Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery

Escamilla, Yolanda; Cardesín, Alda; Samara, Laura; López, Sergio Luis González; Izquierdo, Andrea; Fradera, M.; Vives, Roser; Bernal‐Sprekelsen, Manuel; Pontes, Caridad

doi:10.1007/s00405-019-05575-6

Cited by 20 publications

(7 citation statements)

References 40 publications

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“…Although the amount of blood loss was reduced by dexmedetomidine, the operation time was not shortened. Similar studies have also shown that dexmedetomidine improves the quality of the surgical eld without signi cantly affecting operation time [8,32]. No difference in the requirement of fentanyl was observed between the groups, but the remifentanil requirement in the dexmedetomidine group was signi cantly decreased.…”

Section: Discussionmentioning

confidence: 66%

Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

Jin

Jiang

et al. 2020

Preprint

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Background: Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with hematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension, and may decrease blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries.Methods: The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level, intraoperative heart rate, and blood pressure (T0: preoperative; T1: at incision; T2: 30 minutes after incision; T3: 60 minutes after incision; T4: 120 minutes after incision); dose of fentanyl, remifentanil, urapidil, and esmolol; operation time; incidence of allogeneic blood transfusion; crystalloid fluids volume; and colloidal fluid volume. Results: A total of 1,247 patients were included in the study, and 557 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1–T4, blood pressure at T1, remifentanil and esmolol dosage, and crystalloid fluid volume in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group. Conclusions: Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery.Trial registration number: ChiCTR1800018794 (retrospectively registered)Name of registry: Chinese Clinical Trial RegistryDate of registration: 2018/10/09URL: www.chictr.org.cn/showproj.aspx?proj=30612

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Section: Discussionmentioning

confidence: 66%

Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

Jin

Jiang

et al. 2020

Preprint

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show abstract

“…Although the amount of blood loss was reduced by dexmedetomidine, the operation time was not shortened. Similar studies have also shown that dexmedetomidine improves the quality of the surgical field without significantly affecting operation time [ 8 , 35 ]. No difference in the requirement of fentanyl was observed between the groups, but the remifentanil requirement in the dexmedetomidine group was significantly decreased.…”

Section: Discussionmentioning

confidence: 90%

Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study

Jin

Sun

et al. 2021

Eur J Med Res

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Background Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with haematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension and may reduce blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries. Methods The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level; intraoperative heart rate and blood pressure (T1: at incision; T2: 30 min after incision; T3: 60 min after incision; T4: 120 min after incision); dosage of fentanyl, remifentanil, urapidil, and esmolol; operation time; and incidence of allogeneic blood transfusion. Results A total of 1247 patients were included in this study, and 540 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1–T4, blood pressure at T1, and remifentanil and esmolol dosage in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group. Conclusions Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery. Trial registration: ChiCTR1800018794 (retrospectively registered) Name of registry: Chinese Clinical Trial Registry Date of registration: 2018/10/09 URL: www.chictr.org.cn/showproj.aspx?proj=30612

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“…These results were in line with those of the study done by Escamilla et al . [ 17 ] who, when comparing the efficacy of clonidine and dexmedetomidine to improve the quality of the surgical field by hypotensive anaesthesia in FESS, found no significant differences between clonidine and dexmedetomidine in the quality of surgical field. Soliman R, et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study

et al. 2021

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Background and Aims: Excessive bleeding is a major concern in functional endoscopic sinus surgery (FESS) under general anaesthesia; this can be decreased by various hypotensive agents. This study was conducted to compare the hypotensive effectiveness and haemodynamic stability of dexmedetomidine and clonidine in patients undergoing elective FESS. Methods: In this prospective double-blinded interventional study, 70 adult patients of either sex, 20–50 years of age, posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of intravenous (IV) dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and group B received a loading dose of IV clonidine 2 μg/kg, followed by 1 μg/kg/h infusion. Surgical field quality, emergence time, sedation score, visual analogue score, recovery profile and haemodynamic parameters were recorded. Statistical analysis was done by Student's unpaired t -test to evaluate the significance of normally distributed variables, whereas Mann–Whitney test and Chi-square test were used for ordinal data and categorical variables and proportions, respectively. Results: In both the groups, target mean arterial pressure (MAP) of 65–70 mmHg and improved surgical field quality were achieved. MAP and heart rate (HR) were statistically significantly lower in the dexmedetomidine group with a longer duration of post-operative analgesia ( P = 0.001). None of the groups showed any statistically significant adverse effects. Conclusions: Both dexmedetomidine and clonidine can be used for controlled hypotension to improve surgical field quality in FESS. Dexmedetomidine provides more haemodynamic stability and an additional benefit of post-operative analgesia and conscious sedation.

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Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery

Cited by 20 publications

References 40 publications

Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study

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