Ocena korelacji średniego ciśnienia tętniczego z krwawieniem śródoperacyjnym przy wolnej czynności serca w trakcie endoskopowej chirurgii zatok przynosowych

Sieśkiewicz, Andrzej; Drozdowski, Andrzej; Rogowski, Marek

doi:10.1016/s0030-6657(10)70020-2

Cited by 24 publications

(13 citation statements)

References 13 publications

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“…[12] found that esmolol provides hemodynamic stability and good surgical field visibility and should be considered as an alternative to nitroglycerin. Sieskiewicz et al .,[13] concluded that if HR is around 60 beats/min there is no need to decrease the MAP to dangerously low levels to achieve good operative field conditions. Other studies[1415] comparing propofol and isoflurane also showed decreasing heart rate with fentanyl boluses provides a better operative field.…”

Section: Discussionmentioning

confidence: 99%

Comparison of quality of the surgical field after controlled hypotension using esmolol and magnesium sulfate during endoscopic sinus surgery

Jangra

Malhotra

Gupta

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Most vital aspect of Endoscopic Sinus Surgery (ESS) is an optimal visibility in the surgical field. This invariably requires controlled hypotension to facilitate surgical dissection and to decrease operative time. We used esmolol and magnesium sulfate to achieve controlled hypotension and assessed the quality of the surgical field in ESS.Material and Methods:A total of 30 patients undergoing ESS, were enrolled in three parallel groups of 10 patients each in a prospective randomized double-blind study. “Magnesium Sulfate group” received magnesium sulfate 40 mg/kg intravenously (i.v.) as a bolus over 10 min before induction of anesthesia, followed by 15-30 mg/kg/h through infusion. “Esmolol group” received 0.5 mg/kg i.v. bolus over 10 min after induction followed by 150-300 μg/kg/min infusion and “control group” received normal saline in same volume schedule. The primary aim was to assess the quality of surgical field, using Fromme scale. Category Scale values of all the three groups were compared using Kruskal-Wallis analysis of variance (ANOVA) test. Hemodynamic data was compared using ANOVA test.Results:Quality of the surgical field was better in both magnesium sulfate and esmolol groups as compared to the control group. Durations of anesthesia and surgery were significantly lower in esmolol group as compared to the control group. Blood loss was comparable in all the three groups.Conclusion:Quality of the surgical field was better in esmolol and magnesium sulfate groups as compared to control group. Duration of surgery was significantly less in esmolol group as compared to other two groups.

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Section: Discussionmentioning

confidence: 99%

Comparison of quality of the surgical field after controlled hypotension using esmolol and magnesium sulfate during endoscopic sinus surgery

Jangra

Malhotra

Gupta

et al. 2016

J Anaesthesiol Clin Pharmacol

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“…Sieśkiewicz et al [4] evaluated the relationship between mean arterial pressure and perioperative bleeding during FESS in patients with a low heart rate. They found that intraoperative bleeding is largely a function of MAP and HR: when the HR is maintained at 60 beats/min, there is no need, in many cases, to intensively reduce bleeding to achieve optimal surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…In that same study [4], Sieśkiewicz and colleagues used the Fromm and Boezzart scale [20] to evaluate perioperative bleeding and surgical field visibility. They found good results with an MAP between 65 and 78 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery

Miłoński

Zielińska‐Bliźniewska

Golusiński

et al. 2012

Eur Arch Otorhinolaryngol

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The aim of the study was to assess the effect of three different types of anaesthesia on perioperative bleeding control and to analyse the mean arterial blood pressure and heart rate in patients undergoing endoscopic paranasal sinus surgery. Ninety patients (30 women and 60 men, aged 18–85 years) scheduled to undergo functional endoscopic sinus surgery in the years 2008–2010 were identified as candidates for inclusion in the study. Patients were randomly assigned to one of three groups (30 patients each) according to the type of general anaesthesia to be administered. Groups I and II both received inhalation anaesthesia (sevoflurane for sedation) and intravenous anaesthesia (fentanyl in group I, remifentanil in group II). Anaesthesia was delivered solely via intravenous route (TIVA) in group III, with propofol used for sedation and remifentanil for analgesia. Blood pressure and heart rate were monitored during surgery and post-surgically for 4 h. Mean anaesthesia duration in groups I, II and III was 108.7 ± 20.8, 112.6 ± 22.2 and 103.7 ± 17.5 min and the surgery duration was 71.3 ± 16.7, 78.8 ± 24.2 and 66.5 ± 15.5 min, respectively. Mean blood loss during surgery was 365.0 ± 176.2, 340.0 ± 150.5 and 225.0 ± 91.7 ml, with a mean blood loss rate of 5.1 ± 2.4, 4.5 ± 2.2 and 3.4 ± 1.1 ml/min in groups I, II and III, respectively. Technologically advanced control of the drug dose with the TIVA technique allows for better control of perioperative bleeding.

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“…Our recommendation allows to maintain MAP at 65–70 mm Hg, to avoid organ hypoperfusion [24, 36]. Although controlled hypotension seems to be effective in reducing intraoperative bleeding during endoscopic sinus surgery, its use during endoscopic endonasal skull base surgery for intradural lesion is cautious.…”

Section: Anesthesia Considerationsmentioning

confidence: 99%

Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

et al. 2013

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Hemostasis is critical for adequate anatomical visualization during endoscopic endonasal skull base surgery. Reduction of intraoperative bleeding should be considered during the treatment planning and continued throughout the perioperative period. Preoperative preparations include the optimization of comorbidities and cessation of drugs that may inhibit coagulation. Intraoperative considerations comprise anesthetic and surgical aspects. Controlled hypotension is the main anesthetic technique to reduce bleeding; however, there is controversy regarding its effectiveness; what the appropriate mean arterial pressure is and how to maintain it. In extradural cases, we advocate a mean arterial pressure of 65–70 mm Hg to reduce bleeding while preventing ischemic complications. For dealing intradural lesion, controlled hypotension should be cautious. We do not advocate a marked blood pressure reduction, as this often affects the perfusion of neural structures. Further reduction could lead to stroke or loss of cranial nerve function. From the surgical perspective, there are novel technologies and techniques that reduce bleeding, thus, improving the visualization of the surgical field.

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Ocena korelacji średniego ciśnienia tętniczego z krwawieniem śródoperacyjnym przy wolnej czynności serca w trakcie endoskopowej chirurgii zatok przynosowych

Abstract: With the stable low heart rate at the minimal physiological values the bleeding in the operative field depends on MAP. Keeping HR around 60 b/min there is no need to decrease the MAP to dangerously low levels to achieve good operative field conditions in great proportion of patients.

Cited by 24 publications

References 13 publications

Comparison of quality of the surgical field after controlled hypotension using esmolol and magnesium sulfate during endoscopic sinus surgery

Comparison of quality of the surgical field after controlled hypotension using esmolol and magnesium sulfate during endoscopic sinus surgery

Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery

Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

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