Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized StudyFunding This study is supported by grant funds from Siriraj Research Development Fund (R016032005), Faculty of Medicine, Siriraj Hospital, Mahidol University.
Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time.
Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg/kg, followed by 0.2 mcg/kg/h, and to group II at the same loading dose, followed by 0.5 mcg/kg/h. Comparative analyses were performed using the Student's t-test, repeated-measures analysis of variance, and Mann–Whitney U test; p-values < 0.05 were considered statistically significant.
Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension (p = 0.034).
Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg/kg/h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.
Artikel online veröffentlicht:
06. Februar 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Fan YP, Lv MH, Feng SY. et al. Full endoscopic trans-sphenoidal surgery for pituitary adenoma-emphasized on surgical skill of otolaryngologist. Indian J Otolaryngol Head Neck Surg 2014; 66 (Suppl. 01) 334-340
- 2 Gopalakrishna KN, Dash PK, Chatterjee N, Easwer HV, Ganesamoorthi A. Dexmedetomidine as an anesthetic adjuvant in patients undergoing trans-sphenoidal resection of pituitary tumor. J Neurosurg Anesthesiol 2015; 27 (03) 209-215
- 3 Jan S, Ali Z, Nisar Y. et al. A comparison of dexmedetomidine and clonidine in attenuating the hemodynamic responses at various surgical stages in patients undergoing elective transnasal trans-sphenoidal resection of pituitary tumors. Anesth Essays Res 2017; 11 (04) 1079-1083
- 4 Salimi A, Sharifi G, Bahrani H. et al. Dexmedetomidine could enhance surgical satisfaction in trans-sphenoidal resection of pituitary adenoma. J Neurosurg Sci 2017; 61 (01) 46-52
- 5 Bala R, Chaturvedi A, Pandia MP, Bithal PK. Intraoperative dexmedetomidine maintains hemodynamic stability and hastens postoperative recovery in patients undergoing trans-sphenoidal pituitary surgery. J Neurosci Rural Pract 2019; 10 (04) 599-605
- 6 Obara S. Dexmedetomidine as an adjuvant during general anesthesia. J Anesth 2018; 32 (03) 313-315
- 7 Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol 2012; 62 (01) 118-133
- 8 Lee S. Dexmedetomidine: present and future directions. Korean J Anesthesiol 2019; 72 (04) 323-330
- 9 Davy A, Fessler J, Fischler M, LE Guen M. Dexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery. Minerva Anestesiol 2017; 83 (12) 1294-1308
- 10 Liu Z, Gao C, Liu C. et al. Supplementation with dexmedetomidine for trans-sphenoidal resection of pituitary adenoma: a meta-analysis of randomized controlled trials. Clin Neuropharmacol 2021; 44 (01) 17-20
- 11 Muangman S, Dachasilaruk S, Punkla W. et al. Descriptive study: anesthesia for awake craniotomy in Siriraj Hospital. Siriraj Med J 2016; 68 (02) 65-71
- 12 Sirivanasandha B, Jindawatthana I, Rodchour S. et al. Recovery profiles after general anesthesia in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery with or without dexmedetomidine as an anesthetic adjuvant: a double blinded randomized study. J Med Assoc Thai 2018; 101 (09) S93-S100
- 13 Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev 2019; 9 (09) CD003843
- 14 Soliman R, Fouad E. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: a double-blind randomised study. Indian J Anaesth 2017; 61 (05) 410-417
- 15 Miller TE, Myles PS. Perioperative fluid therapy for major surgery. Anesthesiology 2019; 130 (05) 825-832
- 16 Hwang SH, Lee HS, Joo YH, Seo JH, Kang JM. Efficacy of dexmedetomidine on perioperative morbidity during nasal surgery: a meta-analysis. Laryngoscope 2018; 128 (03) 573-580
- 17 Tsaousi GG, Tsitsopoulos PP, Foroglou NG. et al. Control of hemodynamic responses and perioperative outcomes in trans-sphenoidal pituitary surgery: a qualitative systematic review of the available evidence. J Neurosurg Anesthesiol 2022; 34 (04) 372-383
- 18 Lee HS, Yoon HY, Jin HJ, Hwang SH. Can dexmedetomidine influence recovery profiles from general anesthesia in nasal surgery?. Otolaryngol Head Neck Surg 2018; 158 (01) 43-53
- 19 Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth 2013; 111 (02) 222-228
- 20 Polat R, Peker K, Baran I, Bumin Aydın G, Topçu Gülöksüz Ç, Dönmez A. Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery: a randomized double-blind trial. Anaesthesist 2015; 64 (10) 740-746
- 21 Garg A, Kamal M, Mohammed S, Singariya G, Chouhan DS, Biyani G. Efficacy of dexmedetomidine for prevention of emergence agitation in patients posted for nasal surgery under desflurane anaesthesia: a prospective double-blinded randomised controlled trial. Indian J Anaesth 2018; 62 (07) 524-530
- 22 Abdallah MYY, Khafagy YW, AbdAllah MYY. Efficacy of dexmedetomidine versus propofol in patients undergoing endoscopic transnasal trans-sphenoidal pituitary tumor resection. Anesth Essays Res 2021; 15 (04) 368-374