Comparison of the effects of dexmedetomidine and nitroglycerin on cerebral oxygen saturation using near-infrared spectroscopy in patients undergoing controlled hypotensive anaesthesia: A randomised controlled non-inferiority trial

• Published in: Indian journal of anaesthesia Vol. 68; no. 3; pp. 254 - 260
• Main Authors: Rao, J Koteswara, Chhabra, Swati, Mohammed, Sadik, Bhatia, Pradeep K, Goyal, Shilpa, Kumar, Rakesh
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.03.2024; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Analysis; Anesthesia; cerebral desaturation events; Clinical outcomes; Clinical trials; Dexmedetomidine; Heart rate; Hypotension; hypotensive anaesthesia; Infrared spectroscopy; near-infrared spectroscopy; Nitrates; Nitroglycerin; Original; Oxygen saturation; regional cerebral oxygen saturation; Spectrum analysis; Survival analysis; dexmedetomidine; hypotensive anaesthesia; near-infrared spectroscopy; Cerebral desaturation events; regional cerebral oxygen saturation; nitroglycerin
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.ija_712_23

There is limited literature wherein the hypotensive drugs have been compared to know the cerebral effects by monitoring regional cerebral oxygen saturation (rScO ). This study aimed to compare the effects of dexmedetomidine and nitroglycerin on rScO during controlled hypotensive anaesthesia using near-infrared spectroscopy (NIRS). The primary objective was to evaluate the non-inferiority of dexmedetomidine versus nitroglycerin in the occurrence of cerebral desaturation events (CDEs) during hypotensive anaesthesia. Adult patients scheduled to undergo head and neck surgery under general anaesthesia randomised to receive either dexmedetomidine or nitroglycerin infusion for controlled hypotensive anaesthesia. Cerebral oximetry was monitored with NIRS, and data regarding CDEs, bilateral rScO , and peri-operative haemodynamics were collected. Continuous data were analysed using unpaired Student's -tests except for intra-group analyses, which were analysed using paired t-tests. Categorical data were analysed using the Chi-square test. For comparison of time to CDEs, Kaplan-Meier survival analysis with log-rank test was performed. Of the 82 patients in both groups, CDEs were observed in 15 patients each. A decrease from baseline by 20% was observed in three patients: one in Group N and two in Group D. Statistically, there was an equal risk of getting CDEs in the groups. The time to CDE was comparable ( > 0.05). The difference in heart rate was statistically significant ( < 0.001). Dexmedetomidine is non-inferior to nitroglycerin in terms of the occurrence of cerebral desaturation events when used for controlled hypotensive anaesthesia in head and neck surgeries.