Assessing Dexmedetomidine’s Effectiveness and Hemodynamic Impact as a Hypotensive Agent in Posterior Fixation Surgery for Traumatic Spine Injuries

Abstract

Background: The aim of this study was to assess the effectiveness of dexmedetomidine (DEX) as a medication for inducing controlled hypotension during posterior fixation surgery for traumatic spine injuries, and to compare its performance with that of nitroglycerin (NTG).Methods: Fifty patients classified as ASA I or II and aged between 20-60 years, scheduled for posterior fixation surgery, were randomly divided into two groups. One group received a dexmedetomidine (DEX) dose of 1 µ g/kg over 10 minutes before anesthesia induction, followed by a maintenance infusion of 0.2-0.7 g/kg/h during the procedure. The other group received a nitroglycerin (NTG) infusion of 3-5 µg/kg/min after anesthesia induction to maintain the mean arterial blood pressure (MAP) between 65 and 70 mmHg. The study compared the two groups concerning the achievement of the target MAP, intraoperative blood loss, and the ability to reverse the hypotensive state. Continuous variables were assessed using a Student’s t-test, while categorical variables were analyzed with a chi-square test. A P-value less than 0.05 was considered statistically significant. Results: In the DEX group, patients achieved the target mean arterial blood pressure (MAP) with superior control over heart rate (HR) compared to the NTG group during the observation period. Notably, the DEX group also exhibited significantly less intraoperative blood loss (420.11 149.34 ml) in contrast to the NTG group (560.51 160.88 ml), with a P-value of 0.01. However, the time required for hypotension reversal in the NTG group (5.60 1.93 min) was shorter than that in the DEX group (9.10 2.16 min), albeit without statistical significance (P = 0.65). Conclusion: Dexmedetomidine (DEX) has proven to be a both effective and safe agent for inducing controlled hypotension in adults undergoing posterior fixation spine surgery.