Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.01.008
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: randomized clinical study

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Akcan Akkaya; Umit Yasar Tekelioglu; Abdullah Demirhan; Murat Bilgi; Isa Yildiz; Tayfun Apuhan; Hasan Kocoglu

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Abstract

Background and objectives: Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. Method: 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50 mg kg−1 over 10 min and maintained at 15 mg kg−1 h−1; in Group D, dexmedetomidine was given at 1 mcg kg−1 10 min before induction and maintained at 0.6 mcg kg−1 h−1. Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. Results: Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. Conclusions: Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

Keywords

Endoscopic sinus surgery, Magnesium, Dexmedetomidine, Hypotension

Resumo

Justificativa e objetivo: Uma quantidade, mesmo pequena, de sangramento durante a cirurgia endoscópica pode alterar o campo endoscópico e dificultar o procedimento. Várias técnicas, incluindo hipotensão induzida, podem minimizar o sangramento durante a cirurgia endoscópica. O objetivo deste estudo foi comparar a qualidade da visibilidade cirúrgica, os parâmetros hemodinâmicos, a dor no período pós-operatório e outros efeitos do sulfato de magnésio, um agente hipotensor, com os da dexmedetomidina, inicialmente desenvolvida para sedação em curto prazo em unidade de terapia intensiva, mas que também é um sedativo agonista alfa-2. Métodos: Foram alocados 60 pacientes entre 18 e 45 anos em dois grupos: Grupo M (magnésio) e Grupo D (dexmedetomidina). No Grupo M, sulfato de magnésio foi administrado pré-indução a uma dose de carga de 50 mg kg−1 por 10 minutos e mantida com 15 mg kg−1 h−1; no Grupo D, dexmedetomidina foi administrada a uma dose de 1 mcg kg−1 10 minutos antes da indução e mantida com 0,6 mcg kg−1 h−1. No período intraoperatório, foram registrados os parâmetros hemodinâmicos e respiratórios e a avaliação do campo cirúrgico com uma escala de seis pontos. Durante o período pós-operatório foram registrados os valores da escala numérica de 11 pontos para avaliar a dor, a escala de sedação de Ramsay, a escala de avaliação de náusea/vômito, o perfil dos efeitos adversos e pruridos. Resultados: O Grupo D apresentou redução significativa da frequência cardíaca e do escore na escala de avaliação do campo cirúrgico intraoperatório. A média do tempo cirúrgico foi de 50 minutos e o Grupo M apresentou um número maior de cirurgias prolongadas. Não houve diferença significativa em outros parâmetros. Conclusão: Por causa da reducção da taxa de sangramento e da frequência cardíaca em cirurgia endoscópica e dos impactos positivos sobre a duração da cirurgia, consideramos dexmedetomidina como melhor opção que o sulfato de magnésio

Palavras-chave

Cirurgia endoscópica sinusal, Sulfato de Magnésio, Dexmedetomidina, Hipotensão

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