Comparison Effect of Clonidine and Magnesium Sulfate on Bleeding Volume during Septorhinoplasty: A Double-Blind, Randomized Clinical Trial
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Abstract
Background: Control of hemodynamic changes and blood loss is a daily challenge in general anesthesia for patients undergoing septorhinoplasty. This study aimed to evaluate the effects of magnesium sulfate and clonidine on the control of hemodynamic factors and bleeding volume during this procedure.
Methods: This double-blind, randomized clinical trial study was conducted on 60 patients undergoing septorhinoplasty at 5th Azar Medical & Educational Centre of Gorgan in 2021-2022. Patients were divided into two intervention groups (50 mg/kg of magnesium sulfate) and control group (5 μg/kg of clonidine) with permutation random block allocation. All patients underwent induced hypotension. Before induction of anesthesia and every 5 minutes afterwards, blood pressure was recorded. Blood loss volume was calculated at the end of the surgery.
Results: In the magnesium group, 36 individuals were evaluated, while in the clonidine group, 24 individuals were examined. There were no statistically significant differences in baseline characteristics of patients in the two groups and the duration of surgery. Both drugs were equally effective in inducing hypotension, however blood pressure changes in magnesium group were more trivial than clonidine group. The bleeding volume in the magnesium sulfate and clonidine groups was 139.44 ml and 141.25, respectively and this difference was not statistically significant (p-value=0.634).
Conclusion: The results of this study showed that magnesium sulfate can be effectively used as an alternative to clonidine in controlling hemodynamic changes and ultimately reducing blood loss volume during septorhinoplasty surgery. In addition, magnesium is at least as effective as clonidine in stabilizing hemodynamic changes.
[2] Ors S OM. Late postoperative massive bleeding in septorhinoplasty: A prospective study. Plast Surg (Oakv). 2016; 2:96-8.
[3] Tuncel U TA, Bayraktar MA, Erkorkmaz U, Kostakoglu N. Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty. J Craniomaxillofac Surg. 2013; 41:124-8.
[4] Giovannitti JA Jr TS, Crawford JJ. Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesth Prog. 2015; 62(1): 31-9.
[5] Jabalameli M HM, Soltani H, Hashemi J. Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery. Journal of Research in Medical Sciences. 2005; 1:25-30.
[6] Elsharnouby NM EM. Magnesium sulfate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006; 96(6):727-31.
[7] Shimosawa T TK, Ando K, Fujita T. Magnesium inhibits norepinephrine release by blocking N-type calcium channels at peripheral sympathetic nerve endings. Hypertension. 2004; 44:897-902.
[8] Soave PM CG, Costa R, Arcangeli A. Magnesium and anaesthesia. Curr Drug Targets. 2009; 10: 734-43.
[9] Razavi M NM, Ahmadi M, Kashani I. Comparison of Labetalol and Nitroglycerine,s Effects on Deliberate Hypotension in Septo-Rhinoplasty Ssurgery, a Randomized Clinical. Rev Clin Med. 2020;7(4):176-9.
[10] Reena, Vikram A. Comparative evaluation of clonidine and magnesium sulfate infusions upon intraoperative hemodynamics and anesthetic consumption, and postoperative recovery profile in lumbar spine surgery: a prospective, randomized, placebo controlled, double-blind study. Acta Anaesth Belg. 2017; 68:31-8.
[11] Aparna B, Krusha Suresh S, Spoorti P, Tanya G, Chandrakala S. Comparison of Effect of Clonidine and Magnesium Sulfate on Attenuation of Haemodynamic Response to CO2 Pneumoperitoneum in Patients undergoing Laparoscopic Surgeries- A Randomised Clinical Study. Journal of Clinical and Diagnostic Research. 2022; 16(6).
[12] Mohamed Ali HS ea. A comparative study of clonidine and magnesium sulfate premedication on perioperative hormonal stress responses, hemodynamic stability and postoperative analgesia in patients with gallbladder diseases undergoing laparoscopic cholecystectomy. A randomized, double-blind, controlled study. Egyptian J Anaesthesia. 2022; 38(1).
[13] Rajabi M RM, Hamidi-Shad M, Tabasi Z, Akbari H, Hajian A. Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section. Anesth Pain Med. 2020;10(5).
[14] Kim DH LJ, Kim SW, Hwang SH. The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis. Clin Exp Otorhinolaryngol. 2021; 14(2):200-9.
[15] Rokhtabnak F DMS, Ghodraty M, Pournajafian A, Maleki Delarestaghi M, Tehrani Banihashemi A, Araghi Z. Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate. Anesth Pain Med. 2017; 7(6).
[16] Aboelsuod M SS. Dexmedetomidine versus magnesium sulfate for controlled hypotension during rhinoplasty surgeries: A prospective randomized comparative study. Egyptian J Anaesthesia. 2023; 39:657-64.
[17] Mireskandari SM ea. The effectiveness of intravenous magnesium sulfate for deliberate hypotension in rhinoplasty. Arch Anesth & Crit Care. 2015; 1(4):112-5.
[18] Ghazipour A AK, Sarafraz M, Abshirini H, Akbari N. Can clonidine as a pre-anaesthetic drug decrease bleeding during rhinoplasty surgery?. Indian J Otolaryngol Head Neck Surg. 2013; 65(2):301-3.
[19] Kosucu M TE, Arslan E, Omur S, Livaoglu M. Effects of perioperative magnesium sulfate with controlled hypotension on intraoperative bleeding and postoperative ecchymosis and edema in open rhinoplasty. Am J Otolaryngol. 2020; 41(6).
[20] Kalra NK VA, Agarwal A, Pandey H. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2011; 27(3): 344-8.
[21] Altan A TN, Yildiz F, Türkmen A, Ustün H. Effects of magnesium sulfate and clonidine on propofol consumption, haemodynamics and postoperative recovery. Br J Anaesth. 2005; 94(4):438-41.
[22] Ray M BD, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulfate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Indian J Anaesth 2010; 54(2):137-41.
[23] Rajabi M RM, Hamidi-Shad M, Tabasi Z, Akbari H, Hajian A. Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section. Anesth Pain Med. 2020; 10(5).
[24] McGuire C NS, Samargandi OA, Bezuhly M. Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty: A Systematic Review and Meta-analysis. J. AMA Facial Plast Surg. 2019; 21(3):191-8.
[25] de Vasconcellos SJA dN-JE, de Aguiar Menezes MV, Tavares Mendes ML, de Souza Dantas R, Martins-Filho PRS. Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2018; 144(9):816-23.
[26] Ping WD ZQ, Sun HF, Lu HS, Li F. Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial. Medicine (Baltimore). 2019; 98(16).
[27] Motazedian G SM, Jahromi M S S, Ghaedi M. Bleeding Management In Rhinoplasty Surgery: A Systematic Review Study On Clinical Trial Studies Conducted In Iran. Int J Med Invest. 2021; 10(4):32-4.
[28] Jouybar R NM, Asmarian N. Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty. BMC Anesthesiol. 2022; 22(1).
[29] Vyas V GR, Dubey P. Comparative Efficacy and Safety of Intravenous Clonidine and Tramadol for Control of Postspinal Anesthesia Shivering. Anesth Essays Res. 2018; 12(3):663-8.
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