General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture

Abstract

Background: Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures.

Methods: Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups.

Results: Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV.

Conclusions: MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.

Keywords: Dexmedetomidine; General anesthesia; Nasal bone fracture.

Fig. 1

Changes in hemodynamic variables. GA: general anesthesia, MAC: monitored anesthetic care with dexmedetomidine. T0: baseline, T1: after intubation in the GA group or 5 min after dexmedetomidine infusion in the MAC group, T2 and T3: 5 and 10 min after T1, T4: after closed reduction. ^*P < 0.05 between MAC group and GA group. ^†Within group difference compared to baseline (T0) value.