الفهرس 
Introduction
Spine fusion surgeryOnly 14 pages are availabe for public view
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Abstract
Spine surgeries are associated with significant blood loss, which vary from 10 to 30 mL/kg and its volume depends on the number of spinal levels fused; body weight, surgery for tumors, - and raised intra-abdominal pressure in the prone position.This loss results from decorticated bone and disruption of rich vascular network.
Blood loss in spine surgery has a significant impact on patient morbidity, length of surgery, and total cost. In addition to maintaining patients’ hemodynamics, the control of blood loss is essential in attaining adequate visualization of the surgical field. Due to the proximity of tenuous neurovascular structures, the importance of a dry surgical field cannot be overemphasized. Realizing this goal requires collaboration between surgical and anesthetic teams. Although there is no standardized system for blood sparing, there are a number of techniques and approaches that can be employed to minimize blood loss perioperatively.
Controlled hypotension is among the most widely used techniques for reducing blood loss in various types of surgery including spine surgery.
The aim of this work was to evaluate the effect of preoperative clonidine vs Atenolol on providing optimum surgical field in patients undergoing spine fusion surgery, to minimize intraoperative blood loss and finally to assess intraoperative surgeon satisfaction.
This was a prospective double blinded Randomized clinical study was carried out in orthopedic department, Assiut university Hospitals in the period from April 2016 to April 2017,after taking approval from hospital ethics committee, 60 patients ASA I&II were included in the study were divided into three groups I , II , III of 20 patients each. group I received tab placebo , group II received tab atenolol 50mg , and group III received tab clonidine 100 μg.
The primary outcome of this study was to check The hemodynamic parameters like Heart rate(HR), mean arterial blood pressure(MAP), oxygen saturation(SPO2%), and to measure intraoperative blood loss.
The secondary outcome was to evaluate the surgeon opinion and the quality of the surgical field using the pre-defined average category scale (ACS) at the end of surgical procedure.
Our current results showed that there was no statistically significant difference between three groups regarding age and operation time, also there was any stastistically significant difference between three groups regarding the effect on intraoperative& postop. O2 saturation (spo2%) .
As regard the effect on intraoperative& postop. Heart rate (HR) and mean arterial pressure (MAP) there was more decrease in both in atenolol group II <clonidine group III< control group I.
As regard intraoperative blood loss, and blood transfusion it was noticeable that both were less in group II >group III>group I
As regard surgeon opinion the field was much better in group II than in group III than in group I .
Actually there is no similar studies done before to compare these two drugs in such type of surgery, but some studies used either clonidine alone or atenolol alone with placebo, and some studies compare them in other types of surgeries like ENT, Neurosurgery, maxillofacial surgery, and fibreoptic bronchoscopy so it was difficult to compare our results with the results of these studies.