Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa

Sieśkiewicz, Andrzej; Reszeć, Joanna; Piszczatowski, Bartosz; Olszewska, Ewa; Klimiuk, Piotr Adrian; Chyczewski, L; Rogowski, Marek

doi:10.1016/j.advms.2013.10.001

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Impaired visibility due to excessive bleeding is a major hurdle that has been reported for FESS under general anesthesia (GA). [ 2 ] Intraoperative bleeding may be reduced most effectively by induced systemic hypotension. There are several important advantages of using the intentional hypotensive anesthetic technique during the FESSs like reduction in blood loss, hence, reduction in blood transfusion rate, improvement in the surgical field, and reduction of the duration of surgery.…”

Section: Introductionmentioning

confidence: 99%

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study

Das¹,

Mukherje²,

Chhaule³

et al. 2016

Saudi J Anaesth

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Background:Functional endoscopic sinus surgery (FESS) is the mainstay of a therapeutic technique for nasal pathologies. This study is to compare the ability of preoperative dexmedetomidine versus clonidine for producing controlled hypotensive anesthesia during FESS in adults in an ambulatory care setting.Materials and Methods:Sixty patients (25-50 years) posted for ambulatory FESS procedures under general anesthesia were randomly divided into Group C and D (n = 33 each) receiving dexmedetomidine 1 μg/kg and clonidine 1.5 μg/kg, respectively; both diluted in 100 ml saline solution 15 min before anesthetic induction. Nasal bleeding and surgeon's satisfaction score; amount and number of patients receiving fentanyl and nitroglycerine for analgesia and deliberate hypotension, duration of hypotension, post anesthesia care unit (PACU) and hospital stay; hemodynamic parameters and side effects were recorded for each patient.Results:Number and dosage of nitroglycerine used was significantly (P = 0.034 and 0.0001 respectively) lower in Group D compared to that in Group C. Similarly, number of patients requiring fentanyl and dosage of same was significantly lower in Group D. But, the duration of controlled hypotension was almost similar in both the groups. Group D patients suffered from significantly less nasal bleeding and surgeon's satisfaction score was also high in this group. Discharge from PACU was significantly earlier in Group D, but hospital discharge timing was quite comparable among two groups. Intraoperative hemodynamics was significantly lower in Group D (P < 0.05) without any appreciable side effects.Conclusion:Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia, and thus, allowing less nasal bleeding as well as more surgeons’ satisfaction score.

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Section: Introductionmentioning

confidence: 99%

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study

Das¹,

Mukherje²,

Chhaule³

et al. 2016

Saudi J Anaesth

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“…Intraoperative bleeding is most common factor that diminishes visibility resulting in an increased incidence of complications. 1 Reduced visibility of the surgical field is related to an increased risk of dangerous vascular, nasal (synechiae and anosmia), orbital (optic nerve damage, nasolacrimal duct damage, and extraocular muscle damage), and intracranial complications (CSF leak causing meningitis), prolonged duration of intervention and reduced quality of intervention. Surgical bleeding during FESS is mainly local bleeding which is difficult to control due to anatomical and pathological characteristics.…”

Section: Introductionmentioning

confidence: 99%

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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“…Functional endoscopic sinus surgery (FESS) is a crucial therapeutic approach for nasal sinus diseases ( 1 , 2 ). Impairment of operative field visibility by bleeding is an essential concern in FESS, and serious problems have been documented for FESS due to reduced visibility ( 3 , 4 ). As a result, controlled hypotensive anesthesia is essential in FESS as it decreases intraoperative blood loss, creating an optimal field for surgery ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study

Rehab,

Bakr,

Algazzar

et al. 2023

Anesth Pain Med

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Background: The sympatholytic property of dexmedetomidine (DEX) makes it suitable as a hypotensive drug during functional endoscopic sinus surgery (FESS); however, delayed emergence from anesthesia and high postoperative sedation have been reported. Objectives: Delayed emergence from anesthesia and high postoperative sedation are associated with a prolonged length of stay in the operating room and the postanesthesia care unit (PACU), which increases health care costs. This study aimed to overcome the negative impact of DEX on recovery by using aminophylline. Methods: This randomized, double-blind, placebo-controlled study was conducted on 52 patients planned for elective FESS under general anesthesia with DEX infusion for controlled hypotension during surgery. Patients were equally divided into 2 groups. The aminophylline group received 4 mg/kg aminophylline diluted in 50 mL saline 0.9% over 30 minutes after positioning in a 20-degree reverse Trendelenburg position. The control group received 50 mL saline 0.9% with a similar volume and period as the aminophylline group. Results: The extubation time was significantly shorter in the aminophylline group (6.5 (5.25 - 7.75) minutes) than in the control group (9 (7.25 - 10) minutes) (P-value < 0.001). The PACU discharge time was significantly shorter in the aminophylline group (15 (10 - 20) minutes) compared to the control group (20 (15 - 28.75) minutes) (P-value = 0.036). Intraoperative heart rate and mean arterial pressure were nonsignificantly different between the 2 groups. Ramsay sedation score measurements at 15 min, 30 min, and 60 min after extubation were significantly lower in the aminophylline than in the control group (P-value < 0.05). Complications were nonsignificantly different between the 2 groups. Conclusions: Intraoperative aminophylline infusion enhances the recovery of patients undergoing FESS under DEX hypotensive anesthesia without intraoperative hemodynamic alterations and decreases their postoperative sedation without significant postoperative side effects.

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Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa

Cited by 10 publications

References 15 publications

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study

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

Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study

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