Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-25T01:42:25.663Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty

Published online by Cambridge University Press:  01 May 2007

M. Durmus ,
A. K. But ,
Z. Dogan ,
A. Yucel ,
M. C. Miman  and
M. O. Ersoy
M. Durmus*
Affiliation:
Inonu University, School of Medicine, Department of *Anaesthesiology, Malatya, Turkey
A. K. But
Affiliation:
Inonu University, School of Medicine, Department of *Anaesthesiology, Malatya, Turkey
Z. Dogan
Affiliation:
Inonu University, School of Medicine, Department of *Anaesthesiology, Malatya, Turkey
A. Yucel
Affiliation:
Inonu University, School of Medicine, Department of *Anaesthesiology, Malatya, Turkey
M. C. Miman
Affiliation:
Inonu University, School of Medicine, Department of Otorhinolaryngology, Malatya, Turkey
M. O. Ersoy
Affiliation:
Inonu University, School of Medicine, Department of *Anaesthesiology, Malatya, Turkey
*
Correspondence to: Mahmut Durmus, Department of Anaesthesiology, School of Medicine, Inonu University, 44069 Malatya, Turkey. E-mail: mdurmus@inonu.edu.tr; Tel: +905333468627; Fax: +904223410036
Get access

Summary

Background and objective

The aim of this study was to evaluate the efficacy of dexmedetomidine, an α2-adrenoceptor agonist, on intraoperative bleeding, anaesthetic drug requirement and postoperative pain.

Methods

Forty patients scheduled for elective tympanoplasty and septorhinoplasty operations under general anaesthesia were included in the study. The patients were randomly assigned to receive either a dexmedetomidine 1 μg kg−1 bolus 10 min before induction of anaesthesia plus 0.5 μg kg−1 h−1 infusions during maintenance or placebo. Mean arterial pressure was maintained between 60 and 80 mmHg. Perioperative mean arterial pressure, heart rate, time to extubation and time to awakening were recorded. Bleeding during surgery was assessed by the surgeon, blinded to the study drugs, both intraoperatively and postoperatively as a final personal opinion about the whole surgical process.

Results

The heart rate and mean arterial pressure were significantly lower during induction, operation and extubation in the dexmedetomidine group (P < 0.05). Blood losses were lower in the dexmedetomidine group (P < 0.05). Propofol dose required for induction, and fentanyl and isoflurane consumption were significantly reduced in the dexmedetomidine group (P < 0.05). The total amounts of nitroglycerin and meperidine used were higher in the control group (P < 0.05).

Conclusions

Dexmedetomidine decreased bleeding, postoperative analgesic requirements and intraoperative anaesthetic requirements and was associated with more stable haemodynamic responses to anaesthesia. We conclude that dexmedetomidine is a useful adjuvant to decrease bleeding when a bloodless surgical field is requested.

Keywords

DEXMEDETOMIDINEHYPOTENSION, controlledINTRAOPERATIVE PERIODHAEMORRHAGESURGERY, tympanoplasty, rhinoplasty
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 447 - 453
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Marchal, JM, Gomez-Luque, A, Martos-Crespo, F et al. . Clonidine decrease intraoperative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand 2001; 45: 627–633.CrossRefGoogle ScholarPubMed
2.Degoute, CS, Ray, MJ, Manchon, M et al. . Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth 2001; 48: 20–27.CrossRefGoogle ScholarPubMed
3.Aken, HV, Miller, ED. Deliberate hypotension, In: Miller, RD, ed. Anesthesia, 5th edn, Vol. 1. New York, USA: Churcill Livingstone Inc., 2000.Google Scholar
4.Maze, M, Segal, IS, Bloor, BC. Clonidine and other alpha2 adrenergic agonists: strategies for the rational use of these novel anesthetic agents. J Clin Anesth 1988; 1: 146–157.CrossRefGoogle ScholarPubMed
5.Guo, T-Z, Jiang, J-Y, Buttermann, AE, Maze, M. Dexmedetomidine injection into the locus coeruleus produces antinociception. Anesthesiology 1997; 84: 873–881.Google Scholar
6.Ebert, TJ, Hall, JE, Barney, JA et al. . The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382–394.Google Scholar
7.Aantaa, R, Jaakola, ML, Kallio, A, Kanto, J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology 1997; 86: 1055–1060.CrossRefGoogle ScholarPubMed
8.Hayashi, Y, Maze, M. Alpha 2 adrenoreceptor agonists and anaesthesia. Br J Anaesth 1993; 71: 108–118.Google Scholar
9.Aho, MS, Erkola, OA, Scheinin, H et al. . Effect of intravenously administred dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg 1991; 73: 112–118.CrossRefGoogle ScholarPubMed
10.Aldrete, JA. The post anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89–91.Google Scholar
11.Modig, J. Regional anaesthesia and blood loss. Acta Anaesthesiol Scand 1988; 89 (Suppl): 44–48.CrossRefGoogle ScholarPubMed
12.JrMorgan, GE, Mikhail, MS, Murray, MJ, JrLarson, CP. Clinical Anesthesiology, 3rd edn. Los Angeles, USA: McGraw-Hill Co, 2002.Google Scholar
13.Hersey, SL, O’Dell, NE, Lowe, S. Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescents. Anesth Analg 1997; 84: 1239–1244.CrossRefGoogle ScholarPubMed
14.Shander, A. Surgery without blood. Crit Care Med 2003; 31 (Suppl): 708–714.CrossRefGoogle ScholarPubMed
15.Davies, MJ. Minimising intra-operative blood loss. Transfus Apher Sci 2002; 27: 55–57.CrossRefGoogle ScholarPubMed
16.Simpson, P. Perioperative blood loss and its reduction: the role of the anaesthetist. Br J Anaesth 1992; 69: 498–507.Google Scholar
17.Albera, R, Ferrero, V, Canale, A, De Siena, L. Cochlear blood flow modifications induced by anaesthetic drugs in middle ear surgery: comparison between sevoflurane and propofol. Acta Otolaryngol 2003; 123: 812–816.Google Scholar
18.Ates, Y, Kecik, Y, Yavuzer, S. Anesthetic agents and platelet aggregation. Anesth Analg 1997; 85: 1177–1178.CrossRefGoogle ScholarPubMed
19.Lawrence, CJ, Prinzen, FW, de Lange, S. Effect of dexmedetomidine on nutrient organ blood flow. Anesth Analg 1996; 83: 1160–1165.CrossRefGoogle ScholarPubMed
20.Scholz, J, Tonner, PH. alpha2-Adrenoreceptor agonists in anesthesia: a new paradigm. Curr Opin Anaesthesiol 2000; 13: 437–442.CrossRefGoogle Scholar
21.Bloor, BC, Ward, DS, Belleville, JP, Maze, M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77: 1134–1142.CrossRefGoogle ScholarPubMed
22.Fragen, RJ, Fitzgerald, PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults aged 55–70 years. J Clin Anesth 1999; 11: 466–470.CrossRefGoogle Scholar
23.Scheinin, H, Jaakola, ML, Sjovall, S et al. . Intramuscular dexmedetomidine as premedication for general anesthesia: a comparative multicenter study. Anesthesiology 1993; 78: 1065–1075.CrossRefGoogle ScholarPubMed
24.Talke, P, Tayefeh, F, Sessler, DI et al. . Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology 1997; 87: 835–841.CrossRefGoogle Scholar
25.Peden, CJ, Cloote, AH, Stratford, N, Pry-Roberts, C. The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanyl. Anaesthesia 2001; 56: 408–413.CrossRefGoogle Scholar
26.Mikawa, K, Nishina, K, Maekawa, N, Obara, H. Attenuation of cardiovascular responses to tracheal extubation: verapamil versus diltiazem. Anesth Analg 1996; 82: 1205–1210.Google ScholarPubMed
27.Miller, KA, Harkin, CP, Bailey, PL. Postoperative tracheal extubation. Anesth Analg 1995; 80: 149–172.Google Scholar
28.Fuhrman, TM, Ewell, CL, Pippin, WD, Weaver, JM. Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation. J Clin Anesth 1992; 4: 444–447.CrossRefGoogle ScholarPubMed
29.Jin, F, Chung, F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001; 87: 608–624.CrossRefGoogle ScholarPubMed
30.Aho, M, Scheinin, M, Lehtinen, AM et al. . Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg 1992; 75: 932–939.CrossRefGoogle ScholarPubMed
31.Arain, SR, Ebert, TJ. The efficacy, side effects and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anest Analg 2002; 95: 461–466.CrossRefGoogle ScholarPubMed