Target‑controlled infusion of propofol and remifentanil combined with dexmedetomidine reduces functional endoscopic sinus surgery bleeding

Ding, Dengfeng; Wu, Lifang; Wang, Ping; Jiang, Yibin; Luo, Yumin; Dai, Zhongliang; Zhang, Xueping; Li, Yali

doi:10.3892/etm.2017.5075

Cited by 4 publications

(7 citation statements)

References 34 publications

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“…Propofol, remifentanil and dexmedetomidine have been used in combination in the settings of functional endoscopic sinus surgery (FESS) to reduce intraoperative bleeding and also in pediatric surgery in order to optimize intubating conditions without the use of neuromuscular blockade. 8,11 Ding et. al 8 found that FESS performed using targeted controlled infusions of propofol and remifentanil combined with dexmedetomidine reduced intraoperative bleeding and improved the quality of the surgical field compared to FESS performed using propofol and remifentanil without dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

“…8,11 Ding et. al 8 found that FESS performed using targeted controlled infusions of propofol and remifentanil combined with dexmedetomidine reduced intraoperative bleeding and improved the quality of the surgical field compared to FESS performed using propofol and remifentanil without dexmedetomidine. This was attributed to the inhibition of norepinephrine and resulting lower heart rate associated with dexmedetomidine administration.…”

Section: Discussionmentioning

confidence: 99%

“…5,7 Combining dexmedetomidine with other anesthetics also allows for significant reduction of other anesthetic medication requirements such as opioids and benzodiazepines. 8,9 Kim et al assessed the efficacy of dexmedetomidine-remifentanil compared to propofol-remifentanil in patients undergoing endoscopic submucosal dissection and found that propofol produced a more profound decrease in pharyngeal muscle tone and a reduction in pharyngeal contraction resulting from stimulation of the posterior pharyngeal wall compared to dexmedetomidine. 10 This attribute makes propofol a useful adjunct for patients undergoing thyroplasty with arytenoid adduction.…”

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confidence: 99%

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Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions

et al. 2020

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“…Dexmedetomidine, a potent central alpha-2 agonist, has been shown to have anaesthetic and opioid-sparing effects. 10,18,19 For example, it reduced fentanyl requirements during cholecystectomy 10 and remifentanil requirements during abdominal 18 and nasal surgery. 19 However, previous studies that investigated dexmedetomidine used clinical indicators, such as heart rate and blood pressure or frontal electroencephalogram (EEG) to guide antinociception and consequently have limitations.…”

Section: Introductionmentioning

confidence: 99%

“…10,18,19 For example, it reduced fentanyl requirements during cholecystectomy 10 and remifentanil requirements during abdominal 18 and nasal surgery. 19 However, previous studies that investigated dexmedetomidine used clinical indicators, such as heart rate and blood pressure or frontal electroencephalogram (EEG) to guide antinociception and consequently have limitations. Heart rate and blood pressure have been shown to be less sensitive and specific to the NOL Index 20 whereas frontal EEG evaluates cortical activity, which is principally affected by anaesthetic depth and its sensitivity to nociception may be severely attenuated in the anaesthetised patient.…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception

Coeckelenbergh

Doria

Patricio

et al. 2021

European Journal of Anaesthesiology

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Mean AE SD remifentanil (3.96 AE 1.95 vs. 4.42 AE 2.04 ng ml À1 ; P ¼ 0.0024) and propofol (2.78 AE 1.36 vs. 3.06 AE 1.29 mg ml À1 ; P ¼ 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 AE 0.085 vs. 0.198 AE 0.086 mg kg À1 min À1 ; P ¼ 0.0074) and propofol (5.7 AE 2.72 vs. 7.4 AE 2.80 mg kg À1 h À1 ; P ¼ 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision. CONCLUSION In ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia.

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Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgeries: A Systematic Review

NS,

Shaji

et al. 2024

Int. J. Res. Pharm. Sci.

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This systematic review comprehensively analyzes the literature on hypotensive anesthesia in Functional Endoscopic Sinus Surgeries (FESS), crucial for treating sinonasal disorders. The anesthesia technique choice significantly influences FESS outcomes. Hypotensive anesthesia, involving controlled blood pressure reduction during surgery, garners attention for potential benefits. A database search identified relevant studies examining its efficacy, safety, and impact on intraoperative visibility, surgical time, blood loss, and postoperative outcomes. Various drugs, including inhalational agents, hypocapnia, hypercapnia, local adrenaline, fentanyl, remifentanil, esmolol, dexmedetomidine, and nitroglycerine, have been employed to minimize bleeding and enhance operative conditions. Sevoflurane is a common inhalation agent. Dexmedetomidine, with lower bolus doses, proves advantageous for visibility and achieving a MAP of 60 mm Hg swiftly. Opioids have a lower hypotensive potential, nitroglycerine lacks analgesic effects, and beta-blockers provide favorable conditions. Dexmedetomidine's prolonged analgesia correlates with improved postoperative outcomes. Limited studies explore combined drugs' efficacy or side effects. Cognitive dysfunction is a concern, with hypotension approved up to a MAP of 60 mm Hg. The technique's application extends to children, but careful patient selection is crucial, considering contraindications and comorbidities.

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Target‑controlled infusion of propofol and remifentanil combined with dexmedetomidine reduces functional endoscopic sinus surgery bleeding

Cited by 4 publications

References 34 publications

Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions

Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions

Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception

Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgeries: A Systematic Review

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