Abstract
BackgroundDeliberate hypotension is one way to achieve a bloodless surgical field in endoscopic sinus surgery (ESS). We compared two anaesthesia regimens to induce deliberate hypotension and attempted to determine the most efficient one.MethodsFifty-nine patients undergoing ESS were minimized into two groups. In the CLO group, patients received I.V. sufentanil 0.15 µg/kg together with I.V. clonidine 2–3 µg/kg. In the REMI group, patients received remifentanil at a rate of up to 1 µg/kg/min. Fromme scores were collected 15 min after the incision and at the end of the procedure. Mean arterial pressure readings (MAP), heart rate readings, time to eyes opening, time to extubation, pain scores, analgesic requirements, and oxygen needs were collected and compared.ResultsThere were no significant differences in Fromme scores between the two groups. The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients also received more ephedrine. Significantly fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients in this group also needed less piritramide in the recovery room, and their pain scores were lower at discharge from the recovery room.DiscussionAlthough both anaesthesia regimens offered a similar quality of surgical field, this study suggests that clonidine had a better average safety profile. Furthermore, patients who received this regimen required fewer painkillers immediately after surgery.
Highlights
Over the past decades, endoscopic sinus surgery (ESS) has developed into one of the most frequently used surgical treatments for chronic inflammatory or infectious sinus diseases
To achieve a bloodless surgical field, deliberate hypotension is often used among other interventions, such as preoperative oral corticosteroid treatment prescribed in case of severe disease, moderate hypocapnia, reverse Trendelenburg position, infiltration with a local anesthetic solution containing a vasopressor and/or topical anesthesia of the surgical site
Patients were prospectively randomized in the CLO group or the REMI group using minimization (Saghaei & Saghaei, 2011) the day before or the day of the surgery by the main investigator (Fig. 1)
Summary
Endoscopic sinus surgery (ESS) has developed into one of the most frequently used surgical treatments for chronic inflammatory or infectious sinus diseases. This procedure requires a bloodless surgical field to help the surgeon visualize anatomical structures to avoid injuries and rare, but potentially catastrophic, complications (Baker & Baker, 2010). The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients received more ephedrine. Fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients who received this regimen required fewer painkillers immediately after surgery
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