EFFICACY OF DEXMEDETOMIDINE VERSUS PROPOFOL INFUSION IN PRODUCING CONTROLLED HYPOTENSION DURING FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN A TERTIARY CARE HOSPITAL
2026· Asian Journal of Medical Research and Health Sciences· 0 citations
Abstract
Background:Functional Endoscopic Sinus Surgery (FESS) requires a clear and bloodless surgical field for optimal visualization and prevention of intraoperative complications. Controlled hypotension is commonly employed during FESS to reduce blood loss and improve surgical conditions. Dexmedetomidine and Propofol are widely used agents for controlled hypotensive anesthesia. The present study was conducted to compare the efficacy of dexmedetomidine and propofol infusion in achieving controlled hypotension during FESS.Methodology:This prospective randomized comparative study was conducted in the Department of Anaesthesiology at Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 100 patients aged between 18 and 40 years belonging to ASA Grade I and II undergoing elective FESS were included in the study. Patients were randomly allocated into two groups of 50 each. Group D received dexmedetomidine infusion at 0.4–0.8 μg/kg/hr, while Group P received propofol infusion at 75–100 μg/kg/min following induction of general anesthesia. Intraoperative pulse rate, mean arterial pressure, blood loss, quality of surgical field, sedation score, and complications were assessed and compared between the two groupsResults:Baseline demographic and hemodynamic parameters were comparable between the groups. Intraoperative pulse rate and mean arterial pressure were significantly lower in the dexmedetomidine group at various time intervals compared with the propofol group (p<0.05). Quality of surgical field and mean blood loss were comparable in both groups. Postoperative Ramsay sedation scores at 30 minutes were significantly higher in the propofol group (p=0.023). No major complications were observed in either group.Conclusion:Both dexmedetomidine and propofol were effective and safe agents for controlled hypotension during FESS. Dexmedetomidine provided superior intraoperative hemodynamic stability with comparable surgical field quality and blood loss, making it a useful alternative to propofol for hypotensive anesthesia in endoscopic sinus surgery.
Introduction Propofol-based total intravenous anesthesia (TIVA) with remifentanil is widely used for general anesthesia but is frequently associated with hypotension and bradycardia. Remimazolam, an ultra–short-acting benzodiazepine, provides rapid onset and offset, with the additional advantage of reversal by flumazenil, and may result in less hemodynamic depression. Previous randomized studies have largely focused on the induction phase or the incidence of hypotension, with limited data on continuous intraoperative hemodynamic changes during laparoscopic gynecologic surgery. The study is designed to compare prospectively the intraoperative hemodynamic profiles of remimazolam-based versus propofol-based TIVA in patients undergoing robotic gynecologic surgery in the Trendelenburg position. Methods and Analysis This prospective, single-center, randomized, single-blind, parallel-group superiority trial will be conducted at CHA Ilsan Medical Center, a secondary care university-affiliated hospital. In total, 58 adult patients (aged 19–65 years, American Society of Anesthesiologists physical status I–II) scheduled for elective robotic laparoscopic hysterectomy under general anesthesia will be enrolled and randomly assigned (1:1) to receive either remimazolam- or propofol-based total intravenous anesthesia, both in combination with remifentanil. Continuous invasive mean arterial pressure (MAP) will be monitored using a FloTrac™ sensor (Edwards Lifesciences, Irvine, CA, United States). The primary outcome will be the time-weighted average MAP (TWA-MAP), analyzed using analysis of covariance adjusted for baseline MAP. Secondary outcomes will include the area under the curve for hypertensive and hypotensive burden, as well as the incidence of adverse hemodynamic events, including hypotension, hypertension, bradycardia, and tachycardia. Generalized estimating equations (GEE) will be used to evaluate hemodynamic and respiratory parameters across predefined time points. Discussion This trial is expected to provide prospective, randomized evidence to compare continuous intraoperative blood-pressure trajectories between remimazolam- and propofol-based TIVA during robotic gynecologic surgery. It is anticipated that the findings will clarify the relative hemodynamic stability of these anesthetic agents under the combined physiological challenges of Trendelenburg positioning and pneumoperitoneum. The findings may inform anesthetic drug selection and intraoperative blood pressure management strategies, enhancing cardiovascular stability and improving postoperative outcomes. Clinical Trial Registration ClinicalTrials.gov, identifier NCT07251101.
Jung-Min Lee, Joohyun Lee, S. Kang et al.· Frontiers in Pharmacology· 0 citations
BACKGROUND
Adequate sedation during spinal anesthesia requires careful titration to avoid hemodynamic instability and respiratory complications. We hypothesized that intrathecal fentanyl, used as an adjunct to neuraxial anesthesia, would reduce dexmedetomidine requirements for conscious sedation. This study evaluated the effects of intrathecal fentanyl on the total dose of dexmedetomidine during spinal anesthesia.
METHODS
Sixty-four patients undergoing knee or ankle arthroscopy under spinal anesthesia were randomly assigned to two groups. The fentanyl group received 0.5% bupivacaine 10 mg with fentanyl 20 μg, whereas the control group received bupivacaine 10 mg with saline. After confirmation of sensory block, dexmedetomidine was infused at 1 μg/kg over 10 minutes and maintained at 0.1-1 μg/kg/hour to maintain a bispectral index (BIS) of 70 to 80. The primary outcome was the total dose of dexmedetomidine. Secondary outcomes included BIS values, Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores, mean blood pressure, and heart rate at predefined time points.
RESULTS
The total dose of dexmedetomidine did not differ significantly between the groups. The MOAA/S scores were significantly affected by group, time, and group-by-time interactions (p=0.003, p<0.001, and p=0.007, respectively). The BIS values were influenced by group (p=0.026) and time (p<0.001), but not by group-by-time interactions (p=0.413). Exploratory analyses suggested deeper sedation in the fentanyl group during the early phase of dexmedetomidine infusion. Hemodynamic variables were comparable between the groups.
CONCLUSION
Intrathecal fentanyl did not significantly reduce dexmedetomidine requirements during spinal anesthesia, although it was associated with deeper sedation at several time points.
K. B. Park, J. Yeom, Juhee Min et al.· Journal of Yeungnam Medical...· 0 citations
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery.
Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed.
Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09).
Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
AVINASH KAREKAL, SRINIVAS KURAHATTI, Rashmi C· Asian Journal of Pharmaceuti...· 0 citations
Background:Emergence agitation (EA) is a common and distressing complication following sevoflurane anaesthesia in paediatric patients, characterized by non-purposeful restlessness, crying, and disorientation. Dexmedetomidine, a highly selective α2-agonist, is frequently utilized to prevent EA. However, the optimal administration method, rapid intravenous bolus versus continuous intraoperative infusion, remains debated regarding the balance of efficacy and hemodynamic stability.Aims and Objectives:To systematically compare the clinical effectiveness, postoperative recovery profile, and perioperative hemodynamic stability of a rapid bolus versus a continuous low-dose infusion of dexmedetomidine (0.3 μg/kg) in preventing emergence agitation in children undergoing elective abdominal and genitourinary surgeries under sevoflurane anaesthesia.Materials and Methods:This prospective, randomized, double-blind, comparative study enrolled 80 paediatric patients (ASA physical status I–II, aged 2–12 years) randomly allocated into two equal groups (n=40). Group B received IV dexmedetomidine 0.3 μg/kg as a bolus over 10 minutes; Group I received a continuous infusion at 0.3 μg/kg/hour. Intraoperative Heart Rate and MAP were continuously monitored. Postoperative emergence agitation and pain were assessed using the PAED scale and Observational Pain Scores (OPS) in the PACU.Results:Both techniques provided comparable hemodynamic stability. A transient, statistically significant decrease in MAP (p=0.015) was noted at 10 minutes post dexmedetomidine administration in group B, accompanied by a mild, non significant reduction in heart rate (p=0.184); all values remained within 20% of pre-induction baselines without requiring intervention. Group B demonstrated superior early analgesia (OPSon PACU arrival: 1.8 ± 1.2 vs 4.6 ± 1.8; p<0.001). Extubation times (6.2 ± 1.1 vs 6.5 ± 1.4 min; p=0.284) and emergence times (8.1 ± 1.5 vs 8.4 ± 1.8 min; p=0.418) were highly comparable.Conclusion:A 0.3 μg/kg bolus of dexmedetomidine is hemodynamicallysafe and clinically superior to an equivalent continuous infusion. It provides good early postoperative analgesia and effectively mitigates sevoflurane-induced emergence agitation without extending recovery or extubation times.
Sardar Bhagat Singh, Manmohan Jindal, Namrata Jain et al.· Asian Journal of Medical Res...· 0 citations
Pediatric magnetic resonance imaging (MRI) requires deep sedation to ensure immobility and optimal image quality. Propofol-based total intravenous anesthesia is effective but may cause airway depression and hemodynamic instability at higher doses. Dexmedetomidine has minimal respiratory effects but may prolong sedation. This study evaluated whether a low-dose dexmedetomidine bolus combined with propofol shortens recovery time (primary outcome); improves hemodynamic stability; reduces airway events, induction time, and total propofol dose; and minimizes scan interruptions (secondary outcomes).
In this prospective, randomized controlled trial, children undergoing MRI were assigned to two groups. Group D+P received 0.5 μg/kg of dexmedetomidine over 2–3 minutes plus a 1 mg/kg bolus of propofol followed by infusion; Group P received propofol alone as bolus and infusion. Propofol infusion rate was adjusted to achieve a Ramsay Sedation Scale score of 5–6. Recovery time was analyzed using
t
test; scan interruptions were compared using Chi-square or Fisher’s exact tests.
Group D+P had a shorter recovery time (19.4 ± 35 vs. 31.4 ± 36.1 min;
P
= 0.042) and faster induction (128.9 vs. 224.6 sec;
P
< 0.001). The propofol infusion rate was lower in Group D + P than in Group P (76.3 ± 65.6 vs 123 ± 45.5 μg/kg/min;
P
< 0.001). Additional boluses were more frequent in Group P (
P
= 0.003). Bradycardia occurred in significantly more children in Group D + P than in Group P (
P
= 0.008).
Low-dose dexmedetomidine as an adjunct to propofol for pediatric MRI sedation reduces recovery time, propofol requirement, and airway-related complications, while enabling faster induction and fewer scan interruptions with increased risk of bradycardia.
Kishorkumar Dhanaboopathy, E. Rai, Aparna Williams et al.· Journal of Anaesthesiology C...· 0 citations
Background:Electroconvulsive therapy (ECT) is widely used in the management of severe psychiatric disorders and is associated with significant hemodynamic fluctuations. Attenuation of this hyperdynamic response is essential to improve patient safety. Dexmedetomidine and remifentanil are commonly used adjuncts to anaesthesia for this purpose.
Aim:To compare the effects of intravenous dexmedetomidine and remifentanil as adjuncts to anaesthesia on hemodynamic parameters, depth of anaesthesia, seizure duration, and recovery characteristics in patients undergoing ECT.
Materials and Methods:
This prospective, randomized, single-blinded study included 20 patients (ASA I/II) aged 18–70 years undergoing ECT. Patients were divided into two groups: Group D received dexmedetomidine (1 µg/kg IV over 10 minutes), and Group R received remifentanil (1 µg/kg IV prior to induction). Standard anaesthesia with propofol and succinylcholine was administered. Hemodynamic parameters (HR, SBP, DBP), oxygen saturation, and bispectral index (BIS) were recorded at predefined intervals. Sedation was assessed using the Ramsay Sedation Scale. Statistical analysis was performed using paired t-test and Mann–Whitney U test.
Results:Dexmedetomidine showed significantly better attenuation of heart rate (p = 0.03) and systolic blood pressure (p = 0.04) compared to remifentanil. BIS values were more stable in the dexmedetomidine group (p = 0.02). Sedation scores were significantly higher in Group D during the early recovery period (p = 0.04). There was no significant difference in diastolic blood pressure, oxygen saturation, or seizure duration between the groups.
Conclusion:Dexmedetomidine provides superior hemodynamic stability, better sedation, and more controlled depth of anaesthesia compared to remifentanil in patients undergoing ECT, without affecting seizure duration. It may be considered a preferable adjunct in ECT anaesthesia, particularly in patients at cardiovascular risk.
Dr. Uday Gollamudi, Dr. Pravallika Rallapalli, D. Meena et al.· Adolescência e Saúde· 0 citations
