The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study

Abstract

Background and Aim:Transnasal transsphenoidal resection of pituitary tumours is associated with blood loss and wide fluctuations in haemodynamic parameters. The aim of the present study was to compare the effect of dexmedetomidine and magnesium sulphate during the transsphenoidal resection of pituitary tumours.Methods:The study was a double-blind, randomised study and included 152 patients classified randomly into two groups: Group D: Dexmedetomidine was given as a loading dose 1 μg/kg over 10 min before induction followed by an infusion at 0.5 μg/kg/h during the surgery. Group M: Magnesium sulphate was given as loading dose of 50 mg/kg over 10 min followed by an infusion at 15 mg/kg/h during the surgery. The systolic, diastolic and mean arterial blood pressures, in addition to the amount of blood loss were measured at specific timepoints. Data were described in terms of mean ± standard deviation, median, frequencies, 95% confidence of interval of mean and percentages.Results:Mean bleeding score was lower in Group D than Group M (1.36 ± 0.48 vs. 3.05 ± 0.65, respectively; P = 0.002). Mean blood loss was lower in Group D (157.43 ± 48.79 ml vs.299.47 ± 77.28 ml in Group M; P < 0.001)Heart rate, mean arterial pressure, fentanyl requirements, end-tidal sevoflurane concentration, and extubation and emergence times were lower, while incidence of bradycardia and hypotension were higher in Group D.Conclusions:During transsphenoidal pituitary resection, dexmedetomidine, compared to magnesium, is associated with lower blood loss and better operating conditions but with more hypotension and bradycardia

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].…”

Effectiveness of Dexmedetomidine for Controlled Hypotension in Providing Optimum Surgical Conditions for Functional Endoscopic Sinus Surgeries: A Double-Blinded Randomized Controlled Trial

“…In their study Solimon R et al (8) elucidated that dexmedetomidine is associated with lower blood loss and better-operating conditions in trans sphenoidal pituitary resection when compared to magnesium. We have found similar results in our study in that dexmedetomidine, by virtue of controlled hypotension, provided better operating conditions and reduced blood loss.…”

Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation After Intravenous Dexmedetomidine: A Comparison Between Two Doses

“…[14][15][16][17] Its effectiveness in obtunding the pressor response during intubation has also been compared with other drugs and placebos and found to be more effective than these drugs. [18][19][20][21][22][23][24][25] Dexmedetomidine has been used in different doses in infusion form with or without bolus doses. Some researchers found that Dexmedetomidine given in the dose of 0.25-0.5 µg/Kg body weight only decreased blood pressure while doses of 1-2 µg/Kg was associated with transient increase in blood pressure followed by hypotension and bradycardia with, maximum fall in heart occurred with the dose of 2 µg/Kg body weight.…”

“…and found that it is superior to these drugs in obtunding the hemodynamic changes during intubation. [18][19][20][21][22][23][24][25] Effects of different doses of dexmedetomidine on intubation response have also been studied. Dexmedetomidine in the doses of 0.5 µg/Kg body wt.…”