Dexmedetomidine Efficacy in Quality of Surgical Field During Endoscopic Sinus Surgery

Document Type: Original

Authors

1 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital ,Guilan University of Medical Sciences, Rasht, Iran.

2 Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

3 Student of Medicine,Guilan University of Medical Sciences, Rasht, Iran.

Abstract

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 bleeding scores (P=0.001) than the control group.Surgeon's satisfaction based on a Likert scale (P=0.001) was lower in the control group. The mean of DBP was lower in the DEX group in the 30th(P=0.001), 60th(P=0.001), and 90th(P=0.01) min of the induction. The MAP was lower in the DEX group in the 30th(P=0.015), 60th(P=0.052), and 90th(P=0.046) min of the induction. There were no postoperative adverse effects in the DEX group.
 
Conclusion:
It was observed that DEX improves the quality of the surgical field and hemodynamic stability. In addition, DEX might be safely and effectively used in surgeries in which deliberate hypotension is desirable.

Keywords

Main Subjects


1. Eghbal A, Modir H, Moshiri E, Khalili M, Barsari FZ, Mohammadbeigi A. Hypotensive effect of labetalol and dexmedetomidine blood loss and surgical conditions in functional endoscopic sinus surgery: A double-blind randomized clinical trial. Formosan Journal of Surgery. 2018;51(3):98.

2. Baradaranfar MH, Dadgarnia MH, Mahmoudi H, Behniafard N, Atighechi S, Zand V, et al. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iranian journal of otorhinolaryngology. 2017; 29(91):69.

3. Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol 2008;25(1):22-8.

4. Das A, Chhaule S, Bhattacharya S, Basunia SR, Mitra T, Halder PS, et al. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study.Saudi journal of anaesthesia.  2016;10(3):276.

5. Damm M, Quante G, Jungehuelsing M, Stennert E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002; 112: 310–5.

6. Flint, Paul W, Phelps T. Cummings Otolaryngology head & neck surgery.5th edition Elsevier, Philadelphia; 2010.

7. Wormald PJ. The surgical field in endoscopic sinus surgery. In: Endoscopic Sinus Surgery Anatomy, Three Dimensional Reconstruction and Surgical Technique. 3td edition,Thieme,New York;  2005:7–12.

8. Wormald PJ, van Renen G, Perks J, Jones JA, Langton-Hewer CD .The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 2005;19: 514–20.

9. Shams T, Bahnasawe N S El, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth 2013; 7(2): 175–80.

10. Marzban S, Haddadi S, Mahmoudi Nia H, Heidarzadeh A, Nemati S, Naderi Nabi B.  Comparison of surgical conditions during propofol or isoflurane anesthesia for endoscopic sinus surgery.Anesth Pain Med. 2013 Sep;3(2):234-8.

11.Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty.Eur J Anaesthesiol 2008;25(5):369-74.

12. Ghorbani J, Arastou S, Naeini AS, Raad N, Galougahi MK, Jahangirifard A, et al. Comparing the Effect of Oral Clonidine and Tranexamic Acid on Bleeding and Surgical Field Quality during Functional Endoscopic Sinus Surgery. Iranian journal of otorhinolaryngology. 2018;30(100):255.

13. Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y.Effectivness of dexmedetomidine in reducing bleeding during spetoplasty and tympanoplasty operations. J Clin Anesth  2008;20:437‑41.

14. Guven DG1, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2011; 120(9): 586-92.

15. Praveen DV, Pushparani A, Anand K, Sundaraperumal B.Comparison of dexmedetomidine with nitroglycerinefor hypotensive anaesthesia in functional endoscopic sinus surgery.Indian Journal of Clinical Anaesthesia. 2016;3(3):380-92.

16. Peden CJ, Cloote AH, Stratford N, Prys‑Roberts C. The effect of intravenous dexmedetomidine premedication on the dose of requirements of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia 2001;56:408‑13.

17. Akkaya A, Tekelioglu UY, Demirhan A, Bilgi M, Yildiz I, Apuhan T, et al. Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: Randomized clinical study. Rev Bras Anestesiol 2014;64:406‑12.

18. Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A, et al. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol 2016; 32: 192‑7.

19. Hadavi MR, Zarei Y, Tarogh S. Comparison of effects of labetalol and  nitroglycerine on intraoperative blood loss and surgical field quality in rhinoplasty surgery. World J Plast Surg 2015;4:60-5.

20. Kim H, Ha SH, Kim CH, Lee SH, Choi SH. Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery. Korean J Anesthesiol 2015;68:449-54.

21. Lee J, Kim Y, Park C, Jeon Y, Kim D, Joo J, et al. Comparison between dexmedetomidine and remifentanil for controlled hypotension and recovery in endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2013;122(7):421-6.

22. Moshiri E, Modir H, Bagheri N, Mohammadbeigi A, Jamilian H, Eshrati B, et al.Premedication effect of dexmedetomidine and  alfentanil on seizure time, recovery duration, and hemodynamic responses in electroconvulsive therapy. Ann Card Anaesth 2016;19:263-8.

23. Akkaya A, Tekelioglu UY, Demirhan A, Bilgi M, Yildiz I, Apuhan T, et al.Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: Randomized clinical study. Rev Bras Anestesiol 2014;64:406-12.