Effect of dexmedetomidine infusion on intraoperative blood loss, hemodynamic stability, and anesthetic requirements during elective lumbar spine surgery: a prospective randomized controlled study
Anjali Sathish, Sonali Kore, Kirtibala Dhande, Varsha VyasAbstract
Background:
Elective lumbar spine surgery may be associated with substantial intraoperative blood loss and hemodynamic fluctuations, posing significant anesthetic challenges. Dexmedetomidine provides sympatholytic and anesthetic-sparing effects; however, the optimal dosing regimen remains uncertain. This study compared a loading-dose regimen with a maintenance-infusion regimen without a loading dose for blood loss, hemodynamic stability, anesthetic requirements, and recovery outcomes.
Materials and Methods:
This prospective, randomized controlled study included 50 adult patients with American Society of Anesthesiologists physical status I–II scheduled for elective lumbar spine surgery. We randomly allocated patients to two groups. Group A received a dexmedetomidine loading dose followed by a maintenance infusion, whereas Group B received a maintenance infusion without a loading dose. We recorded and compared intraoperative blood loss, hemodynamic parameters, anesthetic drug requirements, surgical field quality, and recovery characteristics between groups.
Results:
Mean intraoperative blood loss was significantly lower in Group B than in Group A. Patients in Group B showed greater hemodynamic stability, with significantly lower systolic, diastolic, and mean arterial blood pressures. Although the heart rate decreased in both groups, the reduction was significantly greater in Group B. Group B required less isoflurane, fentanyl, and propofol. However, these differences were not statistically significant. Surgical field conditions were also significantly better in Group B. Emergence, tracheal extubation, and recovery times were significantly shorter in Group B than in Group A.
Conclusion:
Dexmedetomidine maintenance infusion without a loading dose was associated with less intraoperative blood loss, improved hemodynamic stability, better surgical field conditions, and faster emergence and recovery in patients undergoing elective lumbar spine surgery. This dosing strategy may therefore be a safer and more effective alternative to the conventional loading-dose regimen.