A randomized control trial to compare the efficacy of dexmedetomidine and labetalol for induced hypotensive anesthesia in ear, nose, and throat surgeries

Abstract

Background and Aim: Induced hypotension is advantageous in certain types of procedures like endoscopic surgeries in which it establishes a clear surgical field and simultaneously reduces surgical blood loss. The quest for an ideal hypotensive agent still continues in this modern era where many classes of antihypertensive drugs are being studied to provide a predictable and safe reduction in blood pressure with least side effect profile. In this study, we aimed to assess the efficacy of dexmedetomidine and labetalol in providing hypotensive anesthesia in patients undergoing ear, nose, and throat surgeries. Materials and Methods: This was a prospective, double-blinded, randomized controlled study. Fifty-eight individuals undergoing ear, nose, and throat surgeries were randomly divided into two groups (Groups A and B). Group A received an intravenous infusion of 0.25 mg/kg of labetalol as a bolus over a period of 10 min before induction of anesthesia and it was followed by a maintenance infusion of 30 mg/h till the end of surgery. Group B received a loading dose of 1 μg/kg of dexmedetomidine intravenously over a period of 10 min before induction of anesthesia and it was followed by a maintenance infusion of 0.4 μg/kg/h till the end of surgery. In both the groups, diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate, and oxy-hemoglobin saturation (SpO2) were recorded. These study variables were recorded before the administration of the study drug, immediately after the administration of the bolus dose of study drug, at the time of induction of anesthesia, immediately after intubation, and then at regular intervals until the end of the surgery. In addition to the abovementioned study, variables blood loss, recovery time, and surgeon satisfaction were also recorded. Results: The heart rate was significantly lower in Group B when compared to Group A at various time intervals. There was no significant difference between the two groups in terms of DBP, SBP, MAP, and SpO2. The blood loss was lesser and the surgeon satisfaction was better in Group B when compared to Group A. The difference in blood loss and surgeon satisfaction was statistically significant between the two groups. However, the recovery time was faster in Group A and the difference was statistically significant. Conclusions: Patients in both the groups showed a reduction in blood pressure, but dexmedetomidine was associated with greater reduction in heart rate, lesser blood loss, and more surgeon satisfaction, whereas labetalol was associated with faster recovery from anesthesia.

Keywords

• blood pressure
• controlled hypotension
• dexmedetomidine
• labetalol