Prospective randomised control study of dexmedetomidine for controlled hypotension in functional endoscopic sinus surgery
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20212783Keywords:
Dexmedetomidine, FESS, Controlled hypotensionAbstract
Background: 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).
Methods: 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.
Results: A statistically significant (p<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).
Conclusions: 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.
References
Vantaa R, Jaakola ML, Kallio A, Kanto J: Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology. 1997;86:1055-60.
Gurbet A, Basagan-Mogol E, Turker G, Ugun F, Kaya FN, Ozcan B. .Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anesth. 2006;53(7);646-52.
Andel A, Andel H, Horauf K, Felferning D, Millesi W, Zimpfer M. The influence of deliberate hypotension on splanchnic perfusion balance with use of either isoflurane or esmolol and nitroglycerin. Anesth Analg. 2001;93:1116-20.
Dikmen B, Sahin F, Ornek D, Pala Y, Kilci O, Horasanli E, Canturk M. Anesthesiology and Reanimation Clinic, Ankara Training & Research Hospital, Turkey. Dexmedetomidine for Controlled Hypotension In Middle Ear Surgery with Low-Flow Anesthesia. Int Adv Otol. 2010; 6(3) 331-336.
Boezaart AP, Van Der Merwe J, Coetzee A. Comparison of sodium nitroprusside and esmolol induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42:373-6.
Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of Outcomes in Patients Given Dexmedetomidine in Functional Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol. 2011;120:586-92.
Durmus M, But AK, Dogan Z, Yucel A, Miman MC, Ersoy MO. Effect of dexmedetomidine on bleeding tympanoplasty or septorhinoplasty. Eur J Anesthesiol. 2007;24: 447-53.
Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anesthesia. Eur J Anaesthesiol. 2008;25:22-8.
Jaakola ML. Dexmedetomidine premedication before intravenous regional anesthesia in minor outpatient hand surgery. J Clin Anesth. 1994;6(3):204-1.
Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth. 1999;83:372-80.
Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative hemodynamic stability. Anesthesia. 1997;52:736-44.
Maroof M, Khan RM, Bhatti TH. Clonidine premedication for induced hypotension with total intravenous anesthesia for middle ear microsurgery. Can J Anaesth. 1994;41:164-5.
Newberg LA, Milde JH, Michenfelder JD. Systemic and cerebral effects of isoflurane-induced hypotension in dogs.Anesthesiol. 1984;60:541.
Newman B, Gelb AW, Lam AM.The effect of isoflurane-induced hypotension on cerebral blood flow and cerebral metabolic rate for oxygen in humans. Anesthesiol. 1986;64:307.
Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. 2008;25:369-74.
Robert K. Stoelting. Pharmacokinetics and Pharmacodynamics of Injected and Inhaled drugs. Inhaled anesthetics comparative pharmacology. 2006;4:38-65.
Miller RD. Millers Anesthesia. Intravenous Anesthetics. 2010;7(1):751-7.
Scheinin H, Vantaa R, Anttila M, Hakola P, Helminen A, Karhuvaara S. Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific alpha2 adrenoreceptor antagonist atipamezole: a pharmacodynamic and kinetic study in healthy volunteers. Anesthesiol. 1998;89:574-84.
Stankiewicz JA. Complications of endoscopic intranasal ethmoidectomy. Laryngoscope. 1987;97:1270-3.
Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in pediatric-aged patients. Paediatr Anaesth 2002;12:171-5.
