scholarly journals Premedication with clonidine before TIVA optimizes surgical field visualization and shortens duration of endoscopic sinus surgery - results of a clinical trial

2013 ◽  
Vol 51 (3) ◽  
pp. 259-264
Author(s):  
K. Wawrzyniak ◽  
K. Kusza ◽  
J.B. Cywinski ◽  
P.K. Burduk ◽  
W. Kazmierczak
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Systemic Blood Pressure ◽  
Sinus Surgery ◽  
Intraoperative Bleeding ◽  
Oral Clonidine ◽  
Hemodynamic Profile ◽  
Surgical Field ◽  
To Receive ◽  
Mean Time

Background: During functional endoscopic sinus surgery (FESS), intraoperative bleeding can significantly compromise visualization of the surgical field. Clonidine constricts peripheral blood vessels and reduces systemic blood pressure, which in combination decrease nasal mucosa blood flow. This dual effect can potentially reduce bleeding during FESS and stabilize the intraoperative hemodynamic profile of the patient. Aim: The aim of this prospective study was to assess if the quality of the surgical field visualization during FESS was improved when clonidine was used as a premedication agent. Methodology: A group of 44 patients undergoing FESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded by the operating surgeon using the scale proposed by Boezaart. The evaluations were done during surgery at 15 minutes (K1), 30 minutes (K2), 60 minutes (K3) and 120 minutes (K4) after incision. Results: The duration of the surgical procedure was significantly shorter in the clonidine group: mean time of surgery: 80 vs. 96 min in the clonidine and midazolam groups, respectively. Also better quality of surgical field was observed at all time points in the clonidine group. Conclusion: Premedication with clonidine before FESS results in shortening of the surgical time and a better quality of the surgical field.

Comparative Study between Nitroglycerine, Magnesium Sulfate and Dexmedetomidine to Induce Hypotension During Functional Endoscopic Sinus Surgery (FESS)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Adel Mekhael Fahmy ◽  
Ehab HamedAbdel Salam ◽  
Mai MohsenAbdel Aziz ◽  
Egyphillines EmadeldinRizk Taleb
Keyword(s):  
Magnesium Sulfate ◽  
Endoscopic Sinus Surgery ◽  
Sedative Effect ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Syringe Pump ◽  
Controlled Hypotension ◽  
Deliberate Hypotension ◽  
Hemodynamic Profile ◽  
Surgical Field

Abstract Background Functional Endoscopic Sinus Surgery (FESS) has been employed as a surgical intervention to treat chronic rhinosinusitis in patients with no response to drug therapy, during which the surgical vision may be greatly reduced by a small amount of bleeding. There by, the intraoperative controlled hypotension can improve the visibility. While excessive bleeding intraoperative cause serious complications in the postoperative period, including eye socket infections, visual acuity damage, meningeal infections, and other. Objective Induced hypotension limits intra operative (IO) blood loss provides better visibility of the surgical field and diminishes the incidence of major complications during Functional Endoscopic Sinus Surgery (FESS). We aimed at comparing Nitroglycerine; Magnesium Sulfate and Dexmedetomidine for inducing controlled hypotension and evaluate narcotic used, mac of inhalational anesthesia, and Ramsay Sedation Scale (RSS) in the recovery and pre-anesthetic time in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Patients and Methods This study was conducted on 75 patients who underwent elective functional endoscopic sinus surgery (FESS) who matched the inclusion criteria and were randomly allocated into 3 groups each containing 25 patients. The first group received loading dose of dexmedetomidine 1μg/kg infused over 10 min before induction of anesthesia then 0.7 μg/kg/h via syringe pump, second group received nitroglycerine infusion at a dose of 2μg/kg/min according to the response started after induction, intubation, positioning and sterilization of the patient and third group received a loading dose of magnesium sulfate 40 mg/kg over 10 minutes followed by an infusion 15mg/kg/h via syringe pump. Results The result of our study showed that dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Conclusion Dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Dexmedetomidine also showed shorter duration of surgery with less blood loss and favorable frommer score with more surgeon satisfaction. Dexmedetomidine showed longest time to 1st analgesic rescue in PACU comparing with magnesium sulfate and nitroglycerine. So, it’s advised to use dexmedetomidine to induce hypotension than magnesium sulfate and nitroglycerine. However, dexmedetomidine should be used with caution as it caused hypotension and bradycardia, t had sedative effect with low aldert score comparing with nitroglycerine and magnesium sulfate.

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 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.

scholarly journals A role of anesthesiologist in reducing surgical bleeding in endoscopic sinus surgery

Medicina ◽  
2010 ◽  
Vol 46 (11) ◽  
pp. 730 ◽  
Author(s):  
Darius Činčikas ◽  
Juozas Ivaškevičius ◽  
Jonas Martinkėnas ◽  
Svajūnas Balseris
Keyword(s):  
General Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Surgical Bleeding ◽  
Surgical Field ◽  
The Impact

Visibility in the surgical field reduced by bleeding is one of the most important problems of endoscopic sinus surgery. It causes the risk of serious complications and reduces intervention quality. Recently, an increasing number of patients undergo surgical interventions under general anesthesia. Since general anesthesia may influence surgical bleeding in physiological and pharmacological pathways, the role of an anesthesiologist is extremely important in reducing bleeding. The impact of different anesthesia methods on quality of the surgical field is being investigated, and the most effective medicines are being sought.

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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