Abstract
ObjectiveWe aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty.Methods and materialsIn this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 μg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 μg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 μg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants.ResultsThe patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group.ConclusionDexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil.Trial registrationIRCT20141009019470N112.
Highlights
IntroductionThe surgical procedure itself and hemodynamic instability in the patient cause intraoperative bleeding, which affects the quality of the surgical field, the intra- and post-operative complications, and the surgical outcome
Rhinoplasty is still one of the most common cosmetic surgeries in the world
The exclusion criteria included a history of hepatic impairment, renal impairment, allergy and hypersensitivity to the drugs used in the study, substance abuse or benzodiazepine addiction, excessive use of analgesics/non-steroidal anti-inflammatory drugs, diabetes mellitus, coagulation and bleeding disorders, use of anticoagulants, cerebrovascular diseases or accidents, cardiovascular disease, heart conduction disorders, morbid obesity (body mass index (BMI) > 40), a positive history of motion sickness, women who had a history of nausea and vomiting before menstruation
Summary
The surgical procedure itself and hemodynamic instability in the patient cause intraoperative bleeding, which affects the quality of the surgical field, the intra- and post-operative complications, and the surgical outcome Various drugs such as Jouybar et al BMC Anesthesiology (2022) 22:24 high-concentration volatile anesthetics, magnesium sulfate, remifentanil, clonidine, calcium channel blockers, tranexamic acid, intravenous nitroglycerin, and sodium nitroprusside have been evaluated to control blood pressure and decrease blood loss during surgery, thereby improving the surgical field quality [1,2,3,4,5]. Due to the synergistic effects of remifentanil with other anesthetics, it can be used intraoperatively to induce mild to moderate hypotension and controlled bradycardia It has been used in various operations like rhinoplasty to reduce bleeding and improve hemodynamic stability [6,7,8]
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