Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials

Autoři: Bingchen Lang aff001;  Lingli Zhang aff001;  Yunzhu Lin aff001;  Wensheng Zhang aff004;  Feng-shan Li aff001;  Shouming Chen aff005
Působiště autorů: Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China aff001;  Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China aff002;  Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China aff003;  Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China aff004;  Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications.


Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.


Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting.


Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.

Klíčová slova:

Hemorrhage – Hypotension – Laparoscopy – Magnesium – Otolaryngological procedures – Sulfates – Surgical and invasive medical procedures – Surgical resection


1. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine: First of two parts-Blood transfusion. N Engl J Med. 1999;340:438–47. doi: 10.1056/NEJM199902113400606 9971869

2. Praveen K, Narayanan V, Muthusekhar MR, Baig MF. Hypotensive anaesthesia and blood loss in orthognathic surgery: a clinical study. Br J Oral Maxillofac Surg. 2001;39:138–40. doi: 10.1054/bjom.2000.0593 11286449

3. Milonski J, Zielinska-Blizniewska H, Golusinski W, Urbaniak J, Sobanski R, Olszewski J. Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2013;270:2045–50. doi: 10.1007/s00405-012-2311-1 23263204

4. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007;67:1053–76. doi: 10.2165/00003495-200767070-00007 17488147

5. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol. 2008;21(4):457–61. doi: 10.1097/ACO.0b013e328305e3ef 18660652

6. Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. The effect of Dexmedetomidine on perioperative hemodynamicsin patients undergoing craniotomy. Anaesth Analg. 2008;107:1340–47.

7. Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth. 2008;20:437–41. doi: 10.1016/j.jclinane.2008.04.008 18929284

8. Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006;96:727–31. doi: 10.1093/bja/ael085 16670112

9. Shimosawa T, Takano K, Ando K, Fujita T. Magnesium inhibits norepinephrine release by blocking N-type calcium channels at peripheral sympathetic nerve endings. Hypertension.2004;44:897–902. doi: 10.1161/01.HYP.0000146536.68208.84 15477382

10. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses. The PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535 19622551

11. Fromme GA, Mackenzie RA, Gould AB Jr, Lund BA, Offord KP. Controlled hypotension for orthognathic surgery. Anesth Analg. 1986;65:683–6. 3706806

12. Aldrete JA. The post-anesthesia recovery score revisited. J Clinical Anesth. 1995;7:89–91.

13. Higgins JP, Altman DG, Sterne JA, editors. Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. London: The Cochrane Collaboration. 2008:187–241.

14. Aboushanab OH, El-Shaarawy AM, Omar AM, Abdelwahab HH. A comparative study between magnesium sulphate and dexmedetomidine for deliberate hypotension during middle ear surgery. Egypt J Anaesth. 2011;27:227–232.

15. Akkaya A, Tekelioglu UY, Demirhan A, Bilgi M, Yildiz I, Apuhan T, et al. Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: randomized clinical study. Rev Bras Anestesiol. 2014;64:406–12. doi: 10.1016/j.bjan.2014.01.008 25437697

16. Bayram A, Ulgey A, Güneş I, Ketenci I, Capar A, Esmaoğlu A, et al. Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery. Rev Bras Anestesiol. 2015;65:61–7. doi: 10.1016/j.bjan.2014.04.003 25497751

17. Modir H, Modir A, Rezaei O, Mohammadbeigi A. Comparing remifentanil, magnesium sulfate, and dexmedetomidine for intraoperative hypotension and bleeding and postoperative recovery in endoscopic sinus surgery and tympanomastoidectomy. Med Gas Res. 2018;8:42–7. doi: 10.4103/2045-9912.235124 30112164

18. Rokhtabnak F, Djalali Motlagh S, Ghodraty M, Pournajafian A, Maleki Delarestaghi M, Tehrani Banihashemi A, et al. Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate. Anesth Pain Med. 2017;7:e64032. doi: 10.5812/aapm.64032 29696129

19. Oommen TG, Segaran S, Zachariah M, Ranjan RV, Pillai AR, Valasareddy S. Effect of magnesium sulphate and dexmedetomidine on blood loss during lumbar spinal fusion surgeries. J Clin Diagn Res. 2018;12:8 (UC01-05).

20. Radwan T, Fahmy R, El Emady M, Reda I. Comparative study between dexmedetomidine, magnesium sulphate and fentanyl as sedatives throughout awake fiberoptic intubation for patients undergoing cervical spine surgeries. Egypt J Anaesth. 2017;33: 345–9.

21. Srivastava VK, Mishra A, Agrawal S, Kumar S, Sharma S, Kumar R. Comparative evaluation of dexmedetomidine and magnesium sulphate on propofol consumption, haemodynamics and postoperative recovery in spine surgery: A prospective, randomized, placebo controlled, double-blind study. Adv Pharm Bull. 2016;6:75–81. doi: 10.15171/apb.2016.012 27123421

22. Soliman R, Fouad E. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study. Indian J Anaesth. 2017;61:410–7. doi: 10.4103/ija.IJA_581_16 28584351

23. Zarif P, Abdelaal Ahmed Mahmoud A, Abdelhaq MM, Mikhail HM, Farag A. Dexmedetomidine versus magnesium sulfate as adjunct during anesthesia for laparoscopic colectomy. Anesthesiol Res Pract. 2016;7172920. doi: 10.1155/2016/7172920 27051421

24. Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56(2):455–63. doi: 10.1111/j.0006-341x.2000.00455.x 10877304

25. Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomesin patients given dexmedetomidine in functional endoscopicsinus surgery. Ann Otol Rhinol Laryngol. 2011;120:586–92. doi: 10.1177/000348941112000906 22032072

26. Ankichetty SP, Ponniah M, Cherian V, Thomas S, Kumar K, Jeslin L, et al. Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol. 2011;27(3):328–32. doi: 10.4103/0970-9185.83675 21897501

27. Tirelli G, Bigarini S, Russolo M, Lucangelo U, Gullo A. Total intravenous anaesthesia in endoscopic sinus-nasal surgery. Acta Otorhinolaryngol Ital. 2004;24(3):137–44. 15584584

28. Sieskiewicz A, Drozdowski A, Rogowski M. The assessment of correlation between mean arterial pressure and intraoperative bleeding during endoscopic sinus surgery in patients with low heart rate. Otolaryngol Polska Polish Otolaryngol. 2010;64(4):225–8.

29. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol 2008;4:619–27. doi: 10.1517/17425255.4.5.619 18484919

30. Steward DJ. A simplified scoring system for the post-operative recovery room. Canadian Anaesthetists’ Society Journal. 1975;22(1):111–113.

31. Aldrete JA, Kroulik D. A post anesthetic recovery score. Anesth Analg. 1970;49:924–933. 5534693

32. Aldrete JA. Post-anesthetic recovery score." Journal of the American College of Surgeons. 2007; 205(5):e3–e4. doi: 10.1016/j.jamcollsurg.2007.07.034 17964430

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