A Comparative Study of the Amount of Bleeding and Hemodynamic Changes between Dexmedetomidine Infusion and Remifentanil Infusion for Controlled Hypotensive Anesthesia in Lumbar Discopathy Surgery: A Double-Blind, Randomized, Clinical Trial

Background The aim of this study was to compare the volume of blood loss and hemodynamic changes in patients undergoing lumbar discopathy, after continuous infusions of dexmedetomidine versus remifentanil during anesthesia with controlled low blood pressure. Methods In this randomized double-blind clinical trial, 60 patients aged 20 to 65 years were randomly assigned to control and intervention groups. The intervention group received a continuous infusion of dexmedetomidine at 0.3 - 0.7 µg/kg/hour plus propofol at 50 - 100 µg/kg/minute. The control group was given a continuous infusion of remifentanil at 0.1 to 1 µg/kg/minute plus the same dose of propofol as above. The primary outcome was the amount of patient's bleeding during surgery, and secondary outcomes were changes in the patient's systolic blood pressure, diastolic blood pressure, mean arterial pressure, and urinary output. Results Univariate and multivariate analyses of the main outcome in the control and intervention groups showed that there was no significant difference between the two drugs with regards to the volume of blood loss, mean arterial pressure, and systolic and diastolic blood pressure. Postoperative side effects were significantly lower in the intervention group (P = 0.002). Conclusions Administration of dexmedetomidine plus propofol in comparison with remifentanil plus propofol did not show any significant difference regarding blood loss and hemodynamic changes; however, it reduced some side effects after surgery and decreased analgesic requirement in the postoperative period. Taken together, the findings of this study do not support strong recommendations for dexmedetomidine infusion for all patients and the decision should be taken with caution on basis of the anesthesiologist’s expert opinion and the patient’s condition during surgery.

[1]  Jing-jing Hao,et al.  Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial , 2015, Journal of neurosurgical anesthesiology.

[2]  Priyamvada Gupta,et al.  Dexmedetomidine as an adjuvant for Hypotensive Anaesthesia during Functional Endoscopic Sinus Surgery (FESS) , 2016 .

[3]  D. A. Kulkarni,et al.  A comparative study between Dexmedetomidine infusion and Propofol infusion for maintenance in patients undergoing Functional Endoscopic Sinus Surgery under General Anaesthesia , 2016 .

[4]  H. Sert,et al.  Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil , 2016, European Archives of Oto-Rhino-Laryngology.

[5]  C. Klingner,et al.  Initial severity of motor and non-motor disabilities in patients with facial palsy: an assessment using patient-reported outcome measures , 2016, European Archives of Oto-Rhino-Laryngology.

[6]  Y. Jeon,et al.  Comparison between Dexmedetomidine and Remifentanil for Controlled Hypotension and Recovery in Endoscopic Sinus Surgery , 2013, The Annals of otology, rhinology, and laryngology.

[7]  V. Arlet,et al.  Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes. , 2013, Middle East journal of anaesthesiology.

[8]  E. Karataş,et al.  Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients? , 2013, The Journal of surgical research.

[9]  F. Imani,et al.  Effect of Clonidine Premedication on Blood Loss in Spine Surgery , 2012, Anesthesiology and pain medicine.

[10]  Achmet Ali,et al.  Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy. , 2009, Middle East journal of anaesthesiology.

[11]  L. Uzun,et al.  Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. , 2008, Journal of clinical anesthesia.

[12]  F. Guarracino,et al.  Plasma BNP and diastolic dysfunction in patients with preserved systolic function: 4AP8-7 , 2007 .

[13]  A. But,et al.  Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty , 2007, European journal of anaesthesiology.

[14]  C. Degoute.  Controlled hypotension: a guide to drug choice. , 2007, Drugs.

[15]  Ahmet Koroglu,et al.  A Comparison of the Sedative, Hemodynamic, and Respiratory Effects of Dexmedetomidine and Propofol in Children Undergoing Magnetic Resonance Imaging , 2006, Anesthesia and analgesia.

[16]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. , 1992, Anesthesiology.

[17]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. , 1992, Anesthesiology.

[18]  A. Lehtinen,et al.  The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. , 1991, Anesthesiology.