Background: Hemodynamic instability is a significant perioperative complication that can threaten surgical outcome through various mechanisms: exacerbating intraoperative bleeding, compromising visibility of the surgical field, and elevating immediate and delayed postoperative complication risks. In septorhinoplasty, a procedure with challenging hemodynamic control due to the nasal anatomy's complexity of vessels, these effects are particularly relevant. This study examines the modulation of important hemodynamic parameters (SBP, DBP, MAP, HR, and SpO₂) by intravenous dexmedetomidine while ensuring cardiovascular stability and dose-dependent effects and optimal timing of administration at different phases of surgery. The findings aim to offer evidence-based recommendations for hemodynamic control in rhinoplasty surgery, which can reduce rates of complications and improve recovery profiles.
Methods: A randomized, double-blind clinical trial was conducted involving 50 eligible patients (aged 18-45 years) scheduled for septorhinoplasty at Ostad Motahari Hospital, Jahrom, during May-September 2023. Participants were randomly allocated to either a dexmedetomidine or control group. Collected data encompassed demographic characteristics (age, gender, BMI=Body mass index) and hemodynamic parameters (systolic/diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation). The data were analyzed using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean, standard deviation, percentage, count, and frequency) and inferential statistical tests (Mann-Whitney U test and independent t-test) were applied. A significance level of P < 0.05 was considered for all statistical analyses.
Results: The dexmedetomidine group demonstrated statistically significant variations in hemodynamic parameters (SBP, DBP, MAP, HR) from pre-induction through post-recovery phases (p<0.001). Significant between-group differences in blood pressure metrics were observed at all measured intervals following induction (1, 5, 15, 30, 60 minutes) and during recovery periods (p<0.05), with the dexmedetomidine group consistently showing lower values. Comparison between the intervention and control groups revealed no statistically significant differences in heart rate and oxygen saturation (O₂ sat) levels (except during recovery time).
Conclusion: The results of this study indicate that dexmedetomidine administration had a significant effect on reducing systolic blood pressure, diastolic blood pressure, and MAP compared to the control group, with this reduction being evident at all measured time points from post-induction to post-recovery. These findings suggest that dexmedetomidine can be effectively used as a blood pressure-lowering agent during surgery without significantly affecting heart rate or the patient's blood oxygen levels.