7. Carinci F, Farina A, Zanetti U, et al. Alveolar ridge augmentation: a comparative longitudinal study between calvaria and iliac crest bone grafts. J Oral Implantol 2005;31:39Y45 8. Patel MF, LangdonJD. Titanium mesh (TiMesh) osteosynthesis: a fast and adaptable method of semi-rigid fixation. Br J Oral Maxillofac Surg 1991;29:316Y324 9. Raveh Y, Stich H, Sutter F, et al. New concepts in the reconstruction of mandibular defects following tumor resection. J Oral Maxillofac Surg 1983;41:3Y16 10. Neumann A, Kevenhoerster K. Biomaterials for craniofacial reconstruction. GMS Curr Top Otorhinolaryngol Head Neck Surg 2009;8:Doc08 Does Oral Clonidine Premedication Decrease Bleeding During Open Rhinoplasty? Reza Tabrizi, DMD, MD,* Hamidreza Eftekharian, MD,Þ Freydoun Pourdanesh, DMD,þ Mohammad Saleh Khaghaninejad, DMD§ Abstract: This uniYblind randomized clinical trial study investi- gated the effect of clonidine premedication on preoperative blood loss during open rhinoplasty. The subjects were randomly divided into 2 groups. The members of the first group received oral cloni- dine as a single dose (0.2 mg) 2 hours before the induction of general anesthesia, whereas the members of the second group received a placebo. All subjects underwent open rhinoplasty without septoplasty. One anesthetic protocol was followed for all subjects. Variable factors include the subjects’ weight, age, sex, and blood pressure during the surgery as well as blood loss during rhinoplasty. Group 1 consisted of 22 women and 11 men, whereas group 2 was composed of 16 women and 17 men. The mean for blood loss amounted to 68.03 T 22.49 mL for group 1 and 132.12 T 78.53 mL for group 2. An assessment demonstrated a significant difference in blood loss between the 2 groups (P G 0.001.) Oral clonidine premedication thus may decrease preoperative bleeding during open rhinoplasty. Key Words: Clonidine, blood loss, rhinoplasty, premedication C lonidine is a centrally and peripherally acting >-2 adrenergic agonist antihypertensive agent that causes reduced sympathetic activity and increased vagal tone. 1 Clonidine has been administered to provide hemodynamic stability during the perioperative period. 2 In addition, clonidine can decrease anesthetic and analgesic re- quirements during surgery. 3 The main routes used preoperatively are the oral and epidural routes. Oral clonidine has been shown to de- crease the need for analgesia during and after surgery under general anesthesia. 4 The preoperative stress response results in the release of cate- cholamines with tachycardia, hypertension, and activation of blood coagulation promoting serious preoperative complications. 5 By at- tenuating the sympathetic outflow, clonidine and other >-2 agonists have been shown to reduce the perioperative stress response. 6,7 The particular mechanism by which clonidine improves outcomes is un- known. Clonidine may cause a decrease in perioperative blood loss. 8,9 Clonidine premedication augments the pressor and tachycardiac responses to ephedrine. 10 Rhinoplasty is a common aesthetic pro- cedure that is not associated with excessive blood loss. However, proper homeostasis is essential for a surgical field that is free of excessive blood, reduced postoperative swelling, and appropriate surgical results. The aim of the current study was to evaluate the effect of oral clonidine premedication on perioperative blood loss during open rhinoplasty. MATERIALS AND METHODS This was a uniYblind randomized clinical trial study. The study sample was derived from candidates for rhinoplasty at Chamran Hospital between September 1, 2010 and October 31, 2012. This study was approved by the research committee of the medical ethics group at Shiraz University of Medical Science. Subjects eligible for study inclusion were in the American Soci- ety of Anesthesiology I category and underwent primary open rhi- noplasty between 18 and 35 years of age. Subjects who had had other operations in conjunction with rhinoplasty were excluded from the study. Subjects were randomly allocated according to randomi- zation lists. The study subjects were randomly divided into 2 groups of 33 subjects each: the members of group 1 received oral clonidine as a single dose (0.2 mg) 2 hours before the induction of general anesthesia, whereas the members of group 2 received a placebo. All of the subjects were monitored for heart rate, noninvasive blood pres- sure, and O 2 saturation. The operation time and blood loss were docu- mented for both groups. Operation time was defined as encompassing the first incision through closure of the incisions and dressing the sur- gical site. Systolic and diastolic blood pressures were measured begin- ning at the onset of the surgery in 5-minute intervals until the end of the operation. The mean systolic and mean diastolic blood pressures were calculated by dividing the sum of the systolic and diastolic blood pressures by the number of measurements. Blood loss was determined by the accumulation of blood in a surgical suction unit (in milliliters). Moreover, the x-rayYdetectable gauze (4 Â 4 cm) was weighed. An increase in gauze weight of 1 gram was considered to be equivalent to a blood loss of 1 mL. All piece of bloody gauze was weighed, and the weights were recorded both before and after the surgery. Each piece of gauze was saved to be weighed in a Beex container to pre- vent the evaporation of fluids from the gauze. Both groups were given a ringer solution (5Y7 mL/kg) in the preinduction anesthesia phase. A total of 3.6 mL of local anesthesia (lidocaine 2% with epinephrine 1/80000) was used as a local infiltration during standardized surgi- cal procedures 10 minutes before the operation to reduce bleeding. The same anesthetic protocol was followed for all subjects. Propofol (2.5 mg/kg) and remifentanil (3 Kg/kg) were used for the induction. Propofol (100 Kg/kg per minute) and remifentanil(0.1 Kg/kg per minute) were infused for anesthetic maintenance during the operation. All sub- jects received N 2 O and O 2 (50%) during the operation. From the *Department of Maxillofacial Surgery, Shahidbeheshti University of Medical Science, Tehran; †Department of Anesthesiology, Shiraz University of Medical Science, Shiraz; ‡Department of Maxillofacial Surgery, Shahidbeheshti University of Medical Sciences, Tehran; and §Department of Maxillofacial Surgery, Shiraz University of Medical Science, Shiraz, Iran. Received September 13, 2013. Accepted for publication December 26, 2013. Address correspondence and reprint requests to Reza Tabrizi, DMD, MD, Oral and Maxillofacial Surgery Department, Shahidbeheshti Dental School, Velenjak, Tehran, Iran; E-mail: Tabmed@gmail.com The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000660 The Journal of Craniofacial Surgery & Volume 25, Number 3, May 2014 Brief Clinical Studies * 2014 Mutaz B. Habal, MD 1101 Copyright © 2014 Mutaz B. Habal, MD. 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