Premedication with clonidine before TIVA optimizes surgical field visualization and shortens duration of endoscopic sinus surgery - results of a clinical trial (original) (raw)
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Journal of Pharmaceutical Research International, 2021
Aim: To study the efficacy of oral clonidine on intraoperative bleeding and consumption of inhalational agent in patients undergoing FESS under general anesthesia. Study Design: Prospective, comparative observational study. Place and Duration of Study: Department of Anesthesiology, AVBRH, from June 2020 to May 2021. Methodology: A total of 30 patients fulfilling inclusion criteria scheduled for FESS were randomly allocated into 2 groups of 15 each; GROUP C (Clonidine group, n=15) who received tab clonidine 5 mcg/kg, 90 minutes before surgery and GROUP M (Multivitamin group, n=15) who received multivitamin tablet. Mean ± standard deviation (SD) or absolute values were used to indicate data; comparison of qualitative data were done using Chi-square test and Fisher’s exact test and quantitative variables using the student ‘t’ Test. P value < 0.05 was taken as statistically significant. Results: Bleeding was considerably less in the group C [1.65 ± 0.4] as compared to group M ...
Anesthesia: Essays and Researches, 2013
Context: Establishing a near perfect surgical fi eld during functional endoscopic sinus surgery (FESS) is essential and even a minor bleeding can severely compromise an already restricted view. So, if controlled hypotension can be provided without compromising the safety of patient by a relatively effortless method, surgical fi eld can be improved greatly. Aims: The aim of this study was to compare the hemodynamic changes and surgical conditions during FESS following oral premedication with clonidine and metoprolol. Settings and Design: A total of 40 patients undergoing FESS were included in this prospective, randomized controlled study. Subjects and Methods: Patients were divided into two equal groups. Group A patients were premedicated with oral clonidine 300 mcg and Group B with oral metoprolol 50 mg, 2 h before surgery. All patients received fentanyl 2 mcg/kg and induced with propofol 2 mg/kg. Intubation was done following vecuronium 1 mg/kg. Anesthesia was maintained with 66% N 2 O, 33% O 2 and 1% isofl urane. The heart rate (HR) and blood pressure (BP) were measured before induction and thereafter every 15 min up to 2 h. The surgeons were asked to estimate the quality of the operative fi eld using a pre-defi ned category scale with scores 1-5. Statistical Analysis: Difference within the groups was analyzed using analysis of variance and post-hoc test was used to test the difference between individual groups. Chi-square test was used to fi nd out the association between categorical variables. Results: Comparison of category scale revealed a lower score in Group A up to 60 min. Group B patients showed a statistically lower HR from pre-induction up to 90 min while systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure did not show a signifi cant difference. Conclusions: Oral premedication with 300 mcg of clonidine produced a better operative fi eld than oral metoprolol 50 mg during FESS.
Oral clonidine: an effective adjuvant in functional endoscopic sinus surgery
International Journal of Basic & Clinical Pharmacology, 2017
Background: A comparative study to evaluate the efficacy of intravenous Dexmedetomidine as a hypotensive agent in comparison to oral Clonidine in Endoscopic Nasal Surgery or Functional Endoscopic Sinus Surgery (FESS).Methods: Forty patients ASA I or II scheduled for Endoscopic Nasal Surgery were equally randomly assigned to receive either dexmedetomidine 1μg/Kg over 10 min before induction of anesthesia followed by 0.5μg/Kg/h infusion during maintenance (Group D), or oral Clonidine (Group C) 2µg/kg with minimal water 1 hour prior starting of surgery. Rescue bolus doses of Propofol (10mg/dose) were given to maintain mean arterial blood pressure (MAP) between (50-70mmHg). General anesthesia was maintained with Isoflurane 1%-2%. The surgical field was assessed using Average Category Scale. Hemodynamic variables (MAP and HR) were recorded at 10 minutes interval.Results: Both group C and group D reached the desired MAP (50-70mmHg) with no intergroup differences in HR but a statistically ...
Journal of Babol University of Medical Sciences, 2020
BACKGROUND AND OBJECTIVE: Intraoperative bleeding during endoscopic sinus surgery compromises the surgeon's vision for surgery at the surgical field. Since tizanidine causes contraction of peripheral blood vessels and hypotension, which together reduce blood flow to nasal mucosa, this study was performed to evaluate the effect of oral tizanidine on the quality of vision at the surgical field during endoscopic sinus surgery. METHODS: This double-blind clinical study was performed on 60 patients. Patients were randomly divided into two groups by computer randomization software (2.0) and received 6 mg tizanidine and placebo before the surgery. During the operation, the quality of the operation field was evaluated and scored by the surgeon based on Boezaart scale. Pain score in recovery and 6 hours after surgery and intraoperative hemodynamic parameters were assessed. FINDINGS: The quality of the surgical field based on the Boezaart scale was significantly better in the group receiving tizanidine (p=0.04). Pain score in recovery was 2.83±1.17 in the case group and 4.53±1.56 in the control group (p=0.001). Pain score 6 hours after surgery in the case group was 3.23±1.22 and in the control group was 4.13±1.33 (p=0.008). Mean arterial blood pressure (p=0.03) and heart rate (p=0.19) during surgery were lower in the tizanidine group. CONCLUSION: The results of the study showed that tizanidine as a perioperative medication before endoscopic sinus surgery improves the quality of vision at the surgical field and provides a better hemodynamic profile for patients.
Dexmedetomidine Efficacy in Quality of Surgical Field During Endoscopic Sinus Surgery
Iranian Journal of Otorhinolaryngology, 2019
Introduction: Blood loss is a common concern during functional endoscopic sinus surgery (FESS). The present study aimed to evaluate the efficacy of dexmedetomidine (DEX) in intraoperative bleeding and surgical field in FESS. Materials and Methods: This double-blind randomized clinical trial was conducted on 72 patients within the age range of 16-60 years who underwent FESS. The subjects were randomly dividedinto two groups. The DEXgroup received 1 mic/kg DEX in 10 min at anesthesia induction followed by 0.4 to 0.8 mic/kg/hour during maintenance, while the control group received normal saline instead of DEX in bolus with the same volumemaintenance. Heart rate, systolic blood pressure, diastolic blood pressure (DBP),mean arterial pressure (MAP),and opioid requirement were evaluated in the 15th, 30th, 60th, and 90thmin of the induction. The surgeon's assessment of the field during surgery and intraoperative bleeding was also recorded in this study. Results: The DEX group had lower ...
The Effect of ??-Blocker Premedication on the Surgical Field During Endoscopic Sinus Surgery
The Laryngoscope, 2004
These studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of -blockers as a premedication could improve the operative field in endoscopic sinus surgery. Study Design: A prospective, randomized, double-blinded, placebo-controlled trial. Methods: Eighty patients undergoing endoscopic sinus surgery who fit the inclusion and exclusion criteria were randomly assigned to receive either a -blocker, Metoprolol (group 1), or a placebo tablet (group 2) 30 minutes before surgery. A standard anesthetic protocol was followed. At the commencement of surgery and at regular 15-minute intervals the surgical field, blood loss, heart rate, blood pressure, and isoflurane concentration were assessed. Results: There was a significant difference in overall mean heart rate between the placebo and -blocker groups (P < .0001). In the entire group, surgical grade correlated with heart rate (r ؍ 0.36, P < .05) but not with mean arterial blood pressure. Mean surgical grade was similar between the placebo and -blocker groups, but early in the study a significantly better surgical field was recorded in the -blocker group (P < .001). Surgical grade was significantly better in those with a mean heart rate of less than 60 beats per minute (P < .02). Conclusion: Although "optimum" conditions were present in the patients receiving -blocker, the authors thought that the grading system was not discriminating enough to demonstrate a significant difference between the groups. The crucial finding in the study was the correlation between heart rate and surgical grade in the entire group. During endoscopic sinus surgery surgery, anesthetic manipulations should be directed at maintaining a low heart rate. Key Words: Endoscopic sinus surgery, prospective randomized controlled study, surgical field.
2016
Functional Endoscopic sinus surgery (FESS), visibility is often affected by intra-nasal bleeding, which can be influenced by various anaesthetics. We conducted a prospective randomized controlled study in 60 ASA I and ASA II patients between 18-60 years of age undergoing functional endoscopic sinus surgery under general anesthesia. Aim: To study and compare hemodynamics, blood loss and operative field visibility between Dexmedetomidine infusion and Propofol infusion when used for maintenance in FESS surgeries. Material and Method: Institutional ethics committee approval and informed written consent were taken. Patients were randomly divided into Group D (Dexmedetomidine) and Group P(Propofol) with 30 patients each. Group D received 0.5mcg/kg/hr Dexmedetomidine and Group P received 100mcg/kg/hr Propofol.for maintenance introperatively. Patients hemodynamics, blood loss were assessed and operatively filed visibility were assessed using a 6 point scale given by Fromme et al and Boezart...
Journal of Anesthesia & Clinical Research, 2014
Aim: The present study was done to evaluate the role of oral clonidine and atenolol in providing optimal surgical field in nasal surgeries under general anaesthesia. Material and methods: 60 patients of ASA grade I & II posted for elective nasal surgeries were randomly divided into two groups of 30 each. Patients received 50 mg oral atenolol in group A and 100 ug oral clonidine in group B two hours prior to surgery. Induction and maintainence of anaesthesia was performed by the same standard protocol. Heart rate, systolic and diastolic blood pressure were recorded during the intra-operative and post-operative period. The surgeon, blinded to group allocation, evaluated the quality of surgical field using a predefined Average Category Scale (ACS). The amount of total blood loss was also recorded.
International Journal of Research in Pharmaceutical Sciences
Rhinoplasty is one frequent surgical procedure of many technical variations that only a few surgeons are considered to have mastered its broad scope. Operative site bleeding is considered to be an exasperating issue in the surgical procedure of rhinoplasty. Over the past few decades, the strategy of lowering patient's blood pressure during anaesthesia or "Hypotensive anaesthesia" has been practised to reduce the blood loss during surgeries. Clonidine is an antihypertensive drug and is suggested to have advantageous effects in controlling the intraoperative blood loss. The objective of this systematic review was to explore and study the existing literature and determine the efficacy of oral clonidine as a premedication in reducing the intraoperative blood loss in rhinoplasty surgeries. Data was gathered from electronic databases like PubMed, Medline and Cochrane central library. An additional manual search was performed with various journals to look for available articl...
International forum of allergy & rhinology, 2016
A clear surgical field is critical during endoscopic sinus surgery (ESS). Hypotensive anesthesia and cardiac output (CO) may optimize the surgical field; however, evidence of their effect on bleeding and cerebral blood flow is conflicting. The aim of this study was to evaluate the effect of blood pressure (BP) and CO on intraoperative bleeding and middle cerebral artery blood flow velocity (Vmca ) during ESS. This was a prospective randomized controlled trial. Patients undergoing ESS for chronic rhinosinusitis at a tertiary institution in 2013 were randomized to receive BP manipulation using target-controlled noradrenaline infusion during surgery to either their left or right sinuses. The contralateral side in each patient served as control. Bleeding was scored using a 0 to 10 point bleeding assessment scale (BAS, 0-10) and Vmca was measured using transcranial Doppler ultrasonography every 10 minutes or when surgically opportune, and time-matched with BP and CO. Data was analyzed us...