Comparison of Laryngeal Mask with Endotracheal Tube for Anesthesia in Endoscopic Sinus Surgery

2008 ◽  
Vol 22 (6) ◽  
pp. 653-657 ◽  
Author(s):  
Ahmed Atef ◽  
Ahmed Fawaz
Keyword(s):  
Endotracheal Tube ◽  
Endoscopic Sinus Surgery ◽  
Laryngeal Mask ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Group I ◽  
Surgical Conditions ◽  
American Society ◽  
American Society Of Anesthesiologists

Background The purpose of this study was to compare surgical conditions, including the amount of intraoperative bleeding as well as intraoperative blood pressure, during functional endoscopic sinus surgery (FESS) using flexible reinforced laryngeal mask airway (FRLMA) versus endotracheal tube (ETT) in maintaining controlled hypotension anesthesia induced by propofol-remifentanil total i.v. anesthesia (TIVA). Methods Sixty normotensive American Society of Anesthesiologists I—II adult patients undergoing FESS under controlled hypotension anesthesia caused by propofol-remifentanil-TIVA were randomly assigned into two groups: group I, FRLMA; group II, ETT. Hemorrhage was measured and the visibility of the operative field was evaluated according to a six-point scale. Results Controlled hypotension was achieved within a shorter period using laryngeal mask using lower rates of remifentanil infusion and lower total dose of remifentanil. Conclusion In summary, our results indicate that airway management using FRLMA during controlled hypotension anesthesia provided better surgical conditions in terms of quality of operative field and blood loss and allowed for convenient induced hypotension with low doses of remifentanil during TIVA in patients undergoing FESS.

scholarly journals Role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery in Private Practice

2020 ◽  
Vol 24 (1) ◽  
pp. 8-13
Author(s):  
Md Nurullah ◽  
Md Arif Hossain Bhuyan ◽  
Syed Ariful Islam ◽  
Md Shah Alam
Keyword(s):  
Heart Rate ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications. Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objective: The objective of study was role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery and designed to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia. Methods: Prospective randomized study includes a total of 60 ASA I-II patients who underwent elective FESS surgery. Patients randomly assigned in two groups the hypotension group (Group A) and the normotension group (Group B). Intraoperative mean arterial pressure (MAP), heart rate (HR) were recorded. Results : This study shows the mean ages of the patients of group A group B were 33.36±7.61 and 32.46±7.73 years respectively. No statistically significant difference was observed among groups at 0.05 level in term of age. The mean heart rate pre-anaesthesia and preoperative among the patients of different groups in different follows up period. Significance differences were observed among groups in term of heart rate at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. The mean arterial mean blood pressure before pre-anaesthesia and preoperative estimation among the patients of different groups in different follows up period. Significance differences were observed among groups at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. Conclusion: This study demonstrated that Controlled hypotension can be achieved equally and effectively by nitroglycerin and labetalol reduced significantly intraoperative hemorrhage and produce hypotensive anesthesia. Both are equally effective in providing ideal surgical field during functional endoscopic sinus surgery (FESS). Bangladesh J Otorhinolaryngol; April 2018; 24(1): 8-13

Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial

2008 ◽  
Vol 122 (7) ◽  
pp. 691-695 ◽  
Author(s):  
K Kaygusuz ◽  
A Yildirim ◽  
I Ozdemir Kol ◽  
S Gursoy ◽  
C Mimaroglu
Keyword(s):  
Mean Arterial Pressure ◽  
Visual Analogue Scale ◽  
Blood Loss ◽  
Arterial Pressure ◽  
Endoscopic Sinus Surgery ◽  
Analogue Scale ◽  
Sinus Surgery ◽  
Operative Field ◽  
Surgical Conditions

AbstractObjective:To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery.Design:Randomised, double-blinded clinical study.Subjects:Sixty-four patients were scheduled for elective tympanoplasty or endoscopic sinus surgery. The patients were randomly divided into two groups: desflurane or isoflurane. After anaesthesia induction, all patients received a continuous remifentanil infusion of 0.2–0.5 µg/kg/min until a mean arterial pressure of 65–75 mmHg was achieved. Heart rate and mean arterial pressure were recorded throughout anaesthesia. Blood loss was measured at the end of surgery. Achievement of a bloodless operative field was rated on a 100 mm visual analogue scale. Following completion of surgery, the time to extubation and to achievement of an Aldrete score of nine or more was recorded.Results:Sixty-three patients were evaluated. The total dose of remifentanil and the total blood loss were similar in both groups (p > 0.05). Time to extubation and to an Aldrete score of nine or more for the desflurane group was significantly less than for the isoflurane group (p < 0.05). No differences were found in the extent of achievement of a bloodless operative field, as assessed via visual analogue scale, comparing the study groups (p > 0.05).Conclusion:Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.

scholarly journals Comparison between Phentolamine and Nitroglycerin for Controlled Hypotension during Functional Endoscopic Sinus Surgery

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Arterial Blood

Background: Intraoperative bleeding is one of the most common complications in Functional endoscopic sinus surgery. Controlled hypotension is a method to minimize surgical blood loss and enhance the operative field visibility. The objective of this study was to compare the efficacy of controlled hypotensive anesthesia with intravenous infusion of phentolamine versus nitroglycerin as regarding intraoperative blood loss and hemodynamic stability. Methods: This current randomized study enrolled 30 patients candidate for Functional endoscopic sinus surgery at Beni-suef university hospital, in 2 equal groups receiving either 0.5 to 10 μg/kg/minute nitroglycerin or 0.1 to 2 mg/minute phentolamine to achieve a mean arterial blood pressure (MAP) of about 50 to 65 mmHg. Mean arterial blood pressure, amount of blood loss and the quality of surgical field using the 0-5 point bleeding scale were recorded. Results: Based on the current study findings, the two drugs produced the desired hypotension on the same time point; there were no significant differences between the study groups regarding the volume of bleeding and operative field visibility. Conclusions: Nitroglycerin and Phentolamine are safe, efficient and might be advisable option for deliberate hypotensive anesthesia throughout Functional endoscopic sinus surgery. Phentolamine can be a good alternative to Nitroglycerin in reduction of MAP during this procedure.

scholarly journals Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 123 ◽  
Author(s):  
Monica Goyal ◽  
Akanksha Dutt ◽  
Anjum S Khan Joad
Keyword(s):  
Laryngeal Mask Airway ◽  
Index Finger ◽  
Elective Surgery ◽  
Study Groups ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Insertion Technique ◽  
Group I ◽  
American Society ◽  
American Society Of Anesthesiologists

We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity were assessed in both study groups. On statistical analysis, both groups were comparable in all respects. From our study it can be concluded that thumb insertion is an effective insertion technique for the LMA Classic™.

scholarly journals To Compare the Efficacy of Dexmedetomidine Versus Labetalol in Providing Controlled Hypotension in Functional Endoscopic Sinus Surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sujay J N ◽  
Shiva Kumar ◽  
Tanushree Vijay
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
P Value ◽  
Controlled Hypotension ◽  
Hemodynamic Stability ◽  
Operative Field ◽  
Field Methods ◽  
Surgical Field ◽  
Group D

Background: Functional endoscopic sinus surgery (FESS) is a surgical intervention for sinus diseases. Bleeding is a common concern during FESS. Hemodynamic stability and quality surgical field visibility help to achieve the best outcomes. Objectives: The present study primarily intended to compare the effectiveness of dexmedetomidine versus labetalol in providing controlled hypotension during FESS and then to assess the quality of the surgical field. Methods: The current research was conducted as a prospective randomized double-blinded clinical study. Sixty patients of the American Society of Anesthesiologists grade I or II status undergoing FESS under general anesthesia were divided into two groups, each with 30 members. Patients receiving dexmedetomidine and labetalol were named as group D and L, respectively. The study intended to manage mean arterial pressure (MAP) between 65 - 75 mmHg. The visibility of the operative field was evaluated using Fromme and Boezaart scoring system. Total intraoperative fentanyl consumption and postoperative first analgesic request time were recorded. Results: The MAP target was achieved in both groups. Intergroup differences concerning MAP were observed in both D (75.0 ± 2.0) and L (82.4 ± 5.2) groups (P-value < 0.05). Scores for blood loss were significantly lower in the D group (1.3 ± 0.3) compared to the L group (2.1 ± 0.3) (P-value < 0.05). There was no intergroup difference concerning the mean heart rate (group D; 70.8 ± 4.2, and group L; 73.4 ± 4.4). The total dose of fentanyl consumed was found to be significantly lower in the group D (41.9 ± 5.8) compared to group L (59.9 ± 5.3) (P-value < 0.05). The first analgesic request time was significantly longer in the group D (50.2 ± 9.1) compared to group L (24.8 ± 5.1) (P-value < 0.05). Conclusions: Dexmedetomidine provided better hemodynamic stability and operative field visibility as compared to labetalol during FESS.

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 Effect of Intravenous Dexamethasone on Propofol Injection Pain: A Randomized Placebo Controlled Study

2020 ◽  
Vol 25 (1) ◽  
pp. 28-33
Author(s):  
Muhammad Sazzad Hossain ◽  
Md Afzalur Rahman ◽  
Mamunur Rashid ◽  
Monirul Islam ◽  
Anisur Rahman Babu ◽  
...  
Keyword(s):  
Normal Saline ◽  
Saline Group ◽  
Controlled Study ◽  
Injection Pain ◽  
Moderate Pain ◽  
Dexamethasone Group ◽  
Group I ◽  
Elective Surgical Procedure ◽  
American Society ◽  
American Society Of Anesthesiologists

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexamethasone group than the saline group (p<0.05). The incidence of mild and moderate pain in dexamethasone groups versus saline group was 30% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with intravenous dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain on propofol injection (POPI). Bangladesh J Otorhinolaryngol; April 2019; 25(1): 28-33

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