Effectiveness of dexmedetomidine in reducing blood loss during middle ear surgery under general anaesthesia: a randomized controlled trial
DOI:
https://doi.org/10.3126/jsan.v3i2.15607Keywords:
Cortical mastoidectomy, Dexmedetomidine, Intraoperative bleeding, TympanoplastyAbstract
Background: Maintenance of relatively dry bloodless field is favoured by surgeons during middle ear surgery under operating microscope as it produces better visibility, ease of operation and reduces operating time. A highly selective alpha2 adrenergic agonist like dexmedetomidine, by virtue of its central sympatholytic, sedative and analgesic-sparing effect may provide such desired operating conditions.
Methods: A randomised double-blind, placebo-controlled study was conducted to evaluate whether dexmedetomidine reduces blood loss in middle ear surgery under general anaesthesia and improve operative field visibility. Fifty-four patients aged 18-40 years, posted for elective middle ear surgeries were randomly divided into two groups. Patients of Group D (n=27) received dexmedetomidine in a loading dose of 1mcg/kg over 10 minutes before induction of anaesthesia followed by steady infusion at 0.4mcg/kg/hr. Group P (n=27) patients received corresponding volumes of normal saline as placebo. The operating surgeon assessed the intraoperative bleeding by a four-point Bleeding Score at a 10-minute interval and the Final Opinion on Bleeding Score at the end of surgery. For the test of statistical significance, a value of p less than 0.05 was chosen.
Results: In Group D, the Bleeding Scores and the Final Opinion on Bleeding Score were significantly lower when compared with Group P (p < 0.05).
Conclusions: Dexmedetomidine was found to significantly reduce intraoperative bleeding. This, in turn, improves operative field visibility and increases surgeons satisfaction during middle-ear surgery under general anaesthesia.
References
<ol>
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</ol>
<li>Cincikas D, Ivaskevicus J. Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina (Kaunas) 2003;39:852-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14515047">[PMid: 14515047]</a></li>
<li>Boezaart AP, Van der Merwe J, Coetzee A. Comparison of sodium nitroprusside and esmolol-induced controlled hypotension for Functional Endoscopic sinus surgery. Can J Anaesth 1995;42:373-6. <a href="http://dx.doi.org/10.1007/BF03015479">http://dx.doi.org/10.1007/BF03015479</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/7614641">[PMid:7614641]</a></li>
<li>Marchal JM, Gomez-Luque A, Martos-Crespo F, Sanchez De La Cuesta F, Martinez-Lopez MC, Delgado-Martinez AD. Clonidine decrease intraoperative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand 2001;45:627-33. <a href="http://dx.doi.org/10.1034/j.1399-6576.2001.045005627.x">http://dx.doi.org/10.1034/j.1399-6576.2001.045005627.x</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/11309017">[PMid:11309017]</a></li>
<li>Durmus M, But AK, Dogan Z, Yucel A, Miman MC, Ersoy MO. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol 2007;24:447-53. <a href="http://dx.doi.org/10.1017/S0265021506002122">http://dx.doi.org/10.1017/S0265021506002122</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/17241505">[PMid:17241505]</a></li>
<li>Testa LD, Tobias JD. Pharmacologic drugs for controlled hypotension. J Clin Anesth 1995;7:326-37. <a href="http://dx.doi.org/10.1016/0952-8180(95)00010-F">http://dx.doi.org/10.1016/0952-8180(95)00010-F</a></li>
<li>Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000;93:382-94. <a href="http://dx.doi.org/10.1097/00000542-200008000-00016">http://dx.doi.org/10.1097/00000542-200008000-00016</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/10910487">[PMid:10910487]</a></li>
<li>Talke P, Richardson CA, Scheinin M, Fischer DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg 1997;85:1136-42. <a href="http://dx.doi.org/10.1213/00000539-199711000-00033">http://dx.doi.org/10.1213/00000539-199711000-00033</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/9356115">[PMid:9356115]</a></li>
<li>Talke PO, Caldwell JE, Richardson CA, Heier T. The effects of clonidine on human digital vasculature. Anesth Analg 2000 91:793-7. <a href="http://dx.doi.org/10.1097/00000539-200010000-00006">http://dx.doi.org/10.1097/00000539-200010000-00006</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/11004028">[PMid:11004028]</a></li>
<li>Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 1997;84:873-81. <a href="http://dx.doi.org/10.1097/00000542-199604000-00015">http://dx.doi.org/10.1097/00000542-199604000-00015</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/8638842">[PMid:8638842]</a></li>
<li>Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705. <a href="http://dx.doi.org/10.1097/00000539-200003000-00035">http://dx.doi.org/10.1097/00000539-200003000-00035</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/10702460">[PMid:10702460]</a></li>
<li>Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine, an (alpha)2-adrenoceptor agonist, reduces anaesthetic requirements for patients undergoing minor gynaecologic surgery. Anaesthesiology 1990;73:230-5. <a href="http://dx.doi.org/10.1097/00000542-199008000-00007">http://dx.doi.org/10.1097/00000542-199008000-00007</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/1974394">[PMid:1974394]</a></li>
<li>Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991;74:997-1002. <a href="http://dx.doi.org/10.1097/00000542-199106000-00005">http://dx.doi.org/10.1097/00000542-199106000-00005</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/1675042">[PMid:1675042]</a></li>
<li>Nasreen F, Bano S, Khan RM, Hasan SA. Dexmedetomidine used to provide hypotensive anesthesia during middle ear surgery. Indian J Otolaryngol Head Neck Surg 2009 61:205-7.</li>
<li>But AK, Ozgul U, Erdil F, Gulhas N, Toprak HI, Durmus M, et al. The effects of pre-operative dexmedetomidine infusion on haemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand 2006;50:1207-12. <a href="http://dx.doi.org/10.1111/j.1399-6576.2006.01136.x">http://dx.doi.org/10.1111/j.1399-6576.2006.01136.x</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/16978159">[PMid:16978159]</a></li>
<li>Kabukcu HK, Sahin N, Temel Y, Titiz TA. Hemodynamics in coronary artery bypass surgery: effects of intraoperative dexmedetomidine administration. Anaesthesist 2011;60:427-31. <a href="http://dx.doi.org/10.1007/s00101-010-1842-3">http://dx.doi.org/10.1007/s00101-010-1842-3</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/21271232">[PMid:21271232]</a></li>
<li>Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery: The effect on recovery outcome variables. Anesth Analg 2008;106:1741-8. <a href="http://dx.doi.org/10.1213/ane.0b013e318172c47c">http://dx.doi.org/10.1213/ane.0b013e318172c47c</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/18499604">[PMid:18499604]</a></li>
<li>Aho M. Erkola O, Kallio A, Scheinin H, Korttila K. Dexmedetomidine infusion for maintenance of anaesthesia in patients undergoing abdominal hysterectomy. Anesth Analg 1992;75:940-6. <a href="http://dx.doi.org/10.1213/00000539-199212000-00012">http://dx.doi.org/10.1213/00000539-199212000-00012</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/1359809">[PMid:1359809]</a></li>
<li>Dyck JB, Maze M, Haack C, Vuorilehto L, Shafer SL. The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrochloride in adult human volunteers. Anaesthesiology 1993;78:813-20. <a href="http://dx.doi.org/10.1097/00000542-199305000-00002">http://dx.doi.org/10.1097/00000542-199305000-00002</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/8098190">[PMid:8098190]</a></li>
<li>Dyck JB, Maze M, Haack C, Azarnoff DL, Vuorilehto L, Shafer SL. Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers. Anaesthesiology 1993;78:821-8. <a href="http://dx.doi.org/10.1097/00000542-199305000-00003">http://dx.doi.org/10.1097/00000542-199305000-00003</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/8098191">[PMid:8098191]</a></li>
<li>Taittonen M, Kirvela OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth 1997;78:400-6. <a href="http://dx.doi.org/10.1093/bja/78.4.400">http://dx.doi.org/10.1093/bja/78.4.400</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/9135361">[PMid:9135361]</a></li>
<li>Roekaerts P, Prinzen F, Willingers H. The effect of dexmedetomidine on systemic haemodynamics, regional myocardial function and blood flow during coronary artery stenosis in acute anaesthetized dogs. J Cardiothorac Anaesth 1994;8:58. <a href="http://dx.doi.org/10.1016/1053-0770(94)90367-0">http://dx.doi.org/10.1016/1053-0770(94)90367-0</a></li>
<li>Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth 2008;20;437-41. <a href="http://dx.doi.org/10.1016/j.jclinane.2008.04.008">http://dx.doi.org/10.1016/j.jclinane.2008.04.008</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/18929284">[PMid:18929284]</a></li>
<li>Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anesthesiol 2008;25:369-74. <a href="http://dx.doi.org/10.1017/S0265021508003761">http://dx.doi.org/10.1017/S0265021508003761</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/18294411">[PMid:18294411]</a></li>
<li>Turan G, Dincer E, Ozgultekin A, Uslu C, Akgun N. Comparison of dexmedetomidine, remifentanil and esmolol in controlled hypotensive anaesthesia. Eur J Anaesthesiol 2008;25:65-6. <a href="http://dx.doi.org/10.1097/00003643-200805001-00206">http://dx.doi.org/10.1097/00003643-200805001-00206</a></li>
<li>Kol IO, Kaygusuz K, Yildirim A, Dogan M, Gursoy S, Yucel E, et al. Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: a double-blind, randomized, controlled trial. Current Therapeutic Research 2009;70:197-208. <a href="http://dx.doi.org/10.1016/j.curtheres.2009.06.001">http://dx.doi.org/10.1016/j.curtheres.2009.06.001</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/24683230">[PMid:24683230]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967361/">[PMCid:PMC3967361]</a></li>
<li>Aboushanab OH, El-Shaarawy AM, Omar AM, Abdelwahab HH. A comparative study between magnesium sulphate and dexmedetomidine for deliberate hypotension during middle ear surgery. Egyptian Journal of Anaesthesia 2011;27:227-32. <a href="http://dx.doi.org/10.1016/j.egja.2011.07.008">http://dx.doi.org/10.1016/j.egja.2011.07.008</a></li>
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2016-09-17
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Sarkar, C., Bhattacharyya, C., Samal, R., De, A., Bhar (Kundu), S., Verma, A. K., & Pal, S. (2016). Effectiveness of dexmedetomidine in reducing blood loss during middle ear surgery under general anaesthesia: a randomized controlled trial. Journal of Society of Anesthesiologists of Nepal, 3(2), 57-63. https://doi.org/10.3126/jsan.v3i2.15607
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