scholarly journals Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

2021 ◽  
Vol 10 (20) ◽  
pp. 4683
Author(s):  
Michał Jan Stasiowski ◽  
Izabela Szumera ◽  
Piotr Wardas ◽  
Seweryn Król ◽  
Jakub Żak ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Hemodynamic Instability ◽  
Sinus Surgery ◽  
Remifentanil Infusion ◽  
State Entropy ◽  
Anesthetic Drugs ◽  
Group A ◽  
Surgical Field ◽  
The Cost

Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 514-520 ◽  
Author(s):  
Peter J. Wormald ◽  
Graham van Renen ◽  
Jonathon Perks ◽  
Janine A. Jones ◽  
Claire D. Langton-Hewer
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Allergic Fungal Sinusitis ◽  
Surgical Field

Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

An Evaluation of Effect of Pterygopalatine Fossa Injection with Local Anesthetic and Adrenalin in the Control of Nasal Bleeding during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (3) ◽  
pp. 288-292 ◽  
Author(s):  
Peter-John Wormald ◽  
Theodore Athanasiadis ◽  
Guy Rees ◽  
Simon Robinson
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Pterygopalatine Fossa ◽  
Sinus Surgery ◽  
Arterial Blood ◽  
Significant Difference ◽  
Nasal Bleeding ◽  
Surgical Field ◽  
The Difference ◽  
End Tidal

Background The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery. Methods A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation. Results At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade. Conclusion Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.

scholarly journals Arnica Montana and Blood Loss, Surgical Field Bleeding and Operative Time in Endoscopic Sinus Surgery: A Randomized-Controlled Trial

2016 ◽  
Vol 31 (1) ◽  
pp. 14-16
Author(s):  
Michael Luke T. Salinas ◽  
Charmagne Ross E. Bato
Keyword(s):  
Blood Loss ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Operative Time ◽  
Controlled Trial ◽  
Sinus Surgery ◽  
Arnica Montana ◽  
Surgical Field ◽  
Grade 3

OBJECTIVE: To determine the association of Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery among adults with chronic rhinosinusitis with nasal polyposis. METHODS: STUDY DESIGN: Single-blinded Randomized Controlled Trial SETTING:     Tertiary government hospital PARTICIPANTS: Forty-one (41) adults aged 19-76 years old with chronic rhinosinusitis with nasal polyposis and meeting inclusion criteria were randomly divided into two groups, Arnica and control. The former took 5 sublingual Boiron® Arnica montana 30C pellets, 12 hours then 1 hour prior to surgery; the latter did not. Both groups had routine oxymetazoline and lidocaine-epinephrine decongestion. Intraoperative blood loss, surgical field bleeding quality and operative time were assessed by blinded surgeons and anesthesiologists. RESULTS: Mean estimated blood loss was 187ml (SD 100.14) for controls versus 72ml (SD 12.59) for the Arnica group; (p < 0.05). Mean operative time was 3.55 hours (SD 1.25) for controls and 3.44 hours (SD 1.57) for the Arnica group; (p=0.9). Surgical field bleeding was graded slight with 75% needing occasional suctioning (grade 2) and 25% needing frequent suctioning (grade 3) in the Arnica group, versus moderate bleeding with more frequent suctioning (grade 4) in 71% and slight bleeding but needing frequent suctioning (grade 3) in 29% of controls. CONCLUSION: In this randomized clinical trial, Arnica montana was associated with less blood loss and less surgical field bleeding compared to controls, but there was no difference in mean operative times.  Arnica montana may be effective in reducing blood loss and improving surgical field quality during endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. KEYWORDS: Arnica montana, hemostasis, surgical

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 Assessment of Nasal Airflow and Pain, Safety and Cost of an Improvised Nasal Airway (Nasogastric) Tube After Endoscopic Sinus Surgery

2020 ◽  
Vol 35 (2) ◽  
pp. 22
Author(s):  
Josephine Grace Rojo ◽  
Rachel Zita Ramos
Keyword(s):  
Pain Score ◽  
Postoperative Period ◽  
Nasogastric Tube ◽  
Endoscopic Sinus Surgery ◽  
Nasal Packing ◽  
Sinus Surgery ◽  
Nasal Airway ◽  
Nasal Airflow ◽  
Significant Difference ◽  
Group A

ABSTRACT Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods:Design: Quasi - Experimental Prospective Cohort StudySetting: Tertiary Government Training HospitalParticipants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.

scholarly journals The effect of magnesium sulfate on surgical field during endoscopic sinus surgery

Medicine ◽  
2019 ◽  
Vol 98 (28) ◽  
pp. e16115
Author(s):  
Wei Liu ◽  
Hong Jiang ◽  
Hong Pu ◽  
Dongli Hu ◽  
Yinglong Zhang
Keyword(s):  
Magnesium Sulfate ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Surgical Field
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