Controlled hypotensive anesthesia for endoscopic endonasal repair of cerebrospinal fluid rhinorrhea: A comparison between clevidipine and esmolol: Randomized controlled study

Abstract

Background: The aim of this study was to evaluate the efficacy of intravenous infusion of clevidipine or esmolol for producing controlled hypotension during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. Patients and methods: Fifty adult ASA I and II patients scheduled for endoscopic repair of CSF rhinorrhea were randomized into one of two groups. Group C (25 patients) received clevidipine 0.5 mcg/kg/min increased by 0.5 mcg/kg/min every 3-5 min to achieve the target mean arterial pressure (MAP) of 55-65 mmHg. Group E (25 patients) received esmolol infusion 50 mcg/kg/min increased by 50 mcg/kg/min every 3-5 min to achieve the target MAP. Surgical field Quality, blood loss, haemodynamic parameters, surgeons' satisfaction and adverse events were recorded. Results: Time to reach target MAP was significantly shorter in group C compared to group E. Number of patients needed nitroglycerine was significantly higher in group E compared to group C (8 versus 2 respectively). The nitroglycerine dose needed/patient in group E was significantly more compared to group C. Surgeon satisfaction score was significantly higher in group C compared to group E. More patients in group E developed bradycardia compared to group C. Mean arterial pressure was significantly lower in group C compared to group E after 5 and 10 min from the start of the studied drugs infusion while it was significantly higher in group C after 25 min from the start of the studied drugs. The heart rate (HR) was significantly lower in group E compared to group C 10 min after starting drugs infusion till the end of surgery. Conclusion: Both clevidipine and esmolol are effective for inducing controlled hypotension during endoscopic repair of CSF rhinorrhea. Clevidipine has the advantage of having shorter time to reach target MAP with less need of additional hypotensive agent and better surgeon satisfaction.

Possibilities of the anesthesiologist to influence the clarity of the operating field in endonasal surgery

“…Mezi často používané léky pro kontrolovanou hypotenzi patří nitráty, betablokátory a gangliové blokátory [5,6,12,13]. Nitráty jsou přímé vazodilatátory, které rychle snižují TK, a zároveň dochází k rychlému obnovení na normální hodnoty po vysazení -tzv.…”

“…Nevýhody jsou reflexní tachykardie, rebound hypertenze, zhoršení hypoxické plicní vazokonstrikce a potenciál toxicity kyanidů při vysokých dávkách [14]. Nitroglyrecin dilatuje žilní kapacitní cévy, což způsobuje pokles žilního návratu, zmenšuje objem cév a srdeční výdej [5].…”

Hypotensive Anaesthesia in Maxillofacial Surgery

“…In addition, the beneficial effect on the reduction of blood loss in maxillofacial surgery was highlighted by Schaberg et al [7], in 1976. For decades, DH has been used in various types of surgeries, such as: spinal surgery, other neurosurgery, orthopedic surgery, craniosynostosis, sinus and middle ear surgery and even in head-injured multi-trauma patients [3,[8][9][10][11][12][13]. Oromaxillofacial surgery is not an exception [14].…”