Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Comparative study of Dexmedetomidine and Esmolol

IF 0.1 Q4 OTORHINOLARYNGOLOGY
Md Shafiul Alam Shaheen, A. Chowdhury, K. Sardar, Mushfiqur Rahman, S. S. Biswas, A. Taous
{"title":"Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Comparative study of Dexmedetomidine and Esmolol","authors":"Md Shafiul Alam Shaheen, A. Chowdhury, K. Sardar, Mushfiqur Rahman, S. S. Biswas, A. Taous","doi":"10.3329/bjo.v24i1.45340","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":53915,"journal":{"name":"Bangladesh Journal of Otorhinolaryngology","volume":null,"pages":null},"PeriodicalIF":0.1000,"publicationDate":"2020-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bangladesh Journal of Otorhinolaryngology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3329/bjo.v24i1.45340","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 1

Abstract

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.
功能性内窥镜鼻窦手术控制性降压:右美托咪定和艾司洛尔的比较研究
背景:功能性内窥镜鼻窦手术(FESS)需要有效控制出血,以提高手术视野的可见性,降低视神经或颈内动脉损伤的风险。控制性低血压是一种用于限制术中失血的技术,为手术提供尽可能好的场地。目的:我们的研究旨在评估右美托咪定作为降压剂与艾司洛尔在功能性内窥镜鼻窦手术(FESS)中的疗效。方法:将60名20-50岁ASA I/II计划进行FESS的患者随机分为两组,每组30名。D组患者在麻醉诱导前10分钟内接受右美托咪定1μg/kg,然后在维持期间输注0.4–0.8μg/kg/hr,E组患者接受艾司洛尔负荷剂量1分钟内输注,然后在保持期间输注0.4-0.8 mg/kg,以将平均动脉压(MAP)维持在(55-65 mmHg)之间。使用平均类别量表评估手术范围,并计算平均失血量。血液动力学变量(MAP、HR);记录术中芬太尼消耗量和麻醉后的总恢复率(Aldrete评分≥9)。在拔管后10、20、30、40和60分钟测定镇静评分,并记录首次镇痛需求的时间。结果:D组和E组均达到了所需的MAP(55-65 mmHg),MAP或HR无组间差异。D组术中芬太尼的平均消耗量显著低于E组。E组达到Aldrete评分≥9的恢复时间显著低于D组。术后10分钟、20分钟和30分钟,E组的镇静评分显著低于D组。D组首次镇痛需求时间明显延长。结论:本研究结果表明,右美托咪定和艾司洛尔均可作为控制性低血压的药物,并能有效地在FESS期间提供理想的手术视野。但右美托咪定具有固有的镇痛、镇静和节省麻醉剂的优点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
17
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信