Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty

Abstract

Objective We aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty. Methods and materials In this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 μg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 μg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 μg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants. Results The patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group. Conclusion Dexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil. Trial registration IRCT20141009019470N112.

Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine

“…The hypotensive effect may be desirable in some situations; for instance, dexmedetomidine has been used intraoperatively to facilitate controlled hypotension [ 35 , 36 ]. Even if dexmedetomidine is more effective than magnesium sulfate, it must be kept in mind that the risk of bradycardia is higher [ 37 ].…”

Comparative study between remifentanil (or fentanyl) and dexmedetomidine for the analgesia of rhinoplasty: A meta-analysis of randomized controlled trials

“…199 publications were identified through the initial search of databases and 4 RCTs were finally included in the meta-analysis. [11][12][13]19] The baseline characteristics of 4 eligible RCTs were summarized in Table 1. The 4 studies were published between 2009 and 2023, and total sample size was 222.…”

“…[9,10] Dexmedetomidine is also reported to improve hemodynamic stability, surgical outcome, patient and surgeon satisfaction. [11] Several randomized controlled trials (RCTs) compared the analgesic efficacy of remifentanil (or fentanyl) versus dexmedetomidine for rhinoplasty, but the results were not well established. [11][12][13] Therefore, this meta-analysis of RCTs aims to evaluate their effectiveness for the satisfaction and surgical outcomes in these patients.…”

Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

“…Lastly, we feel that some of the important conditions like the fusion of sacrum in adults, previous spinal surgeries, and spinal deformities should have been in the exclusion criteria [ 3 ]. Also, Chen et al did not mention the total dose of dexmedetomidine used in each patient, which we believe could have an impact on two factors: (1) mean arterial pressure and (2) patient satisfaction scores [ 4 , 5 ].…”