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Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes.

BACKGROUND
Surgical correction ofscoliosis carries significant blood loss and needs for blood transfusion with its inherent risks and cost. The aim of this double-blind, randomized, controlled study was to compare the effects of esmolol or dexmedetomidine on intraoperative blood loss, anesthetics consumption, intra operative hemodynamic and effects on spinal cord monitoring in patients undergoing scoliosis surgery.


METHODS
After obtaining institute review board approval and written informed consent, 60 adolescents (ASA physical status I-II), 14-18-year of age scheduled for posterior spinal fusion scoliosis surgery were enrolled in the study. Using computer generator software patients were randomly allocated to receive either saline as a control (group C), esmolol (Group E) or dexmedetomidine (Group D).


RESULTS
There was a significant reduction in blood loss in patients who received esmolol and dexmeditomidine compared to control it was as follow; in control group 782+/-86.4 ml (P < or = 0.001), esmolol group 667+/-145.2 ml (P < or = 0.001) and dexmeditomidine group 465 +/-115.3 ml (P < or = 0.001). Mean intraoperative total fentanyl and propofol consumption in the esmolol group was significantly higher than in the dexmedetomidine group, this was especially dramatic for the dexmedetomidine group where the propofol consumption was twice less P < or = 0.001. There was no significant effect seen in SSEPs (amplitude or latency) but there was isolated decrease in motor evoked potential (MEP) amplitude which was within acceptable range that was seen in 6 patients receiving dexmeditomidine at a dose of 0. 7 micro g/Kg/H.


CONCLUSION
Both esmolol and dexmedetomidine, added to anesthetic regimen, provided an effective and well-tolerated method to reduce the amount of blood loss in patients undergoing scoliosis surgery. dexmedetomidine, was associated with plonoged extubation and recovery times.