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Rokhtabnak F, Djalali Motlagh S, Ghodraty M, et al. Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate. Anesth Pain Med. 2017;7(6):e64032doi: 10.5812/aapm.64032.
Rokhtabnak, F., Djalali Motlagh, S., Ghodraty, M., Pournajafian, A., Maleki Delarestaghi, M., Tehrani Banihashemi, A., & Araghi, Z. (2017). Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate. Anesthesiology and pain medicine, 7(6), e64032. https://doi.org/10.5812/aapm.64032
Rokhtabnak, Faranak, et al. "Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate." Anesthesiology and pain medicine vol. 7,6 (2017): e64032. doi: https://doi.org/10.5812/aapm.64032
Rokhtabnak F, Djalali Motlagh S, Ghodraty M, Pournajafian A, Maleki Delarestaghi M, Tehrani Banihashemi A, Araghi Z. Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate. Anesth Pain Med. 2017 Dec 26;7(6):e64032. doi: 10.5812/aapm.64032. eCollection 2017 Dec. PMID: 29696129; PMCID: PMC5903392.
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Anesth Pain Med. 2017 Dec 26;7(6):e64032. doi: 10.5812/aapm.64032. eCollection 2017 Dec.

Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate.

Anesthesiology and pain medicine

Faranak Rokhtabnak, Soudabeh Djalali Motlagh, Mohamadreza Ghodraty, Alireza Pournajafian, Mojtaba Maleki Delarestaghi, Arash Tehrani Banihashemi, Zeinab Araghi

Affiliations

  1. Department of Anesthesia, Iran University of Medical Sciences, Tehran, Iran.
  2. Department of Otolaryngology, Iran University of Medical Sciences, Tehran, Iran.
  3. Preventive Medicine and Public Health Research Center, Community Medicine Department, Iran University of Medical Sciences, Tehran, Iran.

PMID: 29696129 PMCID: PMC5903392 DOI: 10.5812/aapm.64032

Abstract

OBJECTIVE: The current study aimed at comparing the efficacy of dexmedetomidine and magnesium sulfate to control blood pressure (BP) during rhinoplasty and the resultant effects on the quality of surgical field in terms of bleeding and visibility.

METHODS: The current randomized, prospective, double-blind study was conducted on 60 patients aged 18 to 50 years classified as ASA (American Society of Anesthesiologists) physical status I who were candidates for rhinoplasty. Patients were randomly divided into 2 groups: (1) group Dex, received 1 µg/kg dexmedetomidine in 10 minutes before induction of anesthesia, followed by 0.4 - 0.6 µg/kg/hour during the maintenance of anesthesia, and (2) group Mg, received 40 mg/kg in 10 minutes before anesthesia induction followed by 10 - 15 mg/kg/hour during anesthesia maintenance. In both groups, the goal was to achieve a mean arterial pressure (MAP) of 60 - 70 mmHg. Hemodynamic variables, anesthetic, opioid, muscle relaxant requirements, and surgical field condition were recorded. Sedation score, time to reach modified Aldrete score ≥ 9, and adverse effects including nausea and vomiting (N&V) and shivering were recorded.

RESULTS: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between the groups, but heart rate (HR) was significantly lower in the Dex group (P < 0.001), compared with that of the Mg group. Bleeding score was lower (P < 0.001) and surgeon's satisfaction score was higher (P < 0.001) in the Dex group. More patients required fentanyl (P < 0.001) or nitroglycerin (P < 0.001) and the mean fentanyl (P = 0.005) or nitroglycerin (P < 0.001) required doses were higher in the Mg group. Patients in the Dex group required more frequent administration of cisatracurium (P = 0.004). Five patients in the Dex group versus no patients in the Mg group received atropine (P = 0.023). Ramsay sedation score and time to reach modified Aldrete score ≥ 9 were significantly higher in the Dex group (P < 0.001 and P < 0.001, respectively). The incidence rate of N&V and shivering were similar in both groups.

CONCLUSION: Dexmedetomidine was more effective than magnesium to achieve controlled hypotension, and provide a favorable surgical field condition. However, dexmedetomidine also heightened the risk of induced bradycardia and prolonged sedation. These are 2 important points to consider when applying this drug as a hypotensive agent during operation.

Keywords: Anesthesia; Bradycardia; Controlled Hypotension; Dexmedetomidine; Magnesium Sulfate; Rhinoplasty

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