Comparison of infusion of dexmedetomedine and magnesium sulfate on the stability of hemodynamic status during emergency orthopedic surgery: a randomized double-blind clinical trial
Abstract
Objective: Preparing patients for emergency surgeries requires accurate consideration of their clinical condition and medical history to avoid potential hemodynamic instability and compromise the immune system. This study aims to compare the effects of dexmedetomidine and magnesium sulfate infusions in maintaining stable hemodynamics during emergency orthopedic surgery. Methods: The present study was conducted as a randomized and double-blind clinical trial with the participation of 80 patients who were candidates for an emergency orthopedic surgery during 2021. Magnesium sulfate was administered as an intravenous bolus at a loading dose of 50 mg/kg over 10 minutes, followed by a continuous infusion at a rate of 15-20 mg/kg/hour. Dexmedetomidine was administered as an intravenous bolus at a loading dose of 1 mcg/kg over 10 minutes, followed by a continuous infusion at a rate of 0.2-0.7 mcg/kg/hour, depending on patient response. These infusions were initiated 15 minutes before induction of anesthesia and continued until the end of surgery. All drugs (dexmedetomidine and magnesium sulfate) were diluted in a 50-cc syringe and infused. The hemodynamic status (diastolic blood pressure (DBP), systolic blood pressure (SBP) mean arterial pressure (MAP) and heart rate (HR)) of the patients between the two groups was recorded and finally compared with each other. Results: The hemodynamic status (DBP, SBP, MAP and HR) between the two groups at all (perioperative time) times were without significant statistical differences (P˃0.05). Conclusion: Both dexmedetomidine and magnesium sulfate are effective and safe options for achieving hemodynamic stability during emergency orthopedic surgery.
1. Modir H, Mahmoodiyeh B, Moradi AH, Mohseni F, Almasi-Hashiani A. Comparison of the efficacy of supraclavicular block with bupivacaine (0.5%) combined with dexmedetomidine, granisetron and magnesium sulphate in sensory and motor block and haemodynamic parameters of patients in upper-extremity orthopaedic surgery: a randomised clinical study. Advances in Human Biology. 2022;12(3):277-82.
2. Lu Y, Zhang Y, Dong C-S, Yu J-M, Wong GT-C. Preoperative dexmedetomidine prevents tourniquet-induced hypertension in orthopedic operation during general anesthesia. Kaohsiung J Med Sci. 2013;29(5):271-4.
3. Mahdavi F, Haghdoost M. Comparative study of the role of zinc in the scar recovery after abdominal hysterectomy in women with and without cancer and its relation with anthropometric indices of women referred to Tabriz hospitals: a case-control study. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(4):24-30.
4. Mahdavi F, Rostami F, Alvandfar D. Effects of physiotherapy with and without elastic bonding on prevention of deep vein thrombosis in women undergoing total abdominal hysterectomy: a randomized clinical trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(2):1-8.
5. Timer E, Charsouei S, Bebek N, et al. Neurosurgical treatment of nonconvulsive status epilepticus due to focal cortical dysplasia. Epilepsy Behav Case Rep. 2018;10:4-7.
6. Charsouei S, Esfahlani MZ, Dorosti A, Zamiri RE. Effects of COVID-19 pandemic on perceived stress, quality of life, and coping strategies of women with breast cancer with spinal metastasis under chemotherapy. Int J Women's Health Reprod. Sci. 2021:55-60.
7. Ahmed OH, Nour-Eldin TM, Ali WM, Abd El Zaher MA. Comparison of the effect of nitroglycerin, magnesium sulphate and dexmedetomidine as hypotensive agents in lumbar spine surgery. The Egyptian Journal of Hospital Medicine. 2019;76(7):4628-38.
8. Sharma D, Aithal H, Kinjvadekar P, Shah MA, Sahu S, Singh P. Effect of dexmedetomidine-ketofol-isoflurane anaesthesia on the clinico-physiological and haemodynamic stability in canine orthopaedic patients. Indian Journal of Veterinary Surgery. 2021;42(1):56-60.
9. Barakchian SN, Shati M, Mortazavi SS, Nikanfar M, Charsouei S. Psychometric properties of the Persian version of the patient-weighted quality of life in epilepsy inventory-10-P. Epilepsy Beha. 2020;111:107243.
10. Ghojazadeh M, Paknezhad SP, Mohammadzadeh S, et al. Dexmedetomidine for procedural sedation in the emergency department: a systematic review. Shiraz E-Medical Journal. 2022;23(1):e113099.
11. Rezaee M, Sheghaghi Ilkhchi N, Zeinalzadeh M, Alvandfar D. The incidence of the symptoms of deep vein thrombosis in general anesthesia and spinal anesthesia after abdominal hysterectomy. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2021;24(11):45-51.
12. Aboelsuod MAA, Seyam SH. Dexmedetomidine versus magnesium sulfate for controlled hypotension during rhinoplasty surgeries: a prospective randomized comparative study. Egyptian Journal of Anaesthesia. 2023;39(1):657-64.
13. Hashemzadeh K, Dehdilani M, Gol MK. Study of the effects of simple exercise with or without physiotherapy on prevention of deep vein thrombosis among postmenopausal women requiring coronary artery bypass graft surgery. Int J Womens Health Reprod Sci. 2021;9(1):69-74.
14. Hashemzadeh K, Dehdilani M, Gol MK. The effect of interval training on oxidative stress indices among women in preterm labor underwent coronary artery bypass graft. Int J Womens Health Reprod Sci. 2020;8(4):406-411.
15. Haghdoost SM, Gol MK. The necessity of paying more attention to the neurological and psychological problems caused by the COVID-19 pandemic during pregnancy. Health. 2020;3(4):243-4.
16. Shahidi N, Mahdavi F, Gol MK. Comparison of emotional intelligence, body image, and quality of life between rhinoplasty candidates and control group. J Educ Health Promot. 2020;9:153.
17. Khanbabayi Gol M, Eidy M, Zamani Esfahlani M. Frequency ratio of carpal tunnel syndrome in women with breast cancer treated with lymphedema in Tabriz medical education centers; 2018-2019. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;22(12):62-8.
18. Elshahawy ME, Taman HI, Elawady MS, Farid AM. Comparison of dexmedetomidine versus dexamethasone as adjuvants to intrathecal bupivacaine in emergency orthopedic lower limb operations. The Egyptian Journal of Hospital Medicine. 2022;88(1):2382-7.
19. Moshiri E, Modir H, Kamali A, Azami M, Molouk M. Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study. Med Gas Res. 2022;12(3):77-82.
20. Sayyadi H, Zayeri F, Baghestani AR, et al. Assessing risk indicators of allograft survival of renal transplant: an application of joint modeling of longitudinal and time-to-event analysis. ranian Red Crescent Medical Journal.2017;19(3):e40583.
21. Zomorrodi A, Kakei F, Bagheri A, Zomorrodi S, Mohammadrahimi M. Does early removal of foley's catheter have any influence on infection of recipient post renal transplantation? is it safe? a randomized clinical trial. J Nephropathol. 2018;7(3):122-6.
22. Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial. Anaesth. pain intensive care 2023;27(4):456−63.
23. ABD ELMALEK FA, MOHAMED GS-E, ASMAA M, KAMAL F. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anesthesia shivering in lower limb orthopedic surgeries: a randomized controlled trial. The Medical Journal of Cairo University. 2021;89:1843-53.
24. Farshid S, Aghdashi A, Fallahi H, Valizadeh R, Rahimi MM. Evaluation of osteoporosis frequency in patients with recurrent kidney stones. Acta Medica Iranica. 2020:494-9.
25. Kokhaei M, Modir H, Moshiri E, Azami M. Comparative effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients: a randomized clinical trial. Journal of Acute Disease. 2022;11(6):222-7.
26. Kamel R, AL-Rabiey M, Hassan A, Sakr T. A comparative study of intrathecal dexmedetomidine, fentanyl and magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries. Benha Journal of Applied Sciences. 2021;6(3):143-7.
27. Mehta H, Kantharia B. Periarticular infiltration (bupivacaine, adrenaline, magnesium sulphate And dexmedetomidine) for postoperative analgesia in total knee arthroplasty-a case series study. National Journal of Integrated Research in Medicine. 2022;13(1):123-8.
28. Hassan AE-H, Abd-Allah Al-Kumity A, El-Deen Mahmoud Sayed Ahmed A, Shabaiek AE-L. Clinical comparative study between intrathecal dexmedetomidine and dexamethasone on prolonging the duration of intrathecal blockade in lower limb orthopedic surgery. Al-Azhar Medical Journal. 2021;50(2):1467-78.
29. Refaee H, Abo Elela A, Hanna M, Ahmed Ali M, El Khateeb A. Dexmedetomidine versus magnesium as adjuvants to bupivacaine-induced caudal block in children: a randomized, double-blinded, placebo-controlled, trial. Open Access Maced J Med Sci. 2019;7(1):73-6.
30. Sayyah-Melli M, Zonoozi GK, Hashemzadeh S, et al. Comparison of platinum-based neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian cancer. The Journal of Obstetrics and Gynecology of India. 2013;63:405-9.
31. Bayat AM, Azhough R, Hashemzadeh S, Barband A, Yaghoubi AR, Gargari RM. Hydatid cyst of pancreas presented as a pancreatic pseudocyst. Official journal of the American College of Gastroenterology|. 2009;104(5):1324-6.
32. Rostami F, Osquee HO, Mahdavi F, Dousti S. Development of a new psychometric assessment tool for predicting hepatitis B virus infection in pregnant women. Int J Women’s Health Reprod Sci. 2020;8(3):297-302.
33. Mahdavi F, Owaysee Osquee H. Comparison of serum levels of vitamin D after mastectomy in women with and without postoperative infection: case-control study. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(3):33-8.
34. Rousta F, Dadashzadeh M, Mahdavi F, Nasseri AR. Lymph node involvement and related risk factors in patients with breast cancer referred for radiotherapy: a 20-year study on 15 000 women. International Journal of Women's Health & Reproduction Sciences. 2021;9(3):212-6.
35. Sodhi G. Complications and hemodynamic stability associated with the use of dexmedetomidine with bupivacaine Vs fentanyl with bupivacaine in spinal naesthesia undergoing orthopedic lower limb surgeries. J Adv Med Dent Scie Res 2019;7(12): 60-3.
36. Alipour M, Firouzabadi SJP, Shahroudi A, Najafi MN, Molaei E. Compared dexmedetomidine and fentanyl on sensory-motor block in unilateral intrathecal anesthesia of lower-limbs orthopedic surgeries: a randomized double-blind trials. Galen Medical Journal. 2022;11:e2499.
37. Agrawal D, Sinha N, Singh SK. Comparison of intrathecal dexmedetomidine and intrathecal fentanyl as an adjuvant to bupivacaine during spinal anaesthesia for lower limb orthopedic surgery. Asian Journal of Medical Sciences. 2023;14(6).
38. Kumar BT, Sudharani G, Manjula KMU. Effect of dexmedetomidine and magnesium sulphate in control of shivering under neuraxial anaesthesia in patients undergoing lower limb and lower abdominal surgeries. European Journal of Molecular & Clinical Medicine. 2022;9(7):1835-44.
39. Binazir MB, Alizadeh M, Bayrami HJ, Azhough R, Movassaghi R, Nikasa P. The effect of a modified world health organization surgical safety checklist on postoperative complications in a tertiary hospital in iran. Iranian journal of public health. 2015;44(2):292.
40. Aslanabadi S, Azhough R, Motlagh PS, Hadidchi S, Tabrizi AD, Zonouzy KK. Intramedullary spinal cord ganglioglioma presenting with abnormal abdominal wall movement: case report. Neurosurgical focus. 2004;17(4):1-2.
2. Lu Y, Zhang Y, Dong C-S, Yu J-M, Wong GT-C. Preoperative dexmedetomidine prevents tourniquet-induced hypertension in orthopedic operation during general anesthesia. Kaohsiung J Med Sci. 2013;29(5):271-4.
3. Mahdavi F, Haghdoost M. Comparative study of the role of zinc in the scar recovery after abdominal hysterectomy in women with and without cancer and its relation with anthropometric indices of women referred to Tabriz hospitals: a case-control study. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(4):24-30.
4. Mahdavi F, Rostami F, Alvandfar D. Effects of physiotherapy with and without elastic bonding on prevention of deep vein thrombosis in women undergoing total abdominal hysterectomy: a randomized clinical trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(2):1-8.
5. Timer E, Charsouei S, Bebek N, et al. Neurosurgical treatment of nonconvulsive status epilepticus due to focal cortical dysplasia. Epilepsy Behav Case Rep. 2018;10:4-7.
6. Charsouei S, Esfahlani MZ, Dorosti A, Zamiri RE. Effects of COVID-19 pandemic on perceived stress, quality of life, and coping strategies of women with breast cancer with spinal metastasis under chemotherapy. Int J Women's Health Reprod. Sci. 2021:55-60.
7. Ahmed OH, Nour-Eldin TM, Ali WM, Abd El Zaher MA. Comparison of the effect of nitroglycerin, magnesium sulphate and dexmedetomidine as hypotensive agents in lumbar spine surgery. The Egyptian Journal of Hospital Medicine. 2019;76(7):4628-38.
8. Sharma D, Aithal H, Kinjvadekar P, Shah MA, Sahu S, Singh P. Effect of dexmedetomidine-ketofol-isoflurane anaesthesia on the clinico-physiological and haemodynamic stability in canine orthopaedic patients. Indian Journal of Veterinary Surgery. 2021;42(1):56-60.
9. Barakchian SN, Shati M, Mortazavi SS, Nikanfar M, Charsouei S. Psychometric properties of the Persian version of the patient-weighted quality of life in epilepsy inventory-10-P. Epilepsy Beha. 2020;111:107243.
10. Ghojazadeh M, Paknezhad SP, Mohammadzadeh S, et al. Dexmedetomidine for procedural sedation in the emergency department: a systematic review. Shiraz E-Medical Journal. 2022;23(1):e113099.
11. Rezaee M, Sheghaghi Ilkhchi N, Zeinalzadeh M, Alvandfar D. The incidence of the symptoms of deep vein thrombosis in general anesthesia and spinal anesthesia after abdominal hysterectomy. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2021;24(11):45-51.
12. Aboelsuod MAA, Seyam SH. Dexmedetomidine versus magnesium sulfate for controlled hypotension during rhinoplasty surgeries: a prospective randomized comparative study. Egyptian Journal of Anaesthesia. 2023;39(1):657-64.
13. Hashemzadeh K, Dehdilani M, Gol MK. Study of the effects of simple exercise with or without physiotherapy on prevention of deep vein thrombosis among postmenopausal women requiring coronary artery bypass graft surgery. Int J Womens Health Reprod Sci. 2021;9(1):69-74.
14. Hashemzadeh K, Dehdilani M, Gol MK. The effect of interval training on oxidative stress indices among women in preterm labor underwent coronary artery bypass graft. Int J Womens Health Reprod Sci. 2020;8(4):406-411.
15. Haghdoost SM, Gol MK. The necessity of paying more attention to the neurological and psychological problems caused by the COVID-19 pandemic during pregnancy. Health. 2020;3(4):243-4.
16. Shahidi N, Mahdavi F, Gol MK. Comparison of emotional intelligence, body image, and quality of life between rhinoplasty candidates and control group. J Educ Health Promot. 2020;9:153.
17. Khanbabayi Gol M, Eidy M, Zamani Esfahlani M. Frequency ratio of carpal tunnel syndrome in women with breast cancer treated with lymphedema in Tabriz medical education centers; 2018-2019. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;22(12):62-8.
18. Elshahawy ME, Taman HI, Elawady MS, Farid AM. Comparison of dexmedetomidine versus dexamethasone as adjuvants to intrathecal bupivacaine in emergency orthopedic lower limb operations. The Egyptian Journal of Hospital Medicine. 2022;88(1):2382-7.
19. Moshiri E, Modir H, Kamali A, Azami M, Molouk M. Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study. Med Gas Res. 2022;12(3):77-82.
20. Sayyadi H, Zayeri F, Baghestani AR, et al. Assessing risk indicators of allograft survival of renal transplant: an application of joint modeling of longitudinal and time-to-event analysis. ranian Red Crescent Medical Journal.2017;19(3):e40583.
21. Zomorrodi A, Kakei F, Bagheri A, Zomorrodi S, Mohammadrahimi M. Does early removal of foley's catheter have any influence on infection of recipient post renal transplantation? is it safe? a randomized clinical trial. J Nephropathol. 2018;7(3):122-6.
22. Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial. Anaesth. pain intensive care 2023;27(4):456−63.
23. ABD ELMALEK FA, MOHAMED GS-E, ASMAA M, KAMAL F. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anesthesia shivering in lower limb orthopedic surgeries: a randomized controlled trial. The Medical Journal of Cairo University. 2021;89:1843-53.
24. Farshid S, Aghdashi A, Fallahi H, Valizadeh R, Rahimi MM. Evaluation of osteoporosis frequency in patients with recurrent kidney stones. Acta Medica Iranica. 2020:494-9.
25. Kokhaei M, Modir H, Moshiri E, Azami M. Comparative effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients: a randomized clinical trial. Journal of Acute Disease. 2022;11(6):222-7.
26. Kamel R, AL-Rabiey M, Hassan A, Sakr T. A comparative study of intrathecal dexmedetomidine, fentanyl and magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries. Benha Journal of Applied Sciences. 2021;6(3):143-7.
27. Mehta H, Kantharia B. Periarticular infiltration (bupivacaine, adrenaline, magnesium sulphate And dexmedetomidine) for postoperative analgesia in total knee arthroplasty-a case series study. National Journal of Integrated Research in Medicine. 2022;13(1):123-8.
28. Hassan AE-H, Abd-Allah Al-Kumity A, El-Deen Mahmoud Sayed Ahmed A, Shabaiek AE-L. Clinical comparative study between intrathecal dexmedetomidine and dexamethasone on prolonging the duration of intrathecal blockade in lower limb orthopedic surgery. Al-Azhar Medical Journal. 2021;50(2):1467-78.
29. Refaee H, Abo Elela A, Hanna M, Ahmed Ali M, El Khateeb A. Dexmedetomidine versus magnesium as adjuvants to bupivacaine-induced caudal block in children: a randomized, double-blinded, placebo-controlled, trial. Open Access Maced J Med Sci. 2019;7(1):73-6.
30. Sayyah-Melli M, Zonoozi GK, Hashemzadeh S, et al. Comparison of platinum-based neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian cancer. The Journal of Obstetrics and Gynecology of India. 2013;63:405-9.
31. Bayat AM, Azhough R, Hashemzadeh S, Barband A, Yaghoubi AR, Gargari RM. Hydatid cyst of pancreas presented as a pancreatic pseudocyst. Official journal of the American College of Gastroenterology|. 2009;104(5):1324-6.
32. Rostami F, Osquee HO, Mahdavi F, Dousti S. Development of a new psychometric assessment tool for predicting hepatitis B virus infection in pregnant women. Int J Women’s Health Reprod Sci. 2020;8(3):297-302.
33. Mahdavi F, Owaysee Osquee H. Comparison of serum levels of vitamin D after mastectomy in women with and without postoperative infection: case-control study. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(3):33-8.
34. Rousta F, Dadashzadeh M, Mahdavi F, Nasseri AR. Lymph node involvement and related risk factors in patients with breast cancer referred for radiotherapy: a 20-year study on 15 000 women. International Journal of Women's Health & Reproduction Sciences. 2021;9(3):212-6.
35. Sodhi G. Complications and hemodynamic stability associated with the use of dexmedetomidine with bupivacaine Vs fentanyl with bupivacaine in spinal naesthesia undergoing orthopedic lower limb surgeries. J Adv Med Dent Scie Res 2019;7(12): 60-3.
36. Alipour M, Firouzabadi SJP, Shahroudi A, Najafi MN, Molaei E. Compared dexmedetomidine and fentanyl on sensory-motor block in unilateral intrathecal anesthesia of lower-limbs orthopedic surgeries: a randomized double-blind trials. Galen Medical Journal. 2022;11:e2499.
37. Agrawal D, Sinha N, Singh SK. Comparison of intrathecal dexmedetomidine and intrathecal fentanyl as an adjuvant to bupivacaine during spinal anaesthesia for lower limb orthopedic surgery. Asian Journal of Medical Sciences. 2023;14(6).
38. Kumar BT, Sudharani G, Manjula KMU. Effect of dexmedetomidine and magnesium sulphate in control of shivering under neuraxial anaesthesia in patients undergoing lower limb and lower abdominal surgeries. European Journal of Molecular & Clinical Medicine. 2022;9(7):1835-44.
39. Binazir MB, Alizadeh M, Bayrami HJ, Azhough R, Movassaghi R, Nikasa P. The effect of a modified world health organization surgical safety checklist on postoperative complications in a tertiary hospital in iran. Iranian journal of public health. 2015;44(2):292.
40. Aslanabadi S, Azhough R, Motlagh PS, Hadidchi S, Tabrizi AD, Zonouzy KK. Intramedullary spinal cord ganglioglioma presenting with abnormal abdominal wall movement: case report. Neurosurgical focus. 2004;17(4):1-2.
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Irajian M, Moharrami MR, Nazari M, Pilehvar N. Comparison of infusion of dexmedetomedine and magnesium sulfate on the stability of hemodynamic status during emergency orthopedic surgery: a randomized double-blind clinical trial. Front Emerg Med. 2024;.
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