Comparison of dexmedetomidine versus propofol-based anaesthesia for controlled hypotension in functional endoscopic sinus surgery

Bharathwaj, DK; Kamath, Shaila S

doi:10.36303/sajaa.2019.25.2.2051

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…In this study, the quality of surgical field exposure was assessed using the Fromme–Boezaart scoring system and was found to be comparable in both groups. These results are in agreement with those of the study conducted by Bharathwaj and Kamath [ 22 ]. In another study of dexmedetomidine–isoflurane and propofol–fentanyl for FESS in 60 patients, a Fromme’s score of 2 or 3 was found in both groups, with no statistically significant difference [ 23 ].…”

Section: Discussionsupporting

confidence: 94%

“…Consequently, we observed that blood loss was decreased in both groups (dexmedetomidine and propofol) individually as well as in combination; therefore, we compared both drugs for their usefulness in reducing blood loss during FESS. A recent study by Bharathwaj and Kamath [ 22 ] also compared dexmedetomidine and propofol infusion for controlled hypotensive anesthesia in 80 patients undergoing FESS and found that blood loss was 83.75 ± 14.80 ml in the dexmedetomidine group compared to that in the propofol group where it was 96.25 ± 16.12 ml. These results are in concordance with the present study but differ in that they used fixed dosages for infusions (dexmedetomidine, loading dose 0.5 µg/kg for 20 min, maintenance dose 0.3 µg/kg/h, and propofol, started at 12 mg/kg/h for 10 min, then at 10 mg/kg/h for the next 10 min, and a maintenance dose of 8 mg/kg/h).…”

Section: Discussionmentioning

confidence: 99%

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Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial

et al. 2022

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Background: During functional endoscopic sinus surgery (FESS), intranasal bleeding affects operative field visibility and increases the frequency of complications. Therefore, hypotensive anesthesia is a widely used technique to improve surgical outcomes. This study aimed to compare the efficacy of propofol and dexmedetomidine infusion for hypotensive anesthesia in patients undergoing FESS.Methods: This prospective randomized trial was conducted in 80 adult patients aged between 18 and 50 years who were scheduled for FESS under general anesthesia. Patients were randomly divided into two groups: group P (n = 40) received propofol infusion of 100–200 µg/kg/min and group D (n = 40) received dexmedetomidine infusion with a loading dose of 1 µg/kg over 10 min after induction, followed by maintenance infusion of 0.4–0.8 µg/kg/h. Intraoperative blood loss, quality of the surgical field (based on the Fromme–Boezaart scale), hemodynamic control, and patient recovery were recorded. Statistical analysis was performed with SPSS software using Student’s t-test, chi-square test, and Mann–Whitney U test.Results: The mean arterial pressure and heart rate were significantly lower in group D throughout the surgery than in group P. Blood loss was significantly higher in group P (100.73 ± 18.12 ml) than in group D (85.70 ± 18.56 ml). The average number of patients with Fromme’s score 1/2/3 was comparable between the groups. Intraoperatively, only one incidence of bradycardia and hypotension was observed in group D (2.5%) compared with that in group P, which was insignificant.Conclusions: Both dexmedetomidine and propofol are efficacious and safe drugs for facilitating controlled hypotension during FESS; however, dexmedetomidine provides better hemodynamic control and is associated with lesser blood loss without any significant adverse effects.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial

et al. 2022

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“…13 Similarly, Bharathwaj and Kamath in their randomized prospective and single blinded study of patients undergoing FESS found that MAP was significantly lower in dexmedetomidine infusion group when compared with propofol infusion group. 14 In our study, we observed that intraoperatively both dexmedetomidine and propofol were able to reduce heart rate significantly from baseline with heart rate being lower in Group D (63.93±3.362) when compared with Group P (70.52±2.589) and the difference was statistically significant (P<0.05). However, in our study no episodes of bradycardia were observed.…”

Section: Discussionmentioning

confidence: 51%

Comparative study of propofol and dexmedetomidine Infusion for hypotensive anesthesia in FESS surgeries: A randomized prospective double-blind controlled study

et al. 2023

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Background: Intra operative bleeding is most common factor that diminishes visibility resulting in an increased incidence of complications in patients undergoing functional endoscopic sinus surgery (FESS). Methods to reduce intra-operative bleeding include Trendelenburg position, maintenance of normothermia, and controlled hypotension by various anesthetic techniques. Many studies have shown that propofol and dexmedetomidine infusion reduces the amount of bleeding in different surgeries. Aims and Objectives: The aim of the study was to compare the effects of dexmedetomidine and propofol infusion over hemodynamic, quantity of blood loss, and quality of surgical field in patients undergoing FESS and to compare the side effects of dexmedetomidine and propofol infusion in cases undergoing FESS. Materials and Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. The duration of study was 2 years. 60 patients of ASA Grades I and II with age between 20 and 60 years, including both males and females posted for FESS were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into two groups (on the basis of whether they received propofol or dexmedetomidine infusion) of 30 patients each. Hemodynamic parameters (Heart rate and mean arterial pressure [MAP]) quantity of blood loss, quality of surgical field, and side effects were recorded and compared in both the groups. For statistical purposes, P<0.05 was taken as statistically significant. Results: Antrochoanal polyp and chronic sinusitis were the most common indication of FESS in studied cases. Intraoperatively, heart rate was lower in both the groups as compared to baseline. However, the heart rate was lower in the Group D at all times as compared to Group P and the difference was statistically significant from 20 min onward after induction. The mean arterial blood pressure in both the groups was comparable till up to 15 min post induction with no statistical difference. Thereafter, the mean arterial blood pressure was lower in Group D than in Group P throughout the procedure, the difference being statistically significant (P<0.05). The isoflurane requirement in Group D was significantly lower starting from 5 min of induction to throughout the procedure as compared to Group P (P< 0.05). Mean blood loss in Group D was 115.0±16.78 ml and in Group P was 140.47±29.42 ml, the difference in blood loss was statistically significant (P<0.0001). Conclusion: Dexmedetomidine is comparatively better than propofol in controlling heart rate and MAP, reducing the blood loss, and isoflurane requirement in patients undergoing FESS.

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“…Some researchers proved that with dexmedetomidine significantly lowers heart rate than propofol, and that it results in a better hemodynamic profile as regards heart rate and blood pressure than nitroglycerin and magnesium sulfate. 15,19,20,21 On the other hand, Esmail et al reported that propofol reduced heart rate more than dexmedetomidine. This may be due to higher doses of propofol used in this study 50-150 μg/kg/min.…”

Section: Discussionmentioning

confidence: 99%

A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS)

Saleh¹,

Awad²,

Shonoda³

et al. 2022

Anaesth. pain intensive care

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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

show abstract

Comparison of dexmedetomidine versus propofol-based anaesthesia for controlled hypotension in functional endoscopic sinus surgery

Cited by 4 publications

References 18 publications

Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial

Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial

Comparative study of propofol and dexmedetomidine Infusion for hypotensive anesthesia in FESS surgeries: A randomized prospective double-blind controlled study

A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS)

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