A comparative study between dexmedetomidine versus magnesium sulphate for controlled hypotensive anesthesia in rhinoplasty surgeries | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Sarah Amr Abbas Abd Elhalem: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University Cairo,,Egypt

2. Ahmed Abd El Aala El-Shawarby: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University Cairo,,Egypt

3. Karim Youssef Kamel Hakim: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University,Cairo,Egypt

4. Yasser Ahmed Abdel Rahman: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University,Cairo,Egypt

5. Ahmed Abdel Ghany Khalifa: Department of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University,Cairo,Egypt

Abstract:

Background: Rhinoplasty, a widely performed surgical procedure globally, necessitates hypotensive anesthesia to minimize bleeding, which can otherwise compromise surgical outcomes. Controlled hypotension anesthesia enhances the bloodless surgical area, reduces postoperative edema and ecchymosis, and can shorten the duration of the procedure. Many drugs have been used to attain hypotensive anesthesia, including magnesium sulfate, volatile anesthetics, and beta-adrenergic blocking agents. We compared dexmedetomidine with magnesium sulfate for producing hypotensive anesthesia in patients undergoing rhinoplasty. Methodology: We included 42 patients, aged 18-60 y, undergoing rhinoplasty and allocated into Group D and Group M. Group D received dexmedetomidine 1 µg/kg diluted in 50 mL of normal saline, administered IV over 10 min prior to anesthesia. Group M received magnesium sulfate 40 µg/kg diluted as infusion. Both groups received continued infusions afterwards. General anesthesia was induced with propofol and atracurium, intubation done and maintained on sevoflurane in N2O and O2. Vital signs were monitored continuously. The efficacy of hypotensive anesthesia was assessed, along with the recording of postoperative complications and the surgeons' satisfaction. Results: Group D and Group M showed no significant variation in mean arterial pressure. However, significant variation was observed in heart rate (P < 0.05). Group D had better operating area score compared to Group M. Surgeons; satisfaction was notably elevated in the Group D than in the Group M (P < 0.05). Opioids needed were significantly less in the Group D in contrast to the Group M. The amount of atropine needed was higher in the Group D than in the Group M (P < 0.05). Conclusion: Dexmedetomidine proved to be better than magnesium sulfate in achieving hypotensive anesthesia together with providing optimal surgical field conditions. Although magnesium sulfate necessitated additional nitroglycerine, dexmedetomidine increased the risk of bradycardia but reduced the analgesic requirements compared to magnesium sulfate. These factors are crucial when considering the use of dexmedetomidine in rhinoplasty surgery.

Page(s): 894-900

DOI: 10.35975/apic.v28i5.2537

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 5, Year: 2024

Keywords:

Dexmedetomidine , Magnesium sulphate , hypotensive anesthesia

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