Efficacy of Dexmedetomidine versus Propofol in Patients Undergoing Endoscopic Transnasal Transsphenoidal Pituitary Tumor Resection

Background: Dexmedetomidine is associated with good perioperative hemodynamics together with decreased opioid requirements. Furthermore, propofol has been used to achieve hypotensive anesthesia as a part of total intravenous anesthesia. Aims: This study was performed to compare dexmedetomidine and propofol on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumors. Patients and Methods: A total of 110 cases were included in this prospective randomized study. They were randomized into two equal groups; Group D commenced on Dexmedetomidine, and Group P, which received propofol. Comparing intraoperative hemodynamic parameters and the Boezaart Bleeding Scale was our primary outcome. The secondary outcomes included isoflurane and propranolol consumption, recovery, postoperative analgesic profile. Statistical Analysis: IBM's SPSS Statistics (Statistical Package for the Social Sciences) for Windows (version 25, 2017) was used for the statistical analysis of the collected data. Shapiro–Wilk test was used to check the normality of the data distribution. The quantitative variables were expressed as mean and standard deviation, whereas the categorical variables were expressed as frequency and percentage. Independent sample t and Mann − Whitney tests were used for the comparison of parametric and nonparametric continuous data, respectively. For pair-wise comparison of data (within-subjects), the follow-up values were compared to their corresponding basal value using the paired samples t-test or Wilcoxon matched-pairs signed-ranks test. Fisher exact and Chi-square tests were used for inter-group comparison of nominal data using the crosstabs function. Results: Age, gender, body mass index, and systemic comorbidities did not significantly differ between the two groups. Furthermore, heart rate and blood pressure were comparable at baseline, during operation, and after extubation. Boezaart score, blood loss, isoflurane, and propranolol consumption were also comparable between the two groups. Group D expressed significantly longer emergence and extubation times than Group P. Nevertheless, cases in the same group expressed lower Visual Analog Scale values and postoperative analgesic requirements. Conclusion: Although Dexmedetomidine and propofol are associated with comparable intraoperative hemodynamic changes, the former drug appears to be superior regarding pain control, postoperative analgesic requirement.