The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

Nekhendzy, Vladimir; Lemmens, Hendrikus J. M.; Vaughan, Winston C.; Hepworth, Edward J.; Chiu, Alexander G.; Church, Christopher A.; Brock‐Utne, John G.

doi:10.1213/01.ane.0000282781.56025.52

Cited by 39 publications

(42 citation statements)

References 30 publications

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“…[910] Remifentanil and labetalol the two anesthetic drugs that are used in anesthesia during endoscopic sinus surgery to controlled hypotension and providing the better field of operation, but no comparative study has been performed on the use of remifentanil or labetalol for controlled hypotension during endoscopic sinus surgery. The present study was designed to assess the efficacies of labetalol and remifentanil in terms of postoperative analgesia and other complications during and after controlled hypotension for in endoscopic sinus surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

2016

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Objective:This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery.Methods:In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0.5–2.0 mg/min and in the second group, remifentanil with dose of 0.5–1 μg/kg started and then 0.25–0.5 μg/kg/min were prescribed. Hemodynamic parameters during anesthesia and recovery time, surgeon and patient satisfaction, and recovery time were measured and recorded.Findings:Hemodynamics variable were comparable between two groups at different times of the study. The mean of bleeding and the frequency of side effects were higher in labetalol group (P = 0.033 and P < 0.0001, respectively). The median of surgeon satisfaction score in remifentanil group was statistically higher in labetalol group (P < 0.0001). Recovery time, fluid requirement, and pain score in labetalol group reported significantly more than remifentanil group. Richmond Agitation–Sedation Scale status at time points in the postanesthetic care unit showed differences between groups.Conclusion:With infusion of labetalol and remifentanil after a bolus dose we can induce effective controlled hypotension under general anesthesia. Remifentanil is a short-acting narcotic drug; then, patient satisfaction was better and recovery time was shorter. From the economic aspect, labetalol prefers to remifentanil.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

2016

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“…on a scoring scale modified from Boezaart et al 17 (0: best, 10: worst) ( Table 1). 18 The extent of the surgical procedure performed was assessed using a surgical volume scale: 0 to 1 score for surgery on the maxillary and sphenoid sinuses and 0 to 2 score for ethmoid, frontal sinuses and dissection of bulky polypoid disease from the nasal cavity, yielding the maximum score of 8 per side (maximum total score of 16). 18 Increased score was given for the surgical dissection of the ethmoid, frontal sinuses and nasal polypoid disease because of frequently encountered higher blood loss in these regions.…”

Section: Outcome Measurementsmentioning

confidence: 99%

The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery

Cho

Drover

Nekhendzy

et al. 2011

Int Forum Allergy Rhinol

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“…However, a recent study demonstrated no significant difference in the surgical conditions or blood loss among hypocapnia (end tidal carbon dioxide (ETCO 2 ) 27 ± 2 mm Hg), normocapnia (ETCO 2 37 ± 2 mm Hg), or hypercapnia (ETCO 2 60 ± 2 mm Hg) in patients under propofol plus remifentanil anesthesia when heart rate and blood pressure were controlled [18]. Although this study showed that hypercapnia does not yield significantly different intraoperative bleeding, it is known that high hypercapnia produces vasodilatation, increasing cerebral blood flow and brain fullness.…”

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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The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

Abstract: CO2 management during functional endoscopic sinus surgery does not influence operating conditions or blood loss.

Cited by 39 publications

References 30 publications

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery

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

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