the data collector and the statistical analyst were also unaware of the dose of fentanyl injected into patients.…”