scholarly journals Metoprolol Significantly Improves Visual Clarity and Hemodynamic Parameters during Functional Endoscopic Sinus Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 1-8
Author(s):  
Ahmed A. Sadek ◽  
Mokhtar Mostafa ◽  
Tarek Abdel-Monem
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Study ◽  
Double Blind ◽  
Arterial Blood ◽  
Surgical Field ◽  
Group 2

Background and Objectives: The success of functional endoscopic sinus surgery (FESS) depends on the visual clarity of the surgical field, which is understudied. Controlled hypotension has many advantages for FESS including reduction in blood loss and improved quality of the surgical field. This study determined whether the use of β-blockers as a premedication could improve the operative field in FESS. Methods: Sixty patients aged from 18 to 50 years, undergoing septoplasty and FESS were included in this prospective, randomized, double-blind, placebo-controlled study. Patients were randomly assigned to receive either metoprolol (100 mg, group 1) or a placebo (a vitamin tablet, group 2) 60 min before surgery. Results: The average blood loss and surgery duration were not significantly higher in the placebo group. The surgical field was graded using the Fromme-Boezaart scale, and it was significantly clearer (p < 0.001) in metoprolol group. The mean arterial blood pressure was significantly lower in the metoprolol group after 30 min of induction until the end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in those who received metoprolol from before induction of anesthesia up to the end of surgery. Conclusion: Metoprolol significantly improves visual clarity and hemodynamics during FESS. We would recommend the use of metoprolol in FESS and septoplasty.

The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

2007 ◽  
Vol 105 (5) ◽  
pp. 1404-1409 ◽  
Author(s):  
Vladimir Nekhendzy ◽  
Hendrikus J. M. Lemmens ◽  
Winston C. Vaughan ◽  
Edward J. Hepworth ◽  
Alexander G. Chiu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Intraoperative Blood Loss ◽  
Surgical Field

scholarly journals Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Comparative study of Dexmedetomidine and Esmolol

2020 ◽  
Vol 24 (1) ◽  
pp. 37-49
Author(s):  
Md Shafiul Alam Shaheen ◽  
AKM Nurnobi Chowdhury ◽  
Kawsar Sardar ◽  
Mushfiqur Rahman ◽  
Sudhangshu Shekhar Biswas ◽  
...  
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sedation Score ◽  
Sinus Surgery ◽  
Effective Control ◽  
Controlled Hypotension ◽  
Fentanyl Consumption ◽  
Surgical Field ◽  
Group D

Background: Functional endoscopic sinus surgery (FESS) requires effective control of bleeding for better visibility of the operating field and reduced risk of injury to the optic nerve or the internal carotid artery. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objectives: Our study is undertaken to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS). Methods: Sixty (60) patients 20 – 50 years of age, ASA I/II scheduled for FESS were randomly assigned to two equal groups of 30 patients each. Patients of group D received dexmedetomidine 1µg/kg over 10 min before induction of anesthesia followed by 0.4 – 0.8 µg/kg/hr infusion during maintenance and group E received esmolol loading dose 1mg/kg was infused over one min followed by 0.4 – 0.8 mg/kg/hr infusion during maintenance to maintain mean arterial blood pressure (MAP) between (55 – 65 mmHg). The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP, HR); intraoperative fentanyl consumption and total recovery from anesthesia (Aldrete’s score ≥9) were recorded. Sedation score was determined at 10, 20, 30, 40 & 60 min after tracheal extubation and time to first analgesic demand was also recorded. Results:In both group D and group E reached the desired MAP (55–65 mmHg) with no inter group difference in MAP or HR. Mean intraoperative fentanyl consumption was significantly lower in group D than group E. Recovery time to achieved Aldrete’s score ≥9 were significantly lower in group E compared with group D.The sedation score were significantly lower in group E compared with group D at 10 minutes, 20 minutes and 30 minutes postoperatively. Time to first analgesic demand was significantly longer in group D. Conclusion: The result of this study showed that both dexmedetomidine and esmolol can be used as agents for controlled hypotension and are effective in providing ideal surgical field during FESS. But dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 37-49

scholarly journals Oral clonidine: an effective adjuvant in functional endoscopic sinus surgery

2017 ◽  
Vol 6 (11) ◽  
pp. 2631 ◽  
Author(s):  
Amit Kumar Ray ◽  
Anjana Basu Ghosh Dastidar ◽  
Bani P. M. Hembrom
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Category Scale ◽  
Sinus Surgery ◽  
Nasal Surgery ◽  
Oral Clonidine ◽  
Arterial Blood ◽  
Surgical Field ◽  
Group D ◽  
Endoscopic Nasal Surgery

Background: A comparative study to evaluate the efficacy of intravenous Dexmedetomidine as a hypotensive agent in comparison to oral Clonidine in Endoscopic Nasal Surgery or Functional Endoscopic Sinus Surgery (FESS).Methods: Forty patients ASA I or II scheduled for Endoscopic Nasal Surgery were equally randomly assigned to receive either dexmedetomidine 1μg/Kg over 10 min before induction of anesthesia followed by 0.5μg/Kg/h infusion during maintenance (Group D), or oral Clonidine (Group C) 2µg/kg with minimal water 1 hour prior starting of surgery. Rescue bolus doses of Propofol (10mg/dose) were given to maintain mean arterial blood pressure (MAP) between (50-70mmHg). General anesthesia was maintained with Isoflurane 1%-2%. The surgical field was assessed using Average Category Scale. Hemodynamic variables (MAP and HR) were recorded at 10 minutes interval.Results: Both group C and group D reached the desired MAP (50-70mmHg) with no intergroup differences in HR but a statistically significant lower MAP was noticed in group C. The quality of the surgical field in the range of MAP (50-70mmHg) were 2-3 as per average category Scale with significantly lower score in Group C. Mean intraoperative propofol consumption was significantly higher in group D than C group.Conclusions: Both Dexmedetomidine or oral clonidine with isoflurane are safe agents for controlled hypotension, but oral clonidine provides lower MAP and better surgical field. Compared with Dexmedetomidine, oral clonidine offers the advantage of less consumption of propofol.

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