Comparison Between Dexmedetmidine And Esmolol For Controlled Hypotension During The Orthognathic Surgery

Background: Controlled hypotension is used to help control bleeding duringprocedures where surgical hemostasis technically difficult to achieve. A mean arterialblood pressure (MAP) as low as50-60mmHg appears to be well tolerated in healthypatients. Demonstrated benefits of controlled hypotension for orthognathic surgeryinclude a reduction in blood loss, with decreased transfusion requirements andimproved quality of the surgical field.Objective: The aim of this double-blind, randomized, controlled study is to comparethe effects of dexmedetmidine (Dex)，a selective, short-acting, central a2-adrenergicagonist with esmolol (Es)， a very short-acting cardioselective β-blocker onintraoperative blood loss during orthognathic surgical interventions, including Le Fort Iosteotomy, mandibular ramus osteotomy, and both combined, and recovery time，todetermine the range of information available to help surgeons and Anesthesiologistsbetter prepare themselves, their patients, and the auxiliary support needed for this typeof surgery and the transfusion requirements.Methods:90patients,17–36years of age, ASA I-II, randomly divided intoDexmedetmidine group，Esmolol group and nitroglycerine group，All patients receiveda balanced anesthetic technique, with controlled hypotension during the downfractureof the maxilla. We recorded MAP,HR, controlled hypotension time，time to the targetBP，intraoperative blood loss, total recovery time, total remifentanil consumption.Results: No significant difference in the amount of blood loss among the three groupswas observed. Total remifentanil consumption was higher in the Es group versus in theDex group. Recovery time was shorter in the Es group versus in the Dex group.Conclusions: Dexmedetomidine and Esmolo provided effective method of controlledhypotension limiting the blood loss, and Esmolo was associated with significantlyshorter recovery times compared with Dexmedetomidine.