EDITOR:
We read with great interest the study report by Durmus and colleagues [Reference Durmus, But, Dogan, Yucel, Miman and Ersoy1] concerning the effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. The authors showed that, compared to placebo, dexmedetomidine decreased intraoperative mean arterial pressure (MAP), heart rate (HR) and bleeding in the surgical field.
In a similar prospective study, we have assessed the efficacy of dexmedetomidine in achieving controlled hypotension during maxillofacial surgery [Reference Richa, Yazigi, El Hage, Gebara, Hokayem and Antakly2]. Twenty consecutive ASA I patients undergoing maxillofacial surgery under general anaesthesia received a dexmedetomidine intravenous infusion of 0.1 μg kg−1 min−1 for 10 min followed by 0.4–0.7 μg kg−1 h−1, with the objective of maintaining systolic arterial pressure close to 80 mmHg. Dexmedetomidine infusion was stopped 20 min before the end of surgery. Systolic arterial pressure, MAP and HR were continuously monitored and recorded values were presented in Table 1. Systolic arterial pressure was maintained between 80 and 90 mmHg. Bleeding in the operative field was rated by the surgeons as minimal in 80% of patients and as moderate in 20% of patients. The time interval between end of surgery and tracheal extubation was 20 ± 11 min. Although there was not a control group in our study, our results regarding haemodynamic stability and decreased bleeding with dexmedetomidine in maxillofacial surgery were similar to the results reported by Durmus and colleagues in tympanoplasty and septorhinoplasty.
Table 1 Haemodynamic values during surgery.
SAP: systolic arterial pressure; MAP: mean arterial pressure; HR: heart rate; DXM: dexmedetomidine.
Results are expressed as mean ± SD (n = 20).
In summary, our study confirms the conclusion of Durmus and colleagues that dexmedetomidine is efficient in decreasing bleeding when a bloodless surgical field is required. Further controlled studies are needed to compare dexmedetomidine to other hypotensive agents in achieving controlled hypotension during surgery.
