scholarly journals Hypotensive Anesthesia with Propofol Infusion Pump: A Boon for Endoscopic Sinus and Nasal Polyps Surgery

2011 ◽  
Vol 4 (1) ◽  
pp. 5-8
Author(s):  
Sudhir M Naik ◽  
Sarika S Naik
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Sinus Surgery ◽  
Successful Outcome ◽  
Anesthetic Techniques ◽  
Operative Field ◽  
Hypotensive Anesthesia ◽  
Duration Of Surgery

ABSTRACT Background Successful outcome of endoscopic sinus surgery depends on complete visualization of the operative field and intraoperative control of bleeding. Major disadvantage of general anesthesia is the increased bleeding encountered, which can interfere with optimum visualization of the intranasal anatomy unless hypotensive methods are used. Objectives To study the different anesthetic techniques in relation to their impact on blood loss and duration of surgery. The role of propofol was also evaluated. Design Department of Anesthesia and ENT, Head and Neck Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India. Materials and methods 213 cases of endoscopic sinus surgeries done for nasal polyposis, sinusitis, dacryocystitis and septorhinoplasties under local and general anesthesia were evaluated between June 2009 and August 2010. Result A good operative field was seen with propofol anesthesia compared to halothane anesthesia. The problems of fogging and frequent suctioning were lesser with propofol hypotensive anesthesia. Conclusion Hypotensive anesthesia using propofol infusion is the anesthesia of choice for extensive nasal polyposis. Propofol when used both for induction as well as maintenance of general anesthesia in endoscopic sinus surgeries significantly reduces the blood loss, thereby improving the visibility of the endonasal structures and minimizes the chance of complications related to endoscopic sinus surgery.

Effect of Coblation Polypectomy on Estimated Blood Loss in Endoscopic Sinus Surgery

2009 ◽  
Vol 23 (5) ◽  
pp. 535-539 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Thomas J. Walker ◽  
Roy R. Casiano ◽  
Jose W. Ruiz
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Care Center ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
New Device ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
University Of Miami

Background We conducted a pilot study comparing estimated blood loss (EBL) using coblation-assisted endoscopic sinus surgery (CAESS) where coblation is used to debulk nasal polyps before microdebridement with a traditional microdebrider technique in chronic rhinosinusitis (CRS) patients with sinonasal polyps undergoing endoscopic sinus surgery (ESS). Methods A retrospective analysis was performed at a tertiary care center on patients with nasal polyposis undergoing ESS between January 2008 and July 2008. The University of Miami CT staging system was used preoperatively to evaluate the extent of sinonasal disease. The duration of surgery, blood loss per minute, total EBL, and demographic data were collected. Results Twenty-one patients underwent nasal polypectomy/ESS using CAESS and 16 patients underwent nasal polypectomy/ESS using microdebridement. The two groups had comparable University of Miami CT staging scores (p > 0.05). The average EBL was 307.1 ± 169.8 mL using coblation compared with 627.8 ± 424.2 mL using microdebridement (p < 0.05). The average duration of surgery using coblation was 116.2 ± 41.7 minutes, compared with 125.3 ± 48.4 minutes using microdebridement (p > 0.05). The average blood loss per minute was 2.8 ±1.7 mL in the coblation group compared with 4.8 ± 2.1 mL in the microdebridement group (p < 0.05). Subgroup analyses showed a significant decrease in average EBL and EBL/minute to be only significant for revision cases (p < 0.05) and not for primary cases (p > 0.05). Conclusion Coblation-assisted nasal polypectomy/ESS is associated with a statistically significant lower EBL and blood loss per minute when compared with traditional microdebridement technique. Coblation represents a new device that can reduce blood loss in patients with nasal polyposis undergoing traditional revision ESS. Further prospective randomized trials are needed to validate these findings.

Propofol for maintenance of general anesthesia: A technique to limit blood loss during endoscopic sinus surgery

1993 ◽  
Vol 14 (4) ◽  
pp. 262-266 ◽  
Author(s):  
Keith E. Blackwell ◽  
Douglas A. Ross ◽  
Patricia Kapur ◽  
Thomas C. Calcaterra
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery

Anesthetic Choice for Functional Endoscopic Sinus Surgery

1992 ◽  
Vol 6 (1) ◽  
pp. 1-4 ◽  
Author(s):  
John A. Fornadley ◽  
Kevin S. Kennedy ◽  
Joseph F. Wilson ◽  
Peter T. Galantich ◽  
Gregg S. Parker
Keyword(s):  
General Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Patient Comfort ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Local Infiltration ◽  
Local Technique ◽  
Local Anesthetic Injection

Controversy continues concerning the optimal anesthetic technique when completing endoscopic sinus surgery. To attempt to investigate the results using different anesthetic techniques, experience with endoscopic sinus surgery over 12 months (233 cases) was retrospectively reviewed. The use of local anesthetic injection with or without regional blocks (specifically ethmoid and greater palatine) was evaluated, as was the choice of general anesthesia versus local technique in a context of blood loss, patient comfort, and complications. Regional block technique appears to add morbidity for little additional benefit. Endoscopic sinus surgery may be performed safely in appropriately selected patients using either general anesthesia or local infiltration with sedation.

Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial

2008 ◽  
Vol 122 (7) ◽  
pp. 691-695 ◽  
Author(s):  
K Kaygusuz ◽  
A Yildirim ◽  
I Ozdemir Kol ◽  
S Gursoy ◽  
C Mimaroglu
Keyword(s):  
Mean Arterial Pressure ◽  
Visual Analogue Scale ◽  
Blood Loss ◽  
Arterial Pressure ◽  
Endoscopic Sinus Surgery ◽  
Analogue Scale ◽  
Sinus Surgery ◽  
Operative Field ◽  
Surgical Conditions

AbstractObjective:To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery.Design:Randomised, double-blinded clinical study.Subjects:Sixty-four patients were scheduled for elective tympanoplasty or endoscopic sinus surgery. The patients were randomly divided into two groups: desflurane or isoflurane. After anaesthesia induction, all patients received a continuous remifentanil infusion of 0.2–0.5 µg/kg/min until a mean arterial pressure of 65–75 mmHg was achieved. Heart rate and mean arterial pressure were recorded throughout anaesthesia. Blood loss was measured at the end of surgery. Achievement of a bloodless operative field was rated on a 100 mm visual analogue scale. Following completion of surgery, the time to extubation and to achievement of an Aldrete score of nine or more was recorded.Results:Sixty-three patients were evaluated. The total dose of remifentanil and the total blood loss were similar in both groups (p > 0.05). Time to extubation and to an Aldrete score of nine or more for the desflurane group was significantly less than for the isoflurane group (p < 0.05). No differences were found in the extent of achievement of a bloodless operative field, as assessed via visual analogue scale, comparing the study groups (p > 0.05).Conclusion:Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.

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

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Arterial Blood

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.

scholarly journals Comparison between microdebrider assisted surgery and the conventional methods in the surgical treatment of nasal polyps

2018 ◽  
Vol 5 (1) ◽  
pp. 154
Author(s):  
Shama A. Bellad ◽  
N. Manjunath ◽  
Shilpa Ravi
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Nasal Polyposis ◽  
Operative Time ◽  
Sinus Surgery ◽  
Surgery Group ◽  
Surgical Expertise ◽  
Duration Of Surgery ◽  
Conventional Methods ◽  
Surgical Conditions

<p class="abstract"><strong>Background:</strong> Microdebrider is emerging as a convenient tool for various ENT surgeries that helps in easier disease clearance and reduced morbidity. Though it requires some surgical expertise initially to master the skill of handling it, it is worth procuring and using in endoscopic sinus surgery. The present study was conducted to compare the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps.</p><p class="abstract"><strong>Methods:</strong> 30 patients diagnosed with nasal polyposis between the age group of 5 to 60 were equally randomized into 2 surgical groups- powered endoscopic sinus surgery group and conventional endoscopic sinus surgery group with 15 patients in each group. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund–Mackay scoring system and visual analogue scale. The data was statistically analysed.  </p><p class="abstract"><strong>Results:</strong> A significant statistical evidence for a shorter operative time, dryness of the field, better surgical conditions and improved VAS scoring at 3 and 6 months postoperatively was observed in the powered endoscopy group than using conventional techniques.</p><p class="abstract"><strong>Conclusions:</strong> The use of microdebrider in endoscopic sinus surgery has the advantage of complete clearance of disease, smoother intra operative course and better post operative healing when compared to conventional instruments in the treatment of nasal polyps.</p><p> </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.

scholarly journals Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery?

2014 ◽  
Vol 128 (9) ◽  
pp. 814-817 ◽  
Author(s):  
C J Valdes ◽  
Y Al Badaai ◽  
M Bogado ◽  
M Samaha
Keyword(s):  
Blood Loss ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Functional Endoscopic Sinus Surgery ◽  
Pterygopalatine Fossa ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Surgical Field

AbstractObjective:To determine the effect of pterygopalatine fossa injection with xylocaine and adrenaline on: surgical field bleeding and blood loss during functional endoscopic sinus surgery for chronic rhinosinusitis, and the duration of the procedure.Methods:A prospective, single-blinded, controlled trial was performed in a tertiary care academic centre. A total of 45 patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis, whose disease was symmetrical based on computed tomography grading, were included. A unilateral pterygopalatine fossa injection with 1 per cent xylocaine and 1:100 000 adrenaline was performed after the induction of anaesthesia. The contralateral side served as the control. The operating surgeon, who was blinded to the injected side, assessed the surgical field using a validated six-item grading system. Blood loss, blood pressure, heart rate and end-tidal carbon dioxide were recorded every 15 minutes for each side separately, and duration of surgery was noted.Results:There was no statistically significant difference in the surgical field grade between the injected and non-injected sides (p = 0.161). There were no differences in blood loss or duration of surgery.Conclusion:Pterygopalatine fossa injection prior to functional endoscopic sinus surgery did not decrease intra-operative surgical field bleeding, blood loss or duration of surgery.

Comparison of Functional Endoscopic Sinus Surgery under Local and General Anesthesia

1993 ◽  
Vol 102 (4) ◽  
pp. 289-293 ◽  
Author(s):  
Paul D. Gittelman ◽  
Joseph B. Jacobs ◽  
Jane Skorina
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Intravenous Sedation ◽  
New York University ◽  
Major Complications ◽  
Estimated Blood Loss

We present a retrospective comparison of intravenous sedation and general anesthesia techniques employed at New York University—Bellevue Medical Center for functional endoscopic sinus surgery. Some authors have stressed the use of local anesthesia with intravenous sedation in order to avoid complications and reduce blood loss. We have reviewed 232 patients who underwent 401 consecutive ethmoidectomies and maxillary antrostomies. Local anesthesia, employed in 64% of patients, carried an estimated blood loss of 23 mL per side. General anesthesia was associated with an average blood loss of 58 mL per side. The rate of operative complications for local anesthesia was 8.7% per patient, with a 1.6% rate of major complications per side. General anesthesia carried an overall complication rate of 2.4% per patient, with no major complications. General anesthesia is a relatively safe and viable option for endoscopic sinus surgery that in selected cases may be preferable to local anesthesia.

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

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