BackgroundBleeding during surgery can lead to serious complications. Methods and drugs to control bleeding are always important both for the surgeon and anesthesiologist, especially in endoscopic procedures. A lot of efforts are made to optimize the surgical conditions for functional endoscopic sinus surgery. Induced hypotension is widely advocated to prevent bleeding and consequently to improve the quality of an operation . Amongst the pharmacological agents, dexmedetomidine is the most recently introduced drug to provide hypotensive anesthesia during functional endoscopic sinus surgery.ObjectivesThe current study aimed at investigating the effects of intravenous infusion of dexmedetomidine on bleeding, nausea, awakening time, and other intravenous anesthetic doses during functional endoscopic sinus surgery.MethodsSixty patients aged 16 to 60 years with American society of anesthesiologists (ASA) class I or II in Imam Khomeini hospital of Ahvaz, Iran, who were the candidate for the elective functional endoscopic sinus surgery were enrolled in the current double-blind clinical trial. They were randomly divided into 2 groups: group D (receiving dexmedetomidine), and group N (receiving normal saline). Sampling was based on the block randomization method. In group D, a 1-μg/kg dexmedetomidine was injected during 10 minutes just before the induction. Then, 0.5 µg/ kg/ hour infusion was started. Both groups had the same induction and maintenance method as well as the drugs administered for general anesthesia induction. For maintenance, the patients received O2 50%: N2O 50% and 100 μg/kg/minute of propofol and 0.2 μg/kg/minute of remifentanil. In group N, instead of dexmedetomidine in bolus and maintenance, normal saline was used with the same volume. Mean arterial pressure was maintained between 65 to 75 mmHg. The incidence of bleeding, nausea and vomiting after surgery, the amount of maintenance drugs, and awakening time were recorded in a checklist.ResultsThe intravenous use of dexmedetomidine significantly reduced the amount of bleeding (P < 0.0001); in addition, the need for opioids (P < 0.0001) and intravenous anesthetics significantly decreased (P = 0.001). Awakening time was significantly longer (P = 0.001), but its effect on postoperative nausea and vomiting was not significant (P = 0.052).ConclusionsThe current study showed that although propofol and remifentanil compounds can control hemodynamic state, but intravenous infusion of dexmedetomidine during the functional endoscopic sinus surgery reduced the amount of bleeding more significantly. It also reduced the dosage of maintenance drugs.

BackgroundIn the recent decades controlling postoperative pain has become a popular topic as it leads to the patients’ wellbeing and improved life quality, while it reduces the costs for both patients and medical facilities.ObjectivesThis study aimed at comparing intravenous magnesium sulfate versus intravenous sufentanil on the duration of analgesia and postoperative pain in patients undergoing tibia fracture surgery.MethodsThis double blind clinical trial study was performed on 70 candidates of tibia fractures between the ages of 18 and 55 years with American society of anesthesiologists (ASA) class I and II. The patients were randomly divided to 2 groups, 1 receiving magnesium sulfate (M) and another receiving sufentanil (S). Both of the groups underwent spinal anesthesia with 10 mg bupivacaine 0.5%. One hour after ensuring the sensorimotor blockade, in the S group 0.1 µg/kg/hour and in the M group 8 mg/kg/hour was diluted in 1 liter of Ringer’s solution and infused. In this study, full weakness of the lower limb was considered as the sign of sensorimotor blockade initiation. The postoperative pain intensity was measured using the Visual Analog Scale (VAS), 0, 1, 4, 8, 16, and 24 hours after the end of anesthesia duration. In case of VAS ≥ 3, the patients received 0.3 mg/kg pethidine, intravenously. At last, the time of requesting the first narcotic drug and the total usage of pethidine were recorded.Results and ConclusionsSufentanil was found to be more effective than magnesium sulfate in reducing postoperative pain and the time of first narcotics request was later in patients receiving sufentanil (P < 0.05).

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