Background & objective: Patients with chronic sinusitis, not responding to medical treatment are managed with functional endoscopic sinus surgery (FESS) by ENT specialists. The surgery demands a bloodless field for its success. Even minimal amount of blood can obscure the surgical field to the operating surgeon. We compared three drugs, propofol, dexmedetomidine, and nitroglycerin as hypotensive agents and their effect on blood loss in FESS. Methodology: Our study included sixty adult patients scheduled for FESS at Ain Shams University hospitals from September 2018 to September 2019. All patients were ASA I and II and they were distributed into three groups in a random manner, twenty patients in each group. Patients in Group D were administered dexmedetomidine 1 μg/kg as a loading dose over 10 min (in 100 ml normal saline) just after induction, then 0.5 μg/kg/h was infused. Group P patients were administered propofol infusion 8 mg/kg/h. Group N patients were administered nitroglycerin infusion of 2 μg/kg/min. Hemodynamic parameters were recorded every 15 min. We used bleeding score to examine the quality of operating field. We recorded the time to achieve target mean arterial blood pressure. Duration of operation was recorded. Results: In Groups D and P, our target of mean arterial pressure of 55-65 mmHg was achieved. The hypotensive drugs used in these groups offered good quality of surgical field and shorter duration of surgery. Group D also achieved target blood pressure faster than Group P with significantly lower heart rate in Group D. Conclusion: Dexmedetomidine and propofol had more favorable effects for attaining the desired blood pressure than nitroglycerin with lower heart rate in dexmedetomidine group. Dexmedetomidine and propofol were associated with less bleeding and shorter duration of surgery in patients undergoing FESS. Also dexmedetomidine was faster in achieving target blood pressure than propofol. Trial Registry: PACTR202202877370804 Abbreviations: FESS - Functional endoscopic sinus surgery; CSF - Cerebrospinal fluid; GABA - γ-aminobutyric acid’ MAP - Mean arterial blood pressure Key words: Anesthesia; Anesthesia, General; Endoscopy / methods; Humans; Propofol; Dexmedetomidine; Nitroglycerin; Controlled hypotension; FESS. Citation: Saleh SAEM, Awad HGS, Shonoda AMF, ElShorbagy MS, Doaa Mohammed Kamal ElDin DMK. A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS). Anaesth. pain intensive care 2022;26(3):338-346. DOI: 10.35975/apic.v26i3.1908 Received: March 10, 2022; Reviewed: April 07, 2022; Accepted: May 05, 2022 Background & objective: Patients with chronic sinusitis, not responding to medical treatment are managed with functional endoscopic sinus surgery (FESS) by ENT specialists. The surgery demands a bloodless field for its success. Even minimal amount of blood can obscure the surgical field to the operating surgeon. We compared three drugs, propofol, dexmedetomidine, and nitroglycerin as hypotensive agents and their effect on blood loss in FESS. Methodology: Our study included sixty adult patients scheduled for FESS at Ain Shams University hospitals from September 2018 to September 2019. All patients were ASA I and II and they were distributed into three groups in a random manner, twenty patients in each group. Patients in Group D were administered dexmedetomidine 1 μg/kg as a loading dose over 10 min (in 100 ml normal saline) just after induction, then 0.5 μg/kg/h was infused. Group P patients were administered propofol infusion 8 mg/kg/h. Group N patients were administered nitroglycerin infusion of 2 μg/kg/min. Hemodynamic parameters were recorded every 15 min. We used bleeding score to examine the quality of operating field. We recorded the time to achieve target mean arterial blood pressure. Duration of operation was recorded. Results: In Groups D and P, our target of mean arterial pressure of 55-65 mmHg was achieved. The hypotensive drugs used in these groups offered good quality of surgical field and shorter duration of surgery. Group D also achieved target blood pressure faster than Group P with significantly lower heart rate in Group D. Conclusion: Dexmedetomidine and propofol had more favorable effects for attaining the desired blood pressure than nitroglycerin with lower heart rate in dexmedetomidine group. Dexmedetomidine and propofol were associated with less bleeding and shorter duration of surgery in patients undergoing FESS. Also dexmedetomidine was faster in achieving target blood pressure than propofol. Trial Registry: PACTR202202877370804 Abbreviations: FESS - Functional endoscopic sinus surgery; CSF - Cerebrospinal fluid; GABA - γ-aminobutyric acid’ MAP - Mean arterial blood pressure Key words: Anesthesia; Anesthesia, General; Endoscopy / methods; Humans; Propofol; Dexmedetomidine; Nitroglycerin; Controlled hypotension; FESS. Citation: Saleh SAEM, Awad HGS, Shonoda AMF, ElShorbagy MS, Doaa Mohammed Kamal ElDin DMK. A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS). Anaesth. pain intensive care 2022;26(3):338-346. DOI: 10.35975/apic.v26i3.1908 Received: March 10, 2022; Reviewed: April 07, 2022; Accepted: May 05, 2022
Background: Managing ventilation and oxygenation during laparoscopic bariatric procedures in morbidly obese patients represents many challenges. Aim of the Work: To compare the effect of these modes of ventilation on respiratory parameters in obese patients undergoing laparoscopic bariatric surgeries and whether this influences the need of postoperative ventilation or not Patients and Methods: After approval of ethical committee of faculty of Medicine Ain Shams University and obtaining an informed consent from every patient, this randomized controlled clinical trial study was conducted at Ain Shams University Hospitals operating theatre department on 40 obese adult patients of ASA physical status I-II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic bariatric surgery. General anesthesia with endotracheal intubation and controlled ventilation was conducted in all patients. Patients were divided randomly into two equal groups: Group A; received volume controlled ventilation and Group B; received pressure controlled ventilation. Results: The study found no significant difference between the two groups as regards PaO2 and PaO2:FiO2 preoperatively, after pneumoperitonium, at the end of surgery and postoperatively. As regards PaCO2 there was no statistically significant difference between the two groups in the preoperative measurement while there was statistically highly significant difference between the two groups after pneumoperitonium, at the end of surgery and postoperatively with lower PaCO2 in group (B) that received PCV than group (A) that received VCV. There was statistically highly significant difference between the two groups as regards dynamic compliance after intubation, after pneumoperitonium and at the end of the surgery with higher dynamic compliance in group (B) that received PCV. The results showed no statistically significant difference between the two studied groups regarding the need of post-operative ventilation. Conclusion: No significant difference between pressure controlled ventilation and volume controlled ventilation regarding oxygenation and the need of postoperative ventilation but PaCo2 levels are lower and dynamic compliance is higher with pressure controlled ventilation.
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