Anesthesia For Endoscopic Sinus Surgery Research Articles

Efficacy of Ivabradine Versus Propranolol Premedication During Hypotensive Anesthesia in Endoscopic Sinus Surgery

Efficacy of Ivabradine Versus Propranolol Premedication During Hypotensive Anesthesia in Endoscopic Sinus Surgery

Survey of anesthesiologists on anesthetic maintenance techniques and total intravenous anesthesia for endoscopic sinus surgery.

Inhalational anesthesia and total intravenous anesthesia (TIVA) are techniques used for maintenance of general anesthesia for endoscopic sinus surgery (ESS). Growing evidence exists that TIVA may be associated with decreased bleeding and improved surgical fields, yet data suggest it is used in a minority of sinus surgery cases. The objective of this study was to investigate perceptions and approaches to anesthetic maintenance techniques in ESS among anesthesia providers. A total of 719 anesthesiology residents, faculty, and certified registered nurse anesthetists (CRNAs) at 3 tertiary academic centers in the United States were invited to participate in a survey of considerations and practice patterns for inhalational anesthesia and TIVA for ESS. Responses were received from 200 participants (28%). Sixty-five percent of respondents reported a lack of familiarity with current literature on TIVA for ESS. Many considered factors other than surgical field visualization when choosing a maintenance technique. Most were comfortable with performing TIVA but stated they would participate in additional training. The majority of anesthesiology providers were unaware of the existing literature demonstrating advantage in improved surgical visualization with TIVA. Many used a combination of inhaled and intravenous anesthetics for maintenance. These findings suggest that future opportunities may exist to develop education, training, and practice approaches specific to anesthetic techniques for ESS.

Evaluation of cerebral oxygen saturation during hypotensive anesthesia in functional endoscopic sinus surgery.

Background and Aims:Controlled hypotensive anesthesia in endoscopic sinus surgery would provide a clean surgical field. Cerebral oxygen saturation (ScO2) is important in endoscopic sinus surgery patients and it may be low during controlled hypotension. The aim of the present study was to assess ScO2 in these patients.Material and Methods:In this observational study, 41 patients who underwent endoscopic sinus surgery with hypotensive anesthesia were enrolled for the study and all of the patients received the same anesthetic medication, nitroglycerin for controlled hypotension. Variables were measured prior to surgery, after induction of anesthesia, 5 min, and every 30 min after controlled hypotension. Near-infrared spectroscopy was used for ScO2 evaluation. Mean arterial blood pressure (MAP) was maintained at 55–60 mmHg in the surgical duration. We used t-test, Wilcoxon, and repeated measures analysis of variance (ANOVA). We examined the cross-correlation functions of the time series data between end-tidal carbon dioxide (ETCO2)/MAP and ScO2.Results:The mean of intraoperative ScO2 was not significantly different from the baseline evaluation (P > 0.05). ETCO2 was cross correlated with current ScO2 [r: 0.618, confidence interval (CI) 95%: 0.46–0.78]. We found moderate cross correlation between the MAP and current ScO2 (r: 0.728, CI 95%: 0.56–0.88). About 92% of the patients recovered within 30 min. Recovery time was associated with intraoperative MAP (P: 0.004, r: 0.438), intraoperative ETCO2 (P: 0.003, r: 0.450), and ScO2 (P: 0.026, r: 0.348).Conclusions:Based on our findings, the assessment of ScO2 and maintained MAP >55 mmHg may provide safe conditions for endoscopic sinus surgery.

Anaesthesia for Endoscopic Sinus Surgery: A Survey of Anaesthesiologists in Restructured Hospitals in Singapore

Introduction: A cross-sectional survey of anaesthesiologists in Singapore's restructured hospitals was conducted to explore strategies employed to obtain a bloodless surgical field during endoscopic sinus surgery. Methods: All practicing anaesthesiologists in public institutions in Singapore were invited to answer an anonymous questionnaire. A point of contact per institution assisted in distribution and collection of questionnaire forms over a nine-month period. Results: A total of 114 anaesthesiologists completed the survey (response rate 60%). It was observed that 64.9% of respondents do not routinely employ controlled hypotension for endoscopic sinus surgery. Sixty-seven point five per cent chose general anaesthesia without nitrous oxide as the preferred anaesthetic technique for endoscopic sinus surgery. Forty-seven point four per cent opined that anaesthetic technique made no significant difference to outcomes in endoscopic sinus surgery. The most commonly used narcotics in endoscopic sinus surgery by the respondents were morphine (59.6%) and fentanyl (54.4%). However, where total intravenous anaesthesia was adopted, 86.0% of respondents opted to use remifentanil. The most commonly used class of antihypertensives for controlled hypotension was beta-blockers (66.7%). Factors limiting the use of total intravenous anaesthesia were also explored. Conclusion: This survey identifies variations from current evidence in the anaesthetic management of endoscopic sinus surgery among anaesthesiologists in Singapore's public institutions. The reasons behind these variations, which could include surgical preferences, financial, logistical, cultural, and educational factors, should be explored and any issues found addressed as necessary.

Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

BackgroundThe Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.ObjectivesIn this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.Patients and MethodsIn a single–blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol – remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.ResultsThere were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon’s satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).ConclusionsThe amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.

Pilot Study Comparing Total Intravenous Anesthesia to Inhalational Anesthesia in Endoscopic Sinus Surgery: Novel Approach of Blood Flow Quantification

We compared anesthesia with sevoflurane-remifentanil hydrochloride (SR) to total intravenous anesthesia with propofol-remifentanil hydrochloride (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in terms of sinonasal mucosal blood flow, the surgical field visualization score, and blood loss. We performed a double-blinded prospective study at a tertiary care center in 23 adults scheduled to undergo endoscopic sinus surgery for chronic rhinosinusitis. The patients were randomized to receive SR or PR. The sinonasal mucosal blood flow was measured by optical rhinometry. The surgical field visualization score was based on the Boezaart scale. The groups had similar clinical characteristics. During the 60- to 90-minute and 90- to 120-minute operative time windows, the blood flow was significantly greater in the PR group than in the SR group (p = 0.04 and p = 0.03, respectively). The amounts of blood loss in the PR and SR groups were 152.9 +/- 161.3 mL and 355.9 +/- 393.4 mL, respectively (p = 0.12). The median ratios of the surgical field visualization score to the number of sinuses operated on in the PR and SR groups were 2.1 and 1.8, respectively (p = 0.52). The intraoperative blood flow, as determined by optical rhinometry, was significantly greater with anesthesia with PR than with anesthesia with SR, 1 hour into the procedure; however, this difference did not translate into differences in the amounts of operative blood loss or in the surgical field visualization scores.

Comparison of surgical conditions during propofol or desflurane anesthesia for endoscopic sinus surgery

Comparison of surgical conditions during propofol or desflurane anesthesia for endoscopic sinus surgery

Comparison of surgical conditions during propofol or desflurane anesthesia for endoscopic sinus surgery

BackgroundReduction of intraoperative bleeding is necessary to achieve the ideal surgical field for the endoscopic sinus surgery (ESS). Intraoperative intra nasal bleeding is influenced by various anesthetics. This study compared surgical field condition between propofol/remifentanil (PR) based anesthesia and desflurane/remifentanil (DR) based anesthesia.MethodsAmerican Society of Anesthesiologists physical status class I or II patients undergoing ESS were randomly assigned to group PR (n = 36) or group DR (n = 32). The extent of the preoperative surgical lesion was classified as high (> 12) and low (≤ 12) Lund-Mackay (LM) scores according to the computed tomography findings. The target mean blood pressure was maintained at 70-80 mmHg. Only one surgeon was involved in rating the visibility of the surgical field on a numeric rating scale (NRS) every 10 minutes.ResultsThere was a different surgical field grade from PR to DR. The mean (SD) surgical field score of NRS for the PR and DR was 2.3 (0.57) and 2.7 (0.67), respectively (P = 0.006). Especially in the high-LM score patients, the mean (SD) of surgical field score for the PR and DR was 2.4 (0.67) and 3.0 (0.63), respectively (P = 0.012).ConclusionsIn the high-LM score patients, PR based anesthesia resulted in better surgical field condition for ESS than DR based anesthesia. In ESS, PR based anesthesia is considered to be helpful.

Effects of Total Intravenous Anesthesia vs Inhalational Anesthesia in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Randomized Controlled Study

Objective: Compare anesthesia with sevoflurane/remifentanyl (SR) to total intravenous anesthesia with propofol/remifentanyl (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in the following parameters: 1) effects on blood flow to the mucosa; 2) amount of blood loss; and 3) surgical field visualization score (SFS). Method: A total of 23 adults undergoing endoscopic sinus surgery for chronic rhinosinusitis within a 6-month period were randomized to receive SR or PR. The SFS was based on the Boezaart scale. Sinonasal mucosa blood flow was measured by optical rhinometry (OR). Blood loss was recovered with the Neptune Waste Management System. Results: The groups were evenly distributed, with similar clinical characteristics and Lund-Mackay score. Median blood loss was 105 cc in the PR group and 180 cc in the SR group ( P = .15). The length of surgery was 134 minutes in the PR group and 177 minutes in the SR group ( P = .19). The average SFS was 1.6 in the PR group and 2.0 in the SR group ( P = .22). OR showed a decrease in blood flow to -0.1 OR units from the beginning of surgery in the PR group compared with -0.4 OR units in the SR group ( P = .02). Conclusion: Our preliminary results suggest that PR appears to be associated clinically to a decreased blood loss, improved surgical field visualization, and decreased operative time in endoscopic sinus surgery. We showed however that blood flow to the nasal cavity appears to be increased with TIVA.

Anaesthesia for endoscopic sinus surgery

Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative beta blockade is associated with better operating conditions than when vasodilating agents are used. Tight control of CO(2) does not affect the surgical view. The use of a laryngeal mask may be associated with improved surgical conditions and a smoother emergence. It provides airway protection equivalent to that provided by an endotracheal tube in well-selected patients, but offers less protection from gastric regurgitation. Post-operatively, multimodal oral analgesia provides good pain relief, while long-acting local anaesthetics have been shown not to improve analgesia.

Role of Dexamethasone in Reducing Pain after Endoscopic Sinus Surgery in Adults: A Double-Blind Prospective Randomized Trial

We sought to study postoperative pain after endoscopic sinus surgery and to evaluate the efficacy of dexamethasone sodium phosphate in reducing pain and rescue analgesic requirements. In a prospective, double-blind, placebo-controlled clinical trial, 62 patients with chronic rhinosinusitis who were undergoing general anesthesia for endoscopic sinus surgery were randomized to receive either 8 mg (2 mL) of intravenous dexamethasone sodium phosphate or 2 mL of saline solution at the time of induction of anesthesia. After surgery, the patients were observed for 24 hours and were given 1 g of acetaminophen every 6 hours. Pain severity was reported immediately and 6 and 24 hours after surgery on a 10-cm visual analog scale. The need for rescue analgesia with tramadol hydrochloride was recorded and compared between the two groups. The two groups were matched by demographic data, clinical indications, and intraoperative details. The average postoperative pain severity scores at the 3 time intervals were 3.6, 2, and 1 in the dexamethasone group and 3.6, 2.5, and 1.6 in the saline solution group. These differences were not statistically significant. Ten patients in the dexamethasone group required rescue analgesia, compared to 12 in the saline solution group. The average patient required 0.53 doses of rescue analgesic in the dexamethasone group, versus 0.67 doses in the saline solution group. Again, these differences were not statistically significant. Dexamethasone injection at the time of induction of general anesthesia is not superior to placebo in controlling early postoperative pain in patients who undergo endoscopic sinus surgery.

Ventricular fibrillation due to coronary spasm at the site of myocardial bridge -A case report-

Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography.

Comparison of Laryngeal Mask with Endotracheal Tube for Anesthesia in Endoscopic Sinus Surgery

The purpose of this study was to compare surgical conditions, including the amount of intraoperative bleeding as well as intraoperative blood pressure, during functional endoscopic sinus surgery (FESS) using flexible reinforced laryngeal mask airway (FRLMA) versus endotracheal tube (ETT) in maintaining controlled hypotension anesthesia induced by propofol-remifentanil total i.v. anesthesia (TIVA). Sixty normotensive American Society of Anesthesiologists I-II adult patients undergoing FESS under controlled hypotension anesthesia caused by propofol-remifentanil-TIVA were randomly assigned into two groups: group I, FRLMA; group II, ETT. Hemorrhage was measured and the visibility of the operative field was evaluated according to a six-point scale. Controlled hypotension was achieved within a shorter period using laryngeal mask using lower rates of remifentanil infusion and lower total dose of remifentanil. In summary, our results indicate that airway management using FRLMA during controlled hypotension anesthesia provided better surgical conditions in terms of quality of operative field and blood loss and allowed for convenient induced hypotension with low doses of remifentanil during TIVA in patients undergoing FESS.

Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery

Endoscopic sinus surgery (ESS) is often affected by intra-nasal bleeding, which can be influenced by various anaesthetics and preoperative conditions. This study compared the surgical condition and the amount of intra-nasal bleeding between patients given sevoflurane/remifentanil (SR) and propofol/remifentanil (PR) anaesthesia. ASA I or II patients undergoing ESS were randomly assigned to group SR (n=20) or group PR (n=20). The extent of the preoperative surgical lesion was classified as high (> 12) and low Lund-Mackay (LM) (< or = 12) scores according to the computed tomography findings. The amount of intraoperative blood loss was calculated from the patients' haemoglobin (Hb) and the amount of blood in the suction canister. The surgeons rated the visibility of the surgical field on a numeric rating scale (NRS). In the high-LM score patients, the median (1st/3rd quartiles) blood loss for the SR and PR groups was 135 (121/222) and 19 (8/71) ml h(-1), respectively (P<0.01), and the mean (SD) of NRS was 5.8 (2.3) and 2.3 (1.0), respectively (P<0.05). However, in patients with low-LM score, both blood loss and NRS scores were not different between groups SR and PR. In the high-LM score patients, PR anaesthesia results in less blood loss and a better surgical conditions for ESS than SR anaesthesia.

The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery

The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery

Anesthesia in endoscopic sinus surgery.

Successful administration of anesthesia in endoscopic sinus surgery is of critical importance for patient comfort, to reduce bleeding, and for procedure safety. However, surgeons are often reluctant to perform the procedure under local anesthesia with sedation. Over the past four years, patients undergoing ESS have been asked to complete a questionnaire to evaluate their anesthetic experience. A total of 111 completed questionnaires were returned for evaluation. The questionnaire evaluated subjective level of pain, nausea, vomiting, and overall unpleasantness of surgery on a 100 mm visual analog scale. The results from this survey indicate a high level of patient satisfaction with our current anesthetic techniques, while identifying issues with postoperative nausea and vomiting. The results of the survey and a review of the anesthetic issues involved in successfully performing endoscopic sinus surgery are discussed.