scholarly journals A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia

2015 ◽  
Vol 53 (2) ◽  
pp. 107-115
Author(s):  
A. Cardesin ◽  
C. Pontes ◽  
R. Rosell ◽  
Y. Escamilla ◽  
J. Marco ◽  
...  
Keyword(s):  
Sinus Surgery ◽  
Double Blind ◽  
Intraoperative Bleeding ◽  
Hypotensive Anaesthesia ◽  
Video Recordings ◽  
Double Blind Clinical Trial ◽  
Duration Of Surgery ◽  
Vas Scores ◽  
Surgical Field ◽  
Operating Surgeon

Background: Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. Methods: A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. Results: A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. Conclusion: The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

scholarly journals A Comparative Study of Nitroglycerine and Dexmedetomidine for Induced Hypotension in Functional Endoscopic Sinus Surgery

2020 ◽  
Vol 7 (49) ◽  
pp. 2948-2953
Author(s):  
Shruthi M. Shah ◽  
Nidhi Shrenikbhai Reshamwala ◽  
Aakanksha Sanjay Raval ◽  
Krimal Rahulkumar Shah ◽  
Yash Rajendrabhai Joshi
Keyword(s):  
Sinus Surgery ◽  
Haemodynamic Response ◽  
Randomised Control Trial ◽  
Emergence Time ◽  
Induced Hypotension ◽  
Physiological Limits ◽  
Haemodynamic Stability ◽  
Duration Of Surgery ◽  
Surgical Field ◽  
Group D

BACKGROUND We wanted to evaluate the efficacy of IV nitroglycerine and IV dexmedetomidine in achieving and maintaining induced hypotension in patients undergoing FESS under general anaesthesia, compare haemodynamic response in terms of heart rate, blood pressure, mean arterial pressure, compare clarity of the surgical field, compare the effect on duration of surgery and study the intraoperative and postoperative complications, if any. METHODS This is a randomised control trial conducted from 01/01/2018 to 31/12/2018 among 50 patients, ASA 1 & 2 undergoing FESS. They were randomly divided into 2 groups - group D (an infusion of dexmedetomidine was started with a loading dose of 1 μg / Kg over 10 min and thereafter was maintained between 0.5 - 1.0 μg / Kg / h) and group N (an infusion of nitroglycerine was started at the rate of 0.5 μg / Kg / min and was maintained between 0.5 - 2.0 μg / Kg / min). Haemodynamic data was recorded. Both the infusions were titrated to maintain a MAP between 65 and 75 mmHg. The visibility of the surgical site was checked by the surgeon at every 30 minutes using the Fromme and Boezaart scale. RESULTS Both groups consisted of 25 patients each and were demographically similar. In both groups heart rates remained within normal physiological limits, not requiring any pharmacological treatment. Both groups had comparable average MAP during surgery. The group D showed desirable attenuation of haemodynamic response at the time of intubation as well as at extubation. Both groups had comparable duration of surgery. Both the drugs were equally effective in creating clear surgical fields to the surgeons’ satisfaction. Dexmedetomidine provided better intraoperative analgesia and reduced requirement of incremental fentanyl as compared to nitroglycerine. Emergence time was significantly higher in dexmedetomidine group. CONCLUSIONS Both the groups provided comparable clarity of surgical field with comparable haemodynamic parameters during surgery. dexmedetomidine provided better haemodynamic stability and an additional benefit of reduced requirement of intraoperative supplemental analgesia. KEYWORDS Induced hypotension, FESS, Dexmedetomidine, Nitroglycerine

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.

scholarly journals Experimental justification of laser parameters for preventive laser (970 nm) vessel coagulation in intraoperative bleeding

2019 ◽  
Vol 17 (4) ◽  
pp. 57-61
Author(s):  
E. E. Kozyreva ◽  
M. A. Ryabova
Keyword(s):  
Diode Laser ◽  
Laser Power ◽  
Vascular Wall ◽  
Intraoperative Bleeding ◽  
Delayed Bleeding ◽  
Small Vessels ◽  
Vascular Bed ◽  
Duration Of Surgery ◽  
Experimental Justification ◽  
Surgical Field

Intraoperative bleeding impairs visualization of the surgical field. Working in a practically bloodless operating field reduces the duration of surgery and reduces the need for cautery use, which reduces pain in the postoperative period and the risk of delayed bleeding after tonsillectomy.Objective – to select the parameters of a diode laser with a wavelength of 970 nm in order to get optimal hemostatic effect and to develop a technique for safe preventive coagulation of vessels in the surgical wound using diode laser with a wavelength of 970 nm for their bloodless section.Materials and methods. 47 Wistar rats weighing 300–400 g were used in the experiment. After preparation of the surgical field, three groups of vessels were isolated from each rat. The rat vascular bed was used as a model of tonsillar vascular bed in the patients undergoing tonsillectomy. All animals were divided into groups, depending on the laser power. For the experiment we used a diode surgical laser with a wavelength of 970 nm in a constant mode, a fiber diameter of 400 microns. After coagulation of each vessel, a visual and microscopic assessment of the vessels was performed. The study of the possibility of vascular coagulation was evaluated after the vessel was cross-sectioned with a scalpel.Results. Damage to the walls of blood vessels was not observed at powers from 5.0 W to 7.0 W. At the same time, at the laser power from 5.0 W to 6.0 W there was no hemostasis after crossing the vessels. At a power of 6.5 W, adequate hemostasis was observed only in 42 % of cases. The coagulation mode of a diode laser with a wavelength of 970 nm, which is the most effective and safe for surrounding tissues, was observed at a power of 7.0 WConclusions. Exceeding the power levels of a diode laser with a wavelength of 970 nm leads to the formation of carbonization of the surrounding tissues, to a damage of the vascular wall. In order to prevent bleeding, arteries with a diameter of more than 1.5 mm must be stitched. Small vessels with a diameter of less than 0.4 mm do not require preventive coagulation and can be coagulated during the incision with a laser fiber.

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.

The Effect of Perianal Tramadol Infiltration on Postoperative Pain Following Hemorrhoidectomy

2020 ◽  
pp. 000313482098168
Author(s):  
Maryam Hatami ◽  
Mohammad Talebi ◽  
Naimeh Heiranizadeh ◽  
Sedighe Vaziribozorg
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Topical Anesthetic ◽  
Double Blind ◽  
Double Blind Clinical Trial ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Grade 3

Introduction The present study was attempted to evaluate the effect of perianal infiltration of tramadol on postoperative pain in patients undergoing hemorrhoidectomy. Method This double-blind clinical trial study was carried out on 90 patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy. Patients were randomly assigned into 3 groups of control or bupivacaine or tramadol. Before the surgery, perianal infiltration of .25% bupivacaine or tramadol or normal saline was prescribed to each group, respectively. Data on pain severity (based on the visual analog scale (VAS), the duration of surgery, sedation score, pain at the first defecation, first request time for additional analgesia, nausea and vomiting, and analgesic intakes) were evaluated and analyzed. Results Duration of surgery was almost similar in all 3 groups ( P = .974). The results showed a significant difference in pain score between 3 groups ( P ≤.05) at all times after the surgery. In addition, the means of sedation scores ( P = .03), pain score at the first defecation ( P = .001), the time to first analgesic request ( P = .001), and ketorolac administration times ( P = .01) were significantly different between 3 groups. Finally, no complication was reported regarding postoperative nausea and vomiting. Conclusion Given the notable efficacy of tramadol in reducing pain after hemorrhoidectomy and its minor side effects, this medication is suggested as an effective topical anesthetic to decrease pain after hemorrhoidectomy.

scholarly journals The Effect of Pterygopalatine Fossa Block (PPFB) during Endoscopic Sinus Surgery (ESS) on Intraoperative Bleeding: A Randomized Control Trial

2018 ◽  
Vol 1 (2) ◽  
pp. 35-41
Author(s):  
Deepak Paudel ◽  
S.T. Chettri ◽  
S.P. Shah ◽  
B.P. Shah ◽  
S. Manandhar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Randomized Control Trial ◽  
Pterygopalatine Fossa ◽  
Sinus Surgery ◽  
Block Group ◽  
Double Blind ◽  
Intraoperative Complication ◽  
Intraoperative Bleeding ◽  
Randomized Control

Background: Bleeding is the frequent intraoperative complication in most of the surgeries and remains a challenge for the surgeons and anesthesiologists. Major blood loss during FESS is rare but even a small amount of bleeding disturbs the endoscopic surgery field, increases the likelihood of complications, lengthens the time of surgery and results in incomplete surgery. The greater palatine canal (GPC) local injection is used to limit posterior bleeding during sinus surgery. Objective: To study the effect of pterygopalatine fossa block on intraoperative bleeding and operative field optimization during endoscopic sinus surgery. Methods: Prospective double blind randomized control trial. Thirty six patients were recruited in the study who also acted as their own control. PPFB was done only on one side of the nostril and the side was randomized by the lottery; neither the patient nor the operating surgeons were aware of the laterality. Boezaart score was used to quantify the intra-operative blood loss. Results: Blood loss between block group and non-block group was compared. Patients in block group had more stable hemodynamics with no fluctuations, better visibility of the surgical field and decreased blood loss as compared with non-block group. Conclusion: Greater palatine fossa block is a useful adjunct in patients undergoing endoscopic sinus surgery. It provided more stable hemodynamics, good operative conditions by lowering blood loss.

scholarly journals Prospective randomised control study of dexmedetomidine for controlled hypotension in functional endoscopic sinus surgery

2021 ◽  
Author(s):  
Mahendran K. ◽  
Rasika Priya
Keyword(s):  
Mean Arterial Pressure ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
The Awakening ◽  
Duration Of Surgery ◽  
Surgical Field ◽  
Group D ◽  
Dexmedetomidine Infusion

<p class="abstract"><strong>Background: </strong>Functional endoscopic sinus surgery is one of the commonly performed Surgeries. Induced hypotension is a method employed in functional endoscopic sinus surgery to reduce blood loss and to improve the visibility of the surgical field. This study aimed to evaluate the effect of dexmedetomidine infusion on the requirement of Isoflurane to produce controlled hypotension (mean arterial pressure of 60-70 mmHg), quality of the bloodless surgical field, duration of surgery, and the awakening time in patients undergoing Functional endoscopic sinus surgery (FESS).</p><p class="abstract"><strong>Methods: </strong>50 patients were divided into Group D, Group C Group D. After successful tracheal intubation, anesthesia was maintained with 66% nitrous oxide + 33% oxygen + isoflurane titrated to achieve a mean arterial pressure (MAP) of 60-70 mmHg. Isoflurane and dexmedetomidine/saline infusion was stopped 10-15 minutes before the end of surgery. The intraoperative surgical field was assessed by using a 6 points Fromme-Boezaart scale.</p><p class="abstract"><strong>Results:</strong> A statistically significant (p&lt;0.001) reduction in intraoperative isoflurane requirement in patients receiving dexmedetomidine infusion (0.387±0.102) in comparison to those receiving placebo (1.7±0.211). Both the group provided better visualization of the surgical field. The duration of surgery was statistically (p=0.004) low in Group D (76.84±14.174) compared to group C (94.1±25.083). The awakening time in min was statistically (p=0.001) low in group D (5.12±1.691) compared to group C (9.72±1.100).</p><p class="abstract"><strong>Conclusions: </strong>Dexmedetomidine infusion helps in achieving a targeted reduction in MAP reduced intraoperative Isoflurane requirement, better bloodless field, and faster awakening in patients undergoing Functional endoscopic sinus surgery.</p>

scholarly journals Comparison of Labetalol, Nitroglycerine and High Dose Propofol for Induced Hypotension in Functional Endoscopic Sinus Surgery in Massive Nasal Polyposis: A Randomized Trial

2020 ◽  
Author(s):  
Seyed Mohammad Mireskandari ◽  
Jalil Makarem ◽  
Babak Saedi ◽  
Afshin Jafarzadeh ◽  
Kasra Karvandian ◽  
...  
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Randomized Trial ◽  
Sinus Surgery ◽  
P Value ◽  
High Dose ◽  
Induced Hypotension ◽  
Duration Of Surgery ◽  
Field Quality ◽  
Surgical Field

Background: Objective: The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia. Methods: One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale. Results: The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001). Conclusion: Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

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