Evaluation peroperative and early postoperative effects of dexmedetomidine and ketamine sedation on septorhinoplasty operations

Sixty three cases in ASA I-II, who were aged between 18 and 62 years and would undergo septorhinoplasty operation, were randomized into three groups using closed envelop method.Patient was transferred to operation room without administering premedication and standard anesthesia monitoring was performed. Monitoring parameters of the patient were measured and recorded at following time points: T1 (monitoring moment), T2 (2 minutes following induction), T3 (Intubation moment), T4 (Skin incision moment), T5 (end of operation), T6 (baseline spontaneous respiration), T7 (Extubation moment), T8 (swallowing moment), T9 (baseline recovery ? time when eyes were opened) and T10 (verbal cooperation moment).Anesthesia induction was same for all of three patient groups, and induction and endotracheal intubation were performed using IV anesthetic agent propofol 3 mg/kg, muscle relaxant cisatracurium 0.15 mg/kg and narcotic analgesic phentanyl 1 µg/kg.For Group S (Control Group), 15 ml of saline was bolus administered 10 minutes before induction of anesthesia and saline was infused at rate of 15 ml/hour.In Group D, dexmedetomidine at dose of 1 µg/kg was slowly bolus administered (duration of administration is 10 minutes) 10 minutes before induction of anesthesia and later, it was infused at rate of 0.4 µg/kg per hour.In Group K, ketamine at dose of 0.4 mg/kg was intravenously bolus administered 10 minutes before induction of anesthesia followed by infusion at rate of 10 µg/kg/minute after anesthesia was induced.Maintenance of anesthesia was also same for all groups, and inhaler anesthetic agent, 2 ? 2.5 % sevofluran, was delivered within mixture of 50-60 % oxygen and N2O.Sevofluran concentration was adjusted to maximum 2.5 percent when blood pressure and heart rate increased above 20 percent of baseline, and if no response could be obtained, efforts were made to control those parameters by administering extra intravenous phentanyl at dose of 1 µg/kg.Drug infusion was discontinued 15 minutes before surgical intervention was completed.Recovery criteria were evaluated at postoperative 15, 30, 60 and 120 minutes.Postoperative nausea and vomiting were noted, while patient with NSR value above 3-4 were additionally administered analgesic agent, tramadol 50 mg.There was no difference between groups in terms of demographics and duration of surgical intervention.In comparison with ketamine, dexmedetomidine provided positive hemodynamic effects relative to control group throughout recovery period without leading to change in respiratory parameters.Dexmedetomidine shortened time to spontaneous respiration, excluding recovery periods.Ketamine lead to prolongation in time to response to verbal stimulation in comparison with that of dexmedetomidine.Dexmedetomidine and ketamine reduced agitation within postoperative 30 minutes, while sedation ensured by dexmedetomidine was lower than that of ketamine and activation score of dexmedetomidin was higher than that of other two groups up to postoperative 2 hours.High value in first Modified Aldrete Scoring was reached with dexmedetomidine.Ketamine was more efficient for acute postoperative pain within first 30 minutes.Later, the difference disappeared at the end of 24 hours and dexmedetomidine and ketamine gained significant advantage against control group.The frequency of nausea and vomiting within first 2 hours was lower in dexmedetomidine group than other two groups. It was determined that sleep quality score was better in dexmedetomidine group in comparison with that of control group.In conclusion, in current study which compared infusion of dexmedetomidine with ketamine for septorhinoplasty operations, we observed that dexmedetomidine offered more stable hemodynamics, it had positive influences on recovery and it reduced agitation.We also observed that in postoperative 24 hours, dexmedetomidine and ketamine led to reduction in use of opioid agents.