Esmolol versus dexmedetomidine in scoliosis surgery: Study on intraoperative blood loss and hemodynamic changes
Surgical correction ofscoliosis carries significant blood loss and needs for blood transfusion with its inherent risks and cost. The aim of this double-blind, randomized, controlled study was to compare the effects of esmolol or dexmedetomidine on intraoperative blood loss, anesthetics consumption, intra operative hemodynamic and effects on spinal cord monitoring in patients undergoing scoliosis surgery.
After obtaining institute review board approval and written informed consent, 60 adolescents (ASA physical status I-II), 14-18-year of age scheduled for posterior spinal fusion scoliosis surgery were enrolled in the study. Using computer generator software patients were randomly allocated to receive either saline as a control (group C), esmolol (Group E) or dexmedetomidine (Group D).
There was a significant reduction in blood loss in patients who received esmolol and dexmeditomidine compared to control it was as follow; in control group 782+/-86.4 ml (P < or = 0.001), esmolol group 667+/-145.2 ml (P < or = 0.001) and dexmeditomidine group 465 +/-115.3 ml (P < or = 0.001). Mean intraoperative total fentanyl and propofol consumption in the esmolol group was significantly higher than in the dexmedetomidine group, this was especially dramatic for the dexmedetomidine group where the propofol consumption was twice less P < or = 0.001. There was no significant effect seen in SSEPs (amplitude or latency) but there was isolated decrease in motor evoked potential (MEP) amplitude which was within acceptable range that was seen in 6 patients receiving dexmeditomidine at a dose of 0. 7 micro g/Kg/H.
Both esmolol and dexmedetomidine, added to anesthetic regimen, provided an effective and well-tolerated method to reduce the amount of blood loss in patients undergoing scoliosis surgery. dexmedetomidine, was associated with plonoged extubation and recovery times.
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ABSTRACT: Objective The aim of this study was to evaluate the effect of intravenous infusion of dexmedetomidine on intraoperative hemodynamics and blood loss during open nephrolithotomy under general anesthesia in adult patients. Method 50 male and female patients, ASA physical status I and II aged 20-60 years old scheduled for open nephrolithotomy under general anesthesia were randomly allocated into two equal groups: Group D (n = 25): received a bolus dose of IV dexmedetomidine. 1 μg/kg over 10 min before induction of anesthesia and then IV infusion of 0.1-0.5 μg/kg/h guided by the hemodynamics. Group P (n = 25): received a bolus dose of 10 ml Ringer lactate solution before induction of anesthesia, and infusion was continued during surgery. General anesthesia was induced in all patients using fentanyl, propofol and atracurium. The following parameters were recorded: heart rate and systolic and diastolic arterial blood pressure: before and after induction of anesthesia and then every 15 min intraoperatively, volume of blood loss (ml), laboratory hemoglobin % and hematocrit concentration: preoperative, intraoperative and immediate postoperative and number of the transfused units of PRBCs. Results Intraoperative heart rate and systolic and diastolic arterial blood pressure were statistically significantly lower in group D than in group P. The intraoperative blood volume lost was statistically significantly higher in group P than in group D. A number of the transfused units of PRBCs, intraoperative and postoperative hemoglobin % and hematocrit concentration were statistically significantly lower in group P than in group D. Conclusion Dexmedetomidine infusion in patients undergoing open nephrolithotomy under general anesthesia was associated with intraoperative hemodynamic stability, which decreases intraoperative blood loss and the need for intraoperative blood transfusion.
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