The quality of the surgical field during functional endoscopic sinus surgery—The effect of the mode of ventilation—A randomized, prospective, double‐blind study

Gilbey, Peter; Kukuev, Yevgeny; Samet, Alvin; Talmon, Yoav; Ivry, Shimon

doi:10.1002/lary.20614

Cited by 20 publications

(16 citation statements)

References 16 publications

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“…3–7 Many methods have been proposed to create a bloodless field, including patient positioning in reverse Trendelenburg, administration of topical vasoconstrictors, use of a laryngeal mask airway to decrease the hemodynamic response to endotracheal intubation, and manipulation of ventilator settings. 8–12 Additionally, hypotensive medications have been utilized, such as beta blockers, magnesium sulfate, clonidine, and sodium nitroprusside. 4,13–17 It is proposed that these medications reduce the mean arterial pressure (MAP) during the procedure and subsequently decrease blood flow to the nasal mucosal tissue undergoing manipulation.…”

Section: Introductionmentioning

confidence: 99%

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

Kelly

Gollapudy

Riess

et al. 2012

Int Forum Allergy Rhinol

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Background Adequate surgical field visualization is imperative for successful outcomes in endoscopic sinus surgery (ESS). The type of anesthetic administered can alter a patient’s hemodynamics and impact endoscopic visualization during surgery. We review the current evidence regarding the effect of total intravenous anesthesia (TIVA) compared to inhalational anesthesia (INA) on visualization of the surgical field during ESS. Methods A systematic review of the literature was performed. Ovid MEDLINE, Scopus, and Cochrane databases were searched from 1946 to January 2012. Citations from the primary search were reviewed and filtered to identify all relevant abstracts in English. Articles meriting full review included prospective controlled trials enrolling adult patients undergoing ESS that were randomized to a group receiving INA or TIVA with outcome measures focused on surgical field visualization. ‘Results Seven eligible trials fulfilled inclusion criteria. Four of the seven articles demonstrated a statistically significant improvement in surgical field grade during ESS when receiving TIVA compared with INA. However, detailed INA concentrations were often not provided. High levels of INA may have been administered; therefore, side effects of INA rather than effects of an ideal INA administration were possibly represented. Analgesic administration also varied widely among the anesthetic groups further complicating interpretation of study results. The lack of power and the heterogeneity of the studies precluded a formal meta-analysis. Conclusions Although several studies reported that TIVA improve surgical conditions in ESS, however there are significant limitations. These findings prevent any definite recommendation at this point, emphasizing the need for further high quality studies.

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Section: Introductionmentioning

confidence: 99%

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

Kelly

Gollapudy

Riess

et al. 2012

Int Forum Allergy Rhinol

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“…Previous studies have used single doses of metoprolol[11] or esmolol,[2] which are short acting and although did reduce the bleeding initially, the effect did not persist through the length of the surgery. As the effect of the β-blocker wore off, the heart rate and the venous tone increased leading to more bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…[67891011] There is general agreement that bleeding can be reduced by maintaining a low blood pressure during the surgery. This can be achieved using high concentrations of anesthetic agents or administration of vasodilators like sodium nitroprusside.…”

Section: Introductionmentioning

confidence: 99%

Oral bisoprolol improves surgical field during functional endoscopic sinus surgery

Jacob¹,

Chandy²,

Cherian³

2014

J Anaesthesiol Clin Pharmacol

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Background:The success of functional endoscopic sinus surgery (FESS) depends on visual clarity of the surgical field, through the endoscope. The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of bisoprolol (2.5 mg) would reduce the bleeding during FESS and improve the visualization of the operative field.Materials and Methods:Thirty American Society of Anesthesiologists I or II patients, scheduled for FESS were randomized to receive either a placebo (Group A) or 2.5 mg of bisoprolol (Group B) 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP) of 60-70 mmHg, by titrating dose of isoflurane and fentanyl. The concentration of isoflurane used was recorded every 15 min. At the end of the surgery, the volume of blood loss was measured and the surgeon was asked to grade the operative field as per the Fromme-Boezaart Scale.Result:The blood loss was significantly (P < 0.0001) more in the control group (398.67 ± 228.79 ml) as compared with that in the bisoprolol group (110.67 ± 45.35 ml). The surgical field was graded better in those who received bisoprolol as compared with those in the control group (P − 0.0001). The volume percent of isoflurane and the dose of fentanyl used was significantly lower in those who received bisoprolol. During the operative period, the MAPs were 70.0 ± 2.7 (Group A) and 62.6 ± 3.6 mmHg (Group B) and the heart rate was 99.8 ± 5.0/min (Group A) and 69.2 ± 4.4/min (Group B). These differences were statistically significant ( P − 0.001).Conclusion:This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg) can significantly reduce the blood loss during FESS and improve the visualization of the operating field.

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“…A recent study compared efficacy between intermittent positive pressure ventilation and high frequency jet ventilation demonstrating that the total mean blood loss in the high-frequency jet ventilation group (170 mL) was significantly lower than the intermittent positive pressure ventilation group (318.8 mL; P = 0.017). The quality of the surgical field in high-frequency jet ventilation was significantly better than the intermittent positive pressure ventilation group ( P = 0.012) [20]. However, high-frequency jet ventilation is not practical for skull base surgery.…”

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 quality of the surgical field during functional endoscopic sinus surgery—The effect of the mode of ventilation—A randomized, prospective, double‐blind study

Cited by 20 publications

References 16 publications

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

Oral bisoprolol improves surgical field during functional endoscopic sinus surgery

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

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