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

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.

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

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i1.45340 ◽

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

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

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i1.45328 ◽

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

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

Biomedicine Hub ◽

10.1159/000497045 ◽

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.

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Regelung des mittleren arteriellen Blutdrucks im Rahmen einer kontrollierten Hypotension (Control of Mean Arterial Blood Pressure for Controlled Hypotension)

at - Automatisierungstechnik ◽

10.1524/auto.2005.53.12.573 ◽

2005 ◽

Vol 53 (12/2005) ◽

Author(s):

Chi-Ngon Nguyen ◽

Olaf Simanski ◽

Ralf Kähler ◽

Agnes Schubert ◽

Matthias Janda ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Blood Pressure ◽

Mean Arterial Blood Pressure ◽

Controlled Hypotension ◽

Arterial Blood

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Randomized Trial of Hypotensive Epidural Anesthesia in Older Adults

Anesthesiology ◽

10.1097/00000542-199910000-00011 ◽

1999 ◽

Vol 91 (4) ◽

pp. 926-926 ◽

Cited By ~ 114

Author(s):

Pamela Williams-Russo ◽

Nigel E. Sharrock ◽

Steven Mattis ◽

Gregory A. Liguori ◽

Carol Mancuso ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Blood Loss ◽

Elderly Patients ◽

Arterial Blood Pressure ◽

Epidural Anesthesia ◽

Mean Arterial Blood Pressure ◽

Pressure Management ◽

Blood Pressure Management ◽

Arterial Blood

Background Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients. Methods This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement. Results The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates. Conclusions Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.

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

Anesthesiology and Pain Medicine ◽

10.5812/aapm.108915 ◽

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.

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