Comparative Evaluation of Dexmedetomidine Versus Magnesium Sulphate on The Adequacy of Hypotensive Anesthesia and Post-Operative Recovery for Patients Undergoing Endoscopic Transnasal Transsphenoidal Pituitary Tumor Resection

Abstract

Background: Perioperative use of magnesium sulfate (MgSO4), dexmedetomidine, have been tried in order to provide beneficial clinical effects during general anesthesia (GA). However, few literature discussed it with varying results. Several clinical researches have showed that usage of MgSO4 infusion was associated with a reduction in anesthetic requirement and postsurgical analgesic consumption during GA.Objective: This study aimed to assess the pharmacologic effects of the use of dexmedetomidine and MgSO4 on anesthetic requirement, intra operative haemodynamics stability and postsurgical analgesic effects on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumours. Patients and methods: A total of 110 cases were enrolled in this prospective study. They were randomized into 2 groups: Group D (55 cases) that was commenced on dexmedetomidine, and group M (55 cases) which received MgSO4 Results: The mean values of Boezaart score were significantly decreased in Group D in comparison to group M. In addition, isoflurane and propranolol consumption showed a significant decrease in group D. However, blood loss showed no significant difference when comparing the same groups. Group D expressed significantly longer emergence and extubation times compared to Group M. Conclusion: Dexmedetomidine appears to be superior compared to magnesium sulphate in achieving hypotensive anesthesia during pituitary surgery.

A prospective-randomized placebo-controlled trial comparing the effects of nebulized dexmedetomidine v/s dexmedetomidine-lignocaine mixture on intraoperative hemodynamics and surgical field quality in patients undergoing endoscopic transnasal transsphenoidal pituitary tumor surgery

“…The sympatholytic properties of dexmedetomidine could have blunted the response to noxious stimuli during various surgical stages, resulting in a significantly reduced requirement for anesthetics. [12,20,35,36] Our findings align with the previous studies involving intravenous dexmedetomidine in TNTSS, leading to early emergence and extubation. [7,12] In our study, patients in the dexmedetomidine groups had optimal surgical fields, with a substantial percentage of patients having excellent Formmers grades.…”

“…Dexmedetomidine’s ability to attenuate stress-induced hypertension also aided in minimizing surgical field bleeding, resulting in better operating conditions. [ 1 , 18 , 31 , 36 ] The use of intravenous dexmedetomidine in TNTSS has been associated with hypotension and bradycardia, necessitating the use of atropine in one study. [ 35 ] In addition, another study reported prolonged hypotension for up to 30 min following administering an intravenous dexmedetomidine loading dose before anesthesia induction.…”