Faculty Opinions recommendation of Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial.

Purpose: Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. Methods: One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients’ conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. Results: The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). Conclusion: Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

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A Double-Blind Randomized Controlled Trial of Normal Saline, Lactated Ringer's, and Hypertonic Saline Nasal Irrigation Solution after Endoscopic Sinus Surgery

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2014.28.4031 ◽

2014 ◽

Vol 28 (3) ◽

pp. 225-231 ◽

Cited By ~ 34

Author(s):

Tsu-Hui Low ◽

Charmaine M. Woods ◽

Shahid Ullah ◽

A. Simon Carney

Keyword(s):

Randomized Controlled Trial ◽

Hypertonic Saline ◽

Normal Saline ◽

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Sinus Surgery ◽

Double Blind ◽

Nasal Irrigation ◽

Randomized Controlled ◽

Irrigation Solution

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Intravenous Esmolol Infusion Improves Surgical Fields during Sevoflurane-Anesthetized Endoscopic Sinus Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2011.25.3701 ◽

2011 ◽

Vol 25 (6) ◽

pp. e208-e211 ◽

Cited By ~ 16

Author(s):

Ping-Hung Shen ◽

Erik Kent Weitzel ◽

Jen-Tsung Lai ◽

Peter-John Wormald ◽

Chee-Sang Ho

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Sinus Surgery ◽

Constant Infusion ◽

Saline Control ◽

Control Group ◽

Double Blind ◽

The Impact

Background There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. Methods A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Results Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p < 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Conclusion Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

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