Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery

Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery Li-Sha Ye, YiXuan Wang, BenFu Wang, YueXi Jin, WenLian Ye, Tian-Fang Jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3800796/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Nasal endoscopic surgery is a high-resolution, fine-grained procedure. With the development of nasal endoscopic surgery, the demand for a clear surgical field of vision is gradually increasing. Controlled hypotension technology can effectively reduce intraoperative bleeding and provide a clear visual field for surgery. In hypertensive patients, we use dexmedetomidine as an adjuvant on the basis of traditional nitroglycerin controlled hypotension. The experimental results show that the use of dexmedetomidine can help control blood pressure faster to the target blood pressure, while also exhibiting more stable performance during resuscitation and extubation. Although in terms of heart rate Figures Figure 1 Figure 2 Figure 3 Figure 4 INTORDUCTION Many intranasal sinus surgical procedures can be undertaken using the endoscope which provides the surgeon with a clear and well illuminated field of vision, and the ability to inspect recesses with angled distal lenses[ 1 ]. Due to the narrow operating space in the nasal cavity, a small amount of bleeding can also hinder the surgeon and mask key anatomical markers, affecting the quality of the surgery. Therefore, how to reduce and control bleeding and improve the clarity of surgical vision has become a key issue in improving the quality of surgery[ 2 ]. In clinical practice, epinephrine is commonly used to fill the nasal cavity and contract nasal mucosal blood vessels, and some even inject epinephrine under the nasal mucosa, which has a definite effect. And adrenaline is an adrenaline receptor agonist in the efferent nervous system, which stimulates α and β Receptors can cause hemodynamic fluctuations, and short-term high concentrations of adrenaline entering the bloodstream may even cause cardiovascular and cerebrovascular complications such as hypertension, tachycardia, myocardial ischemia, cardiac arrest, and cerebral hemorrhage. The use of preoperative corticosteroids is also increasingly being reported to reduce intraoperative bleeding during endoscopic sinus surgery[ 2 ]. In 1964, Gardner et al[ 3 ]. first applied controlled hypotension in clinical practice, and now controlled hypotension has a history of over 60 years in clinical practice. Currently, controlled hypotension is commonly used in endoscopic sinus surgery to reduce bleeding at the surgical site and make the surgical field clearer. Previous studies on the application of controlled hypotension in nasal endoscopy have mostly been conducted in relatively young and healthy populations. Hypertensive patients often have reduced baroreceptor sensitivity, high blood pressure fluctuations, and increased potential risks during anesthesia. Blood pressure fluctuations are independent risk factors of blood pressure levels, closely related to target organ structure and function damage, cardiovascular and cerebrovascular events, and mortality. Reducing abnormal fluctuations in blood pressure can more effectively alleviate target organ damage. Therefore, effective control of blood pressure fluctuations is the goal and challenge of blood pressure management in perioperative hypertensive patients. Dexmetomidine is a selective drug α 2 adrenergic receptor agonists can lower blood pressure, slow heart rate, calm and relieve pain. The decrease in blood pressure is mainly due to the inhibition of central sympathetic nerve outflow, as well as the stimulation of presynaptic processes α 2 adrenergic receptor reduces norepinephrine release[ 4 ]. In surgical procedures, the use of dexmedetomidine can provide good surgical conditions, controlled hypotension, and reduce the use of opioids[ 5 , 6 ]. Compared with nitroglycerin and esmolol, continuous infusion of dexmedetomidine in healthy individuals under 60 years old is a safe and effective controlled antihypertensive method that can achieve target blood pressure targets, reduce bleeding volume, and maintain good hemodynamics[ 7 ]. There is still little research on the application of dexmedetomidine in hypertensive patients who require controlled hypotension. Based on current research on the pharmacological mechanism of dexmedetomidine, its stabilizing effect on hemodynamics, especially on blood pressure, is determined. However, the reduced sensitivity of the baroreceptor and large blood pressure fluctuations inherent in hypertensive patients demonstrate different characteristics from healthy patients. This study intends to apply dexmedetomidine to hypertensive patients who require nasal endoscopic surgery under controlled hypotension, The purpose of this study was to observe the feasibility of dexmedetomidine under propofol remifentanil combined anesthesia in endoscopic sinus surgery for patients with hypertension, and to provide a more safe and effective method for perioperative controlled hypotension in patients with hypertension, so as to provide reference for clinical practice. METHOD 100 patients were selected for elective nasal endoscopic surgery under general anesthesia. The inclusion criteria were as follows: the patients met the diagnostic criteria for primary hypertension in the 2010 edition of the Chinese Guidelines for the Prevention and Treatment of Hypertension, received standardized antihypertensive treatment before surgery, and had good blood pressure control (< 140/90 mmHg) (1mm Hg = 0.133 kPa); According to the American Society of Anesthesiologists (ASA) standards, all patients were evaluated as Grade II preoperative condition. Randomly divided into a dexmedetomidine group (Group D) and a blank control group (Group C), with 50 cases in each group. Anesthesia method: After the patient enters the room, the upper limb vein access is routinely opened, connected to ECG and pulse oxygen saturation monitoring, and then radial artery puncture is performed under local anesthesia of lidocaine and invasive arterial blood pressure is monitored. Group D patients received intravenous infusion of dexmedetomidine at a loading dose of 0. 5 minutes before anesthesia induction six µ G/kg, followed by 0.4 µ Maintain g/kg/h until 10 minutes before the end of surgery; Group C patients were infused with an equal amount of physiological saline in the same manner. Anesthesia induction: oxygen and denitrogenation were given by mask for 3min to make SpO2 more than 98%. Propofol (target concentration of plasma 3ug/mL) and remifentanil (target concentration of response room 3ng/ml) were infused by target control with a dual channel target control system, atracurium cisbenzenesulfonate was 0.2mg/kg, conventional tracheal intubation was used, and OHMEDA anesthesia machine was connected to control respiration. The respiratory rate was adjusted to 12 times/min, tidal volume was 8 ~ 10ml/kg, and the end expiratory partial pressure of carbon dioxide (PETCO2) was maintained at 30mmHg ~ 35mmHg. During the operation, propofol combined with remifentanil TCI was used to maintain anesthesia. Adjust and maintain anesthesia concentration according to BIS to maintain BIS at 40–60. Propofol and remifentanil were stopped when the hemostatic gauze was filled. After the surgery, the tracheal catheter should be removed after the patient's consciousness is clear, swallowing reflex is restored, and breathing is well restored. Controlled hypotension method: adjust the dosage of propofol and remifentanil to maintain the BIS at 40–60 during the operation, and adjust the dosage of nitroglycerin to maintain the MAP during the operation in the two groups to reduce about 30% (but not less than 60mmHg) compared with that before anesthesia. Stop pumping dexmedetomidine 10 minutes before the end of the surgery, and stop pumping nitroglycerin at the end of the surgery. If the MAP is less than 60 mmHg during and within 30 minutes after surgery, 20–40 µ g of norepinephrine should be administered; HR < 50 times/min, administration of atropine 0.2–0.5 mg. Monitoring indicators: HP monitors ECG, ABP, HR, SpO2, PETCO2. The A-2000XPTM BIS Anesthesia Depth Monitor (Aspect, USA) monitors BIS values, recording electrodes Fp1-A1, Fpz grounded, high-frequency 30Hz, filtering range 50 Hz, low-frequency 2 Hz, scanning speed 25 mm/s, impedance < 5000 ohms. Monitoring time points: Observe and record the invasive mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (T0), at the beginning of hypotension (T1), at the target of hypotension (T2), at the time of extubation (T3), 15 minutes after extubation (T4), and 30 minutes after extubation (T5); The time of reaching the target blood pressure, the dosage of propofol and remifentanil, the dosage of nitroglycerin, the time of extubation and the dosage of antihypertensive drugs after extubation were recorded; VAS score 30 minutes after extubation. Statistical analysis shall be conducted using SPSS statistical software, with measurement data expressed as mean ± standard deviation (‾x ± s). Univariate analysis of variance shall be used for inter group comparison. Count data comparison using χ 2 Inspection. P < 0.05 indicates a statistically significant difference. RESULT Our research group collected 100 patients undergoing nasal endoscopic surgery under general anesthesia and randomly divided them into a dexmedetomidine experimental group and a saline control group, with 50 patients in each group. These patients met the diagnostic criteria for primary hypertension in the 2010 edition of the Chinese Guidelines for the Prevention and Treatment of Hypertension. They received standardized antihypertensive treatment before surgery and had good blood pressure control (<140/90 mmHg) (1mmHg=0.133 kPa). According to the American Society of Anesthesiologists (ASA) standards, all patients were evaluated as Grade II preoperative condition. 1. Faster controlled hypotension with dexmedetomidine After using the above general anesthesia method for anesthesia, we found through data collection and statistical analysis that patients who used a load dose of dexmedetomidine before surgery and maintained it took shorter time to achieve controlled hypotension target blood pressure compared to patients who used physiological saline control (Figure 1). This may be related to the vasodilator effect of dexmedetomidine. Enable patients to achieve target blood pressure better and faster under the action of nitroglycerin. Perhaps the analgesic effect also has a certain effect, and reducing the stimulation of pain on patients can better enable them to achieve the goal of controlled hypotension. The use of dexmedetomidine also inhibits sympathetic nerve stimulation, helping patients control hypotension. 2. Dexmetomidine Makes Blood Pressure More Stable Patients who used dexmedetomidine during surgery showed more stable blood pressure during extubation after surgery, and also had more stable blood pressure during anesthesia and resuscitation (Figure 2). According to statistics, patients who used dexmedetomidine during extubation had better blood pressure stability compared to patients in the saline control group. Patients in the dexmedetomidine group showed a decrease in blood pressure compared to preoperative rest, which is related to the longer half-life of dexmedetomidine and its continuous provision of sedative, analgesic, and vasodilatory effects. Patients who use physiological saline as control will experience a certain degree of blood pressure fluctuation during extubation. This is not beneficial for patients who have just undergone nasal endoscopic surgery. Nasal endoscopic surgery is a delicate surgery that often uses tamponade compression to stop bleeding, which is more likely to cause poor hemostatic effect and the risk of rebleeding in cases of blood pressure fluctuations. These patients had a decrease in blood pressure compared to their resting state at 15 and 30 minutes after extubation. The dexmedetomidine group showed more stable blood pressure than the saline control group, which may be related to the amount of nitroglycerin used during surgery. With the help of dexmedetomidine, patients can quickly control their target blood pressure, thereby reducing the use of nitroglycerin during surgery. Patients in the physiological saline control group need more nitroglycerin to achieve their target blood pressure. This is also one of the advantages of using dexmedetomidine to assist in controlled hypotension during surgery. 3. The Effect Of Dexmedetomidine On Heart Rate In terms of heart rate, after using dexmedetomidine, the patient's heart rate will decrease compared to using physiological saline control due to its inhibitory effect on the sympathetic nervous system. This is clearly reflected in the data. (Figure 3) When the patient uses dexmedetomidine, the degree of heart rate decrease when controlled hypotension reaches the target is greater than that of the saline control group. The decrease in heart rate is more pronounced, which may have adverse factors for patients with sinus bradycardia or atrioventricular block. However, during extubation, patients in the saline control group showed greater fluctuations in heart rate. This is still related to the relatively long-lasting sedative and analgesic effects of dexmedetomidine. Unfortunately, in terms of performance at 15 and 30 minutes after extubation. The degree of heart rate decrease in the dexmedetomidine group was much greater than that in the saline control group. So the use of dexmedetomidine has an impact on the patient's heart rate, atrioventricular conduction, and the inhibition of sympathetic nervous system, which cannot be ignored. 4. Dexmetomidine Is More Beneficial For Postoperative Resuscitation There was no significant difference in the time required for extubation between patients using dexmedetomidine and patients in the saline control group after discontinuing general anesthesia and maintaining medication in terms of anesthesia recovery data. Perhaps it suggests that the use of dexmedetomidine as an adjunct to controlled hypotension does not have a significant impact on the time required for extubation. On the contrary, it has certain benefits for blood pressure fluctuations and heart rate fluctuations during extubation. At the same time, there was no significant difference in observation time between the two groups in the anesthesia and resuscitation room. Some patients in the physiological saline control group may not be able to meet the standard for leaving the anesthesia resuscitation room in a timely manner due to poor postoperative blood pressure, and further observation is required after using antihypertensive drugs to reduce blood pressure, which may delay time. (Figure 4) The sedative and analgesic effects of dexmedetomidine here play a role, allowing patients to more smoothly reach the standard of anesthesia and resuscitation room, with more stable performance. In terms of VAS pain score performance at 30 minutes after surgery, patients who used dexmedetomidine had better postoperative pain relief effect, fewer patients felt pain, and their VAS pain score was lower than that of the saline control group. DISCUSSION Today, with the gradual development of endoscopic sinus surgery, anesthesiologists need to better serve clinical patients. Nasal endoscopic surgery, as a representative of fine surgery, can cause significant interference to the surgical field even with a small amount of bleeding, affecting the progress and effectiveness of the surgery. Good control of blood pressure reduction is essential during this process. After the surgery begins, it quickly enters the stage of precise operations such as cutting open the mucosa and opening the bone structure. Therefore, it is required that our anesthesiologists achieve satisfactory target blood pressure faster after the surgery begins. The use of dexmedetomidine in controlled hypotension during nasal endoscopic surgery can help us achieve target blood pressure faster than traditional nitroglycerin in a short period of time. After the surgery is completed, endoscopic sinus surgery often uses methods such as tamponade compression and spraying hemostatic powder to stop bleeding. If there is a significant fluctuation in the patient's blood pressure at this time, it is easy to cause poor hemostatic effect and cause further bleeding. The use of dexmedetomidine enables patients to have more stable blood pressure performance during and after extubation, reducing the occurrence of adverse events such as bleeding. And there was no adverse effect on the time required for extubation after discontinuation and the observation time in the resuscitation room. Even a relatively long half-life can provide a certain duration of sedative and analgesic effects, making patients have a more comfortable postoperative experience. Combined with dexmedetomidine's multimodal postoperative analgesia, it is beneficial for patients' rehabilitation and long-term benefits, while also in line with the values of comfortable medical treatment. However, for patients who use dexmedetomidine, it is important to conduct preoperative visits. The results suggest that patients who use dexmedetomidine have a significant impact on heart rate, and inhibition of the sympathetic nervous system can cause a certain degree of decrease in heart rate and affect atrioventricular conduction. In terms of side effects statistics, 8 out of 50 patients in the dexmedetomidine group experienced heart rate below 60 beats per minute, and 1 patient had postoperative hypotension. However, no adverse reactions were found in the 50 patients in the saline control group, and on the contrary, 11 patients with postoperative hypertension appeared. The traditional use of nitroglycerin for controlled hypotension during nasal endoscopic surgery poses a risk of poor postoperative blood pressure control and subsequent bleeding. Therefore, with sufficient preoperative visits and preparation, the use of dexmedetomidine assisted controlled hypotension can play a better role in nasal endoscopic surgery. Declarations CONFLICT OF INTERESTS The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. AUTHOR CONTRIBUTION Li-Sha Ye：Project administration (supporting);Methodology (lead); Writing – original draft (lead). Yi-Xuan Wang: Methodology (supporting). Ben-Fu Wang: Methodology (supporting). Yue-Xi Jin: Methodology (supporting). Wen-Lian Ye: Methodology (supporting). Tian-Fang Jiang: Formal analysis (lead); Project administration (lead) ETHICAL STATEMENT clinical trial registry and clinical trial registration number of our study : Wenzhou Medical University Eye Hospital 2023-002-K-02-01 DATA AVAILABILITY STATEMENT The data sets used and analyzed during the current study are avail- able from the corresponding author on reasonable request. ACKNOWLEDGEMENTS: Thanks for all classmates and mentors for their help and guidance. Thanks for all authors for their assistance in the data collection phase. FUNDING STATEENT Wenzhou Science and Technology Bureau, Zhejiang Province, China （Y20220968） ETHICS STATEMENT All procedures in this study were conducted in accordance with the regulations of the human Ethics Committee. References Mackay, I.S., Endoscopic sinus surgery . Ann Acad Med Singap, 1991. 20(5): p. 690–5. Vuncannon, J.R. and S.K. Wise, Hemostasis in endoscopic sinus and skull base surgery . Curr Opin Otolaryngol Head Neck Surg, 2023. 31(1): p. 33–38. Diddle, A.W., P.J. Williamson, and W.H. Gardner, Current Concepts in Management of Obstetric Hemorrhage. Med Times, 1964. 92: p. 1235–41. Du, X., et al., Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients . Acta Cir Bras, 2019. 34(9): p. e201900905. Lang, B., et al., Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials . PLoS One, 2020. 15(1): p. e0227410. Rokhtabnak, F., et al., Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate . Anesth Pain Med, 2017. 7(6): p. e64032. Ruku, R., et al., Randomized Open-Labelled Comparative Evaluation of the Efficacy of Nitroglycerine, Esmolol and Dexmedetomidine in Producing Controlled Hypotension in Spine Surgeries . Anesth Essays Res, 2019. 13(3): p. 486–491. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3800796","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":263364899,"identity":"88e325be-5fcb-4f25-96dc-12715ce6775a","order_by":0,"name":"Li-Sha Ye","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li-Sha","middleName":"","lastName":"Ye","suffix":""},{"id":263364900,"identity":"38e1f1af-be70-4f02-a93b-2aae8bc0a3c1","order_by":1,"name":"YiXuan Wang","email":"","orcid":"","institution":"Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"YiXuan","middleName":"","lastName":"Wang","suffix":""},{"id":263364901,"identity":"cccee0fe-e8da-45a2-b24b-d6cbd4d5f9a4","order_by":2,"name":"BenFu Wang","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"BenFu","middleName":"","lastName":"Wang","suffix":""},{"id":263364902,"identity":"3f847cb7-44dd-4a0b-9020-b2ef5fb2f52a","order_by":3,"name":"YueXi Jin","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"YueXi","middleName":"","lastName":"Jin","suffix":""},{"id":263364903,"identity":"683e841f-11e5-42aa-86c8-c0e7410f7bbc","order_by":4,"name":"WenLian Ye","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"WenLian","middleName":"","lastName":"Ye","suffix":""},{"id":263364904,"identity":"75063a10-7a2a-4a3f-9e5c-3bb4f55f3844","order_by":5,"name":"Tian-Fang Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIie3RsWrDMBCA4RMCa5Hx0MUh0LyCTMAl1A/jIFAWd89QEoHBk4NXZ+g7dMxoc+AufoCMztIpQzs1gVLqOVDV3QrRN2jSjw4dgGX9R5TV3ftntC5YWndvgxLGZbDVimzzRgbloMSD8MbVSJ7LJBzzIcUkBUXdnaKCV2IcLfEWGHZw3v2cCCTN4amNnDum42nS4hS4EmTTGhIKC3F0FJ/lVSUfMpxrSICSzDhY6HMHfbGfa5x94Vp7R3MCCOHIzVCIvSQp0RiD/8srAvtPLlsVj/KGkrxZBJn/KuqNabDipd/gMoo9VnycTo/3E8+Th+5sGuxCCk5/VsMDgNVfLluWZV2Jb1WWVWxywEM/AAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":true,"prefix":"","firstName":"Tian-Fang","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2023-12-24 14:44:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3800796/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3800796/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49077808,"identity":"b3ec78eb-3c62-4fcc-b3f9-b2f5585fc075","added_by":"auto","created_at":"2024-01-02 19:10:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48406,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatients in the dexmedetomidine group received intravenous infusion of dexmedetomidine at a loading dose of 0. 5 minutes before anesthesia induction six μ G/kg, followed by 0.4 μ Maintain g/kg/h until 10 minutes before the end of surgery; Group C patients were infused with an equal amount of physiological saline in the same manner. Statistical data analysis P\u0026lt;0.0001.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3800796/v1/536019afea23d2b32e2f83bc.png"},{"id":49077809,"identity":"8e9213ff-60fd-4431-9963-3ff98e121c22","added_by":"auto","created_at":"2024-01-02 19:10:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54299,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStop pumping dexmedetomidine 10 minutes before the end of the surgery, and stop pumping nitroglycerin at the end of the surgery. Stop general anesthesia and maintain medication to enter the anesthesia recovery stage. Record the blood pressure at the time of extubation, 15 minutes after extubation, and 30 minutes after extubation, and compare it with preoperative resting blood pressure. Statistical analysis showed P\u0026lt;0.05.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3800796/v1/873d79329e61ef5e692c3f87.png"},{"id":49077807,"identity":"479bc76f-1a88-4b73-9478-78c1befe4e7b","added_by":"auto","created_at":"2024-01-02 19:10:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":55578,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCompare the patient's heart rate at target blood pressure, extubation, 15 minutes after extubation, and 30 minutes after extubation with the preoperative resting heart rate. Statistical analysis P\u0026lt;0.05.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3800796/v1/fbb34779b39ec5eda8edabed.png"},{"id":49078601,"identity":"e4bb09e4-5395-4601-bd6c-6ccd997625ec","added_by":"auto","created_at":"2024-01-02 19:18:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":41407,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAfter the surgery, the general anesthesia was discontinued to maintain the medication and enter the anesthesia recovery phase. Compare the time required from discontinuation to extubation between the two groups, P\u0026lt;0.05. Compare the time it takes for patients to enter the anesthesia and resuscitation room after extubation and return to the ward to meet the exit standard, P\u0026lt;0.05. Compare the VAS scores of the two groups of patients 30 minutes after extubation, P\u0026lt;0.05.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3800796/v1/f7669a21185616a0fcfdc9a9.png"},{"id":49078859,"identity":"a6ce1c9a-381a-4cca-bf9a-c91eb9084f48","added_by":"auto","created_at":"2024-01-02 19:34:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":836713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3800796/v1/c68e1e32-0200-4098-acea-49a3ed557557.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery","fulltext":[{"header":"INTORDUCTION","content":"\u003cp\u003eMany intranasal sinus surgical procedures can be undertaken using the endoscope which provides the surgeon with a clear and well illuminated field of vision, and the ability to inspect recesses with angled distal lenses[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to the narrow operating space in the nasal cavity, a small amount of bleeding can also hinder the surgeon and mask key anatomical markers, affecting the quality of the surgery. Therefore, how to reduce and control bleeding and improve the clarity of surgical vision has become a key issue in improving the quality of surgery[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In clinical practice, epinephrine is commonly used to fill the nasal cavity and contract nasal mucosal blood vessels, and some even inject epinephrine under the nasal mucosa, which has a definite effect. And adrenaline is an adrenaline receptor agonist in the efferent nervous system, which stimulates α and β Receptors can cause hemodynamic fluctuations, and short-term high concentrations of adrenaline entering the bloodstream may even cause cardiovascular and cerebrovascular complications such as hypertension, tachycardia, myocardial ischemia, cardiac arrest, and cerebral hemorrhage. The use of preoperative corticosteroids is also increasingly being reported to reduce intraoperative bleeding during endoscopic sinus surgery[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 1964, Gardner et al[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. first applied controlled hypotension in clinical practice, and now controlled hypotension has a history of over 60 years in clinical practice. Currently, controlled hypotension is commonly used in endoscopic sinus surgery to reduce bleeding at the surgical site and make the surgical field clearer.\u003c/p\u003e \u003cp\u003ePrevious studies on the application of controlled hypotension in nasal endoscopy have mostly been conducted in relatively young and healthy populations. Hypertensive patients often have reduced baroreceptor sensitivity, high blood pressure fluctuations, and increased potential risks during anesthesia. Blood pressure fluctuations are independent risk factors of blood pressure levels, closely related to target organ structure and function damage, cardiovascular and cerebrovascular events, and mortality. Reducing abnormal fluctuations in blood pressure can more effectively alleviate target organ damage. Therefore, effective control of blood pressure fluctuations is the goal and challenge of blood pressure management in perioperative hypertensive patients.\u003c/p\u003e \u003cp\u003eDexmetomidine is a selective drug α 2 adrenergic receptor agonists can lower blood pressure, slow heart rate, calm and relieve pain. The decrease in blood pressure is mainly due to the inhibition of central sympathetic nerve outflow, as well as the stimulation of presynaptic processes α 2 adrenergic receptor reduces norepinephrine release[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In surgical procedures, the use of dexmedetomidine can provide good surgical conditions, controlled hypotension, and reduce the use of opioids[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Compared with nitroglycerin and esmolol, continuous infusion of dexmedetomidine in healthy individuals under 60 years old is a safe and effective controlled antihypertensive method that can achieve target blood pressure targets, reduce bleeding volume, and maintain good hemodynamics[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There is still little research on the application of dexmedetomidine in hypertensive patients who require controlled hypotension. Based on current research on the pharmacological mechanism of dexmedetomidine, its stabilizing effect on hemodynamics, especially on blood pressure, is determined. However, the reduced sensitivity of the baroreceptor and large blood pressure fluctuations inherent in hypertensive patients demonstrate different characteristics from healthy patients. This study intends to apply dexmedetomidine to hypertensive patients who require nasal endoscopic surgery under controlled hypotension, The purpose of this study was to observe the feasibility of dexmedetomidine under propofol remifentanil combined anesthesia in endoscopic sinus surgery for patients with hypertension, and to provide a more safe and effective method for perioperative controlled hypotension in patients with hypertension, so as to provide reference for clinical practice.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"METHOD","content":"\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e100 patients were selected for elective nasal endoscopic surgery under general anesthesia. The inclusion criteria were as follows: the patients met the diagnostic criteria for primary hypertension in the 2010 edition of the Chinese Guidelines for the Prevention and Treatment of Hypertension, received standardized antihypertensive treatment before surgery, and had good blood pressure control (\u0026lt; 140/90 mmHg) (1mm Hg = 0.133 kPa); According to the American Society of Anesthesiologists (ASA) standards, all patients were evaluated as Grade II preoperative condition. Randomly divided into a dexmedetomidine group (Group D) and a blank control group (Group C), with 50 cases in each group.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAnesthesia method: After the patient enters the room, the upper limb vein access is routinely opened, connected to ECG and pulse oxygen saturation monitoring, and then radial artery puncture is performed under local anesthesia of lidocaine and invasive arterial blood pressure is monitored. Group D patients received intravenous infusion of dexmedetomidine at a loading dose of 0. 5 minutes before anesthesia induction six µ G/kg, followed by 0.4 µ Maintain g/kg/h until 10 minutes before the end of surgery; Group C patients were infused with an equal amount of physiological saline in the same manner. Anesthesia induction: oxygen and denitrogenation were given by mask for 3min to make SpO2 more than 98%. Propofol (target concentration of plasma 3ug/mL) and remifentanil (target concentration of response room 3ng/ml) were infused by target control with a dual channel target control system, atracurium cisbenzenesulfonate was 0.2mg/kg, conventional tracheal intubation was used, and OHMEDA anesthesia machine was connected to control respiration. The respiratory rate was adjusted to 12 times/min, tidal volume was 8 ~ 10ml/kg, and the end expiratory partial pressure of carbon dioxide (PETCO2) was maintained at 30mmHg ~ 35mmHg. During the operation, propofol combined with remifentanil TCI was used to maintain anesthesia. Adjust and maintain anesthesia concentration according to BIS to maintain BIS at 40–60. Propofol and remifentanil were stopped when the hemostatic gauze was filled. After the surgery, the tracheal catheter should be removed after the patient's consciousness is clear, swallowing reflex is restored, and breathing is well restored.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eControlled hypotension method: adjust the dosage of propofol and remifentanil to maintain the BIS at 40–60 during the operation, and adjust the dosage of nitroglycerin to maintain the MAP during the operation in the two groups to reduce about 30% (but not less than 60mmHg) compared with that before anesthesia. Stop pumping dexmedetomidine 10 minutes before the end of the surgery, and stop pumping nitroglycerin at the end of the surgery. If the MAP is less than 60 mmHg during and within 30 minutes after surgery, 20–40 µ g of norepinephrine should be administered; HR \u0026lt; 50 times/min, administration of atropine 0.2–0.5 mg.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMonitoring indicators: HP monitors ECG, ABP, HR, SpO2, PETCO2. The A-2000XPTM BIS Anesthesia Depth Monitor (Aspect, USA) monitors BIS values, recording electrodes Fp1-A1, Fpz grounded, high-frequency 30Hz, filtering range 50 Hz, low-frequency 2 Hz, scanning speed 25 mm/s, impedance \u0026lt; 5000 ohms.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMonitoring time points: Observe and record the invasive mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (T0), at the beginning of hypotension (T1), at the target of hypotension (T2), at the time of extubation (T3), 15 minutes after extubation (T4), and 30 minutes after extubation (T5); The time of reaching the target blood pressure, the dosage of propofol and remifentanil, the dosage of nitroglycerin, the time of extubation and the dosage of antihypertensive drugs after extubation were recorded; VAS score 30 minutes after extubation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStatistical analysis shall be conducted using SPSS statistical software, with measurement data expressed as mean ± standard deviation (‾x ± s). Univariate analysis of variance shall be used for inter group comparison. Count data comparison using χ 2 Inspection. P \u0026lt; 0.05 indicates a statistically significant difference.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e"},{"header":"RESULT","content":"\u003cp\u003eOur research group collected 100 patients undergoing nasal endoscopic surgery under general anesthesia and randomly divided them into a dexmedetomidine experimental group and a saline control group, with 50 patients in each group. These patients met the diagnostic criteria for primary hypertension in the 2010 edition of the Chinese Guidelines for the Prevention and Treatment of Hypertension. They received standardized antihypertensive treatment before surgery and had good blood pressure control (\u0026lt;140/90 mmHg) (1mmHg=0.133 kPa). According to the American Society of Anesthesiologists (ASA) standards, all patients were evaluated as Grade II preoperative condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Faster controlled hypotension with dexmedetomidine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter using the above general anesthesia method for anesthesia, we found through data collection and statistical analysis that patients who used a load dose of dexmedetomidine before surgery and maintained it took shorter time to achieve controlled hypotension target blood pressure compared to patients who used physiological saline control (Figure 1).\u003c/p\u003e\n\u003cp\u003eThis may be related to the vasodilator effect of dexmedetomidine. Enable patients to achieve target blood pressure better and faster under the action of nitroglycerin. Perhaps the analgesic effect also has a certain effect, and reducing the stimulation of pain on patients can better enable them to achieve the goal of controlled hypotension. The use of dexmedetomidine also inhibits sympathetic nerve stimulation, helping patients control hypotension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDexmetomidine Makes Blood Pressure More Stable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who used dexmedetomidine during surgery showed more stable blood pressure during extubation after surgery, and also had more stable blood pressure during anesthesia and resuscitation (Figure 2).\u003c/p\u003e\n\u003cp\u003eAccording to statistics, patients who used dexmedetomidine during extubation had better blood pressure stability compared to patients in the saline control group. Patients in the dexmedetomidine group showed a decrease in blood pressure compared to preoperative rest, which is related to the longer half-life of dexmedetomidine and its continuous provision of sedative, analgesic, and vasodilatory effects. Patients who use physiological saline as control will experience a certain degree of blood pressure fluctuation during extubation. This is not beneficial for patients who have just undergone nasal endoscopic surgery. Nasal endoscopic surgery is a delicate surgery that often uses tamponade compression to stop bleeding, which is more likely to cause poor hemostatic effect and the risk of rebleeding in cases of blood pressure fluctuations. These patients had a decrease in blood pressure compared to their resting state at 15 and 30 minutes after extubation. The dexmedetomidine group showed more stable blood pressure than the saline control group, which may be related to the amount of nitroglycerin used during surgery. With the help of dexmedetomidine, patients can quickly control their target blood pressure, thereby reducing the use of nitroglycerin during surgery. Patients in the physiological saline control group need more nitroglycerin to achieve their target blood pressure. This is also one of the advantages of using dexmedetomidine to assist in controlled hypotension during surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;The Effect Of Dexmedetomidine On Heart Rate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn terms of heart rate, after using dexmedetomidine, the patient\u0026apos;s heart rate will decrease compared to using physiological saline control due to its inhibitory effect on the sympathetic nervous system. This is clearly reflected in the data. (Figure 3)\u003c/p\u003e\n\u003cp\u003eWhen the patient uses dexmedetomidine, the degree of heart rate decrease when controlled hypotension reaches the target is greater than that of the saline control group. The decrease in heart rate is more pronounced, which may have adverse factors for patients with sinus bradycardia or atrioventricular block. However, during extubation, patients in the saline control group showed greater fluctuations in heart rate. This is still related to the relatively long-lasting sedative and analgesic effects of dexmedetomidine. Unfortunately, in terms of performance at 15 and 30 minutes after extubation. The degree of heart rate decrease in the dexmedetomidine group was much greater than that in the saline control group. So the use of dexmedetomidine has an impact on the patient\u0026apos;s heart rate, atrioventricular conduction, and the inhibition of sympathetic nervous system, which cannot be ignored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDexmetomidine Is More Beneficial For Postoperative Resuscitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no significant difference in the time required for extubation between patients using dexmedetomidine and patients in the saline control group after discontinuing general anesthesia and maintaining medication in terms of anesthesia recovery data. Perhaps it suggests that the use of dexmedetomidine as an adjunct to controlled hypotension does not have a significant impact on the time required for extubation. On the contrary, it has certain benefits for blood pressure fluctuations and heart rate fluctuations during extubation. At the same time, there was no significant difference in observation time between the two groups in the anesthesia and resuscitation room. Some patients in the physiological saline control group may not be able to meet the standard for leaving the anesthesia resuscitation room in a timely manner due to poor postoperative blood pressure, and further observation is required after using antihypertensive drugs to reduce blood pressure, which may delay time. (Figure 4)\u003c/p\u003e\n\u003cp\u003eThe sedative and analgesic effects of dexmedetomidine here play a role, allowing patients to more smoothly reach the standard of anesthesia and resuscitation room, with more stable performance. In terms of VAS pain score performance at 30 minutes after surgery, patients who used dexmedetomidine had better postoperative pain relief effect, fewer patients felt pain, and their VAS pain score was lower than that of the saline control group.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eToday, with the gradual development of endoscopic sinus surgery, anesthesiologists need to better serve clinical patients. Nasal endoscopic surgery, as a representative of fine surgery, can cause significant interference to the surgical field even with a small amount of bleeding, affecting the progress and effectiveness of the surgery. Good control of blood pressure reduction is essential during this process. After the surgery begins, it quickly enters the stage of precise operations such as cutting open the mucosa and opening the bone structure. Therefore, it is required that our anesthesiologists achieve satisfactory target blood pressure faster after the surgery begins. The use of dexmedetomidine in controlled hypotension during nasal endoscopic surgery can help us achieve target blood pressure faster than traditional nitroglycerin in a short period of time. After the surgery is completed, endoscopic sinus surgery often uses methods such as tamponade compression and spraying hemostatic powder to stop bleeding. If there is a significant fluctuation in the patient's blood pressure at this time, it is easy to cause poor hemostatic effect and cause further bleeding. The use of dexmedetomidine enables patients to have more stable blood pressure performance during and after extubation, reducing the occurrence of adverse events such as bleeding. And there was no adverse effect on the time required for extubation after discontinuation and the observation time in the resuscitation room. Even a relatively long half-life can provide a certain duration of sedative and analgesic effects, making patients have a more comfortable postoperative experience. Combined with dexmedetomidine's multimodal postoperative analgesia, it is beneficial for patients' rehabilitation and long-term benefits, while also in line with the values of comfortable medical treatment.\u003c/p\u003e \u003cp\u003eHowever, for patients who use dexmedetomidine, it is important to conduct preoperative visits. The results suggest that patients who use dexmedetomidine have a significant impact on heart rate, and inhibition of the sympathetic nervous system can cause a certain degree of decrease in heart rate and affect atrioventricular conduction. In terms of side effects statistics, 8 out of 50 patients in the dexmedetomidine group experienced heart rate below 60 beats per minute, and 1 patient had postoperative hypotension. However, no adverse reactions were found in the 50 patients in the saline control group, and on the contrary, 11 patients with postoperative hypertension appeared. The traditional use of nitroglycerin for controlled hypotension during nasal endoscopic surgery poses a risk of poor postoperative blood pressure control and subsequent bleeding. Therefore, with sufficient preoperative visits and preparation, the use of dexmedetomidine assisted controlled hypotension can play a better role in nasal endoscopic surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTERESTS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi-Sha Ye：Project administration (supporting);Methodology (lead); Writing \u0026ndash; original draft (lead).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYi-Xuan Wang: Methodology (supporting).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBen-Fu Wang: Methodology (supporting).\u003c/p\u003e\n\u003cp\u003eYue-Xi Jin: Methodology (supporting).\u003c/p\u003e\n\u003cp\u003eWen-Lian Ye: Methodology (supporting).\u003c/p\u003e\n\u003cp\u003eTian-Fang Jiang: Formal analysis (lead); Project administration (lead)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;clinical trial registry and clinical trial registration number of our study :\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWenzhou Medical University Eye Hospital \u0026nbsp; 2023-002-K-02-01\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and analyzed during the current study are avail- able from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks for all classmates and mentors for their help and guidance. Thanks for all authors for their assistance in the data collection phase.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING STATEENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWenzhou Science and Technology Bureau, Zhejiang Province, China\u0026nbsp;（Y20220968）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures in this study were conducted in accordance with the regulations of the human Ethics Committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMackay, I.S., \u003cem\u003eEndoscopic sinus surgery\u003c/em\u003e. Ann Acad Med Singap, 1991. 20(5): p.\u0026nbsp;690\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVuncannon, J.R. and S.K. Wise, \u003cem\u003eHemostasis in endoscopic sinus and skull base surgery\u003c/em\u003e. Curr Opin Otolaryngol Head Neck Surg, 2023. 31(1): p.\u0026nbsp;33\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiddle, A.W., P.J. Williamson, and W.H. Gardner, Current Concepts in Management of Obstetric Hemorrhage. Med Times, 1964. 92: p.\u0026nbsp;1235\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu, X., et al., \u003cem\u003eProtective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients\u003c/em\u003e. Acta Cir Bras, 2019. 34(9): p.\u0026nbsp;e201900905.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLang, B., et al., \u003cem\u003eComparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials\u003c/em\u003e. PLoS One, 2020. 15(1): p.\u0026nbsp;e0227410.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRokhtabnak, F., et al., \u003cem\u003eControlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate\u003c/em\u003e. Anesth Pain Med, 2017. 7(6): p.\u0026nbsp;e64032.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuku, R., et al., \u003cem\u003eRandomized Open-Labelled Comparative Evaluation of the Efficacy of Nitroglycerine, Esmolol and Dexmedetomidine in Producing Controlled Hypotension in Spine Surgeries\u003c/em\u003e. Anesth Essays Res, 2019. 13(3): p.\u0026nbsp;486\u0026ndash;491.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3800796/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3800796/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNasal endoscopic surgery is a high-resolution, fine-grained procedure. With the development of nasal endoscopic surgery, the demand for a clear surgical field of vision is gradually increasing. Controlled hypotension technology can effectively reduce intraoperative bleeding and provide a clear visual field for surgery. In hypertensive patients, we use dexmedetomidine as an adjuvant on the basis of traditional nitroglycerin controlled hypotension. The experimental results show that the use of dexmedetomidine can help control blood pressure faster to the target blood pressure, while also exhibiting more stable performance during resuscitation and extubation. Although in terms of heart rate\u003c/p\u003e","manuscriptTitle":"Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 19:10:17","doi":"10.21203/rs.3.rs-3800796/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"750712cf-bf37-4d70-b9e0-988dac963461","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-06T06:59:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-02 19:10:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3800796","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3800796","identity":"rs-3800796","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}