Prevention of hypertension during trans‐sphenoidal surgery — the effect of bilateral maxillary nerve block with local anaesthetics

Chadha, Ritu; Padmanabhan, Vinod; Rout, Amit; Waikar, Hemant Digambar; Mohandas, K

doi:10.1111/j.1399-6576.1997.tb04610.x

Cited by 19 publications

(32 citation statements)

References 7 publications

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“…Trans-nasal rhino septal transsphenoidal approach is one of the most frequently used approaches by neurosurgeons for microsurgical excision of the pituitary gland. [ 1 2 3 ] However, this procedure is frequently associated with severe stress responses causing major hemodynamic changes such as alterations in blood pressure (BP), heart rate (HR), and rhythm. [ 4 5 ] Furthermore, neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to the procedure and to reduce surgical site bleeding.…”

Section: Introductionmentioning

confidence: 99%

Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery

Bhatia

Ghai

Mangal

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background and Aims:Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding.Materials and Methods:Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidal surgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval.Results:Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A.Conclusion:Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions.

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Section: Introductionmentioning

confidence: 99%

Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery

Bhatia

Ghai

Mangal

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…[3] Local anaesthetic infiltrations into the nasal mucosa and maxillary nerve block have also been attempted, with variable results. [4] However, lignocaine in sufficient concentration when given with epinephrine counteracts the cardiovascular side effect of epinephrine but also fails to blunt this response into the deeper part, as infiltration in deeper structure is not possible. [45]…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double-blind, controlled study

et al. 2011

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Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I–II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.

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“…Due to intraoperative use of additional incremental doses of anesthetics and analgesics for blunting these vasopressor responses, achieving smooth and prompt awakening in such a patient is challenging. 13 We used BIS-guided anesthesia to maintain a uniform depth of anesthesia and used esmolol and ephedrine to maintain MAP within 25% of baseline value. Hence, the intraoperative hemodynamic changes were measured at comparable anesthesia depth.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

Bharadwaj

Mahajan

Aggarwal

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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Background Use of short-acting anesthetic agents such as propofol and desflurane allows rapid awakening and prompt neurological assessment of patients undergoing endoscopic transnasal transsphenoidal resection of pituitary tumors. However, there are no studies comparing the effect of these two agents in these patients. We performed this study to compare the intraoperative hemodynamics and postoperative recovery characteristics of patients undergoing endoscopic transnasal transsphenoidal (TNTS) pituitary tumor surgery using bispectral index (BIS)-guided administration of desflurane and propofol. Materials and Methods In this prospective, randomized trial, 60 patients undergoing endoscopic TNTS pituitary surgery were randomized to receive BIS-guided administration of either propofol (Group P) or desflurane (Group D) for the maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), intraoperative complications, time to emergence, extubation, cognition, and modified Aldrete score were evaluated. Statistical analysis was performed using STATA 12.0. Categorical and continuous variables were compared between the groups using Fisher’s exact test and t-test, respectively. Emergence from anesthesia and hemodynamics at various stages of surgery was compared between the groups using Wilcoxon rank sum test. The p-value < 0.05 was considered statistically significant. Results The HR was significantly higher at all stages of surgery in group P (p = 0.01). MAP was comparable between the groups at various time points (p > 0.05). Both emergence time (8.5 vs. 15 minutes; p < 0.00) and extubation time (10 vs. 17.5 minutes; p < 0.00) were significantly shorter in Group D compared with Group P. Modified Aldrete score at 5 and 10 minutes after extubation was higher with desflurane than propofol, but early cognition was comparable between the two groups. Conclusion The hemodynamics and early cognition score were comparable in patients receiving propofol or desflurane. Desflurane provides rapid emergence and recovery when compared with propofol.

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Prevention of hypertension during trans‐sphenoidal surgery — the effect of bilateral maxillary nerve block with local anaesthetics

Abstract: The described technique is a useful adjunct to general anaesthesia for suppressing the haemodynamic responses during trans-sphenoidal surgery.

Cited by 19 publications

References 7 publications

Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery

Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery

Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double-blind, controlled study

Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

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