A comparative clinical study between dexmedetomidine and nitroglycerine for controlled hypotensive anaesthesia in spine surgeries

Abstract

Background and Objective: To reduces the intraoperative blood loss and to provide better visibility of the surgical field controlled hypotension is used. Aim of this study is to compare dexmedetomidine and nitroglycerine as hypotensive agents for inducing controlled hypotension in patients undergoing elective spine surgeries. Materials and Methods: 60 ASA class I or II adult patients undergoing elective spine surgeries were randomly alloca ted into 2 groups of 30 participant in each group DX and group NG . Group DX received dexmeditomidine bolus 1 microgram/kg over 10 minutes before induction and intraoperative infusion of 0.2 -0.7 microgram per kg per hour, while group NG received nitroglycerine intraoperative infusion at 0.5 to 10 microgram/kg/ min titrated to a mean arterial pressure (MAP) of 70 -75 mmHg. In both groups the surgical field quality assessed using Fromme -Boezaart grading. Hemodynamic variable and adverse events were noted. Post operative sedation was also assessed using Ramsay sedation score. Results: The mean heart rate was significantly lower in group DX compared to group NG throughout the procedure. (p<0.001). Mean arterial pressure were found to be significantly lower in group DX than in group NG after induction, after intubation, end of surgery, after extubation, and post operatively (p<0.001), but average intraoperative values were comparable in both groups. Significantly better Fromme -BoezaarT surgical field score was noted in group DX compared to group NG during the intraoperative period. Conclusion: Controlled hypotension using dexmeditomidine as bolus dose 1 microgram per kg intravenous over 10 minutes prior to induction followed by continous intravenous infusion at 0.2 -0.7 microgram per kg per hour, provided more stable hemodynamics and better surgical field quality compared to nitroglycerine intraoperative infusion at 0.5 to 10 microgram/kg/min.