Surgical Field Score Research Articles

A Comparative Study of Magnesium Sulfate, Lignocaine, and Propofol for Attenuating Hemodynamic Response During Functional Endoscopic Sinus Surgery Under General Anaesthesia: A Prospective Randomized Trial.

This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery times compared with propofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agents than lignocaine.

Effects of intra-operative magnesium sulfate infusion on orthognathic surgery: A prospective and randomized controlled trial

PurposeTo comprehensively understand the effects of intra-operative infusion of magnesium sulfate on patients who underwent orthognathic surgery, including remifentanil consumption, postoperative pain, postoperative nausea and vomiting (PONV), inflammatory response, and serum magnesium levels. MethodsSeventy-five adult patients undergoing orthognathic surgery under general balanced anesthesia were randomly divided into two groups. One group (Group M) received 50 mg/kg of magnesium sulfate in 20 mL 0.9 % saline after intubation, followed by a continuous infusion at a rate of 15 mg/kg/h until 30 min before the anticipated end of surgery. The other group (Group C) received an equal volume of isotonic saline as a placebo. (Clinical trial registration number: chiCTR2100045981). ResultsThe primary outcome was remifentanil consumption. The secondary outcomes included the pain score assessed using the verbal numerical rating scale (VNRS) and PONV assessed using a Likert scale. Remifentanil comsumption in Group M was lower than Group C (mean ± SD: 0.146 ± 0.04 μg/kg/min vs. 0.173 ± 0.04 μg/kg/min, P = 0.003). At 2 h after surgery, patients in Group C suffered more severe PONV than those in Group M (median [interquartile range, IQR]: 1 [3] vs. 1 [0], mean rank: 31.45 vs. 42.71, P = 0.040). At post-anesthesia care unit (PACU), postoperative pain in Group C was severe than Group M (3 [1] vs. 3 [0], mean rank: 31.45 vs. 42.71, P = 0.013). Changes in haemodynamics and surgical field scores did not differ between the groups (all P > 0.05). The levels of cytokines (IL-4, IL-6, IL-8, IL-10, TNF-a, and MIP-1β) were not significantly different between the groups after surgery (all P > 0.05). Postoperative serum magnesium levels in Group C were lower than those in Group M (0.74 ± 0.07 mmol/L vs. 0.91 ± 0.08 mmol/L, P = 0.000) and the preoperative level (0.74 ± 0.07 mmol/L vs. 0.83 ± 0.06 mmol/L, P = 0.219). ConclusionsIn orthognathic surgery, magnesium sulfate administration can reduce remifentanil requirement and relieve PONV and postoperative pain in the early postoperative phase.

”The efficacy of oral versus intravenous tranexamic acid in functional endoscopic sinus surgery”. A prospective, randomized, controlled trial

ABSTRACT Background Functional endoscopic sinus surgery (FESS) is a common procedure for the treatment of chronic sinusitis and minimal bleeding inside the narrow surgical field affects the surgical visualization, prolongs operative time, and increases ocular and intracranial injuries. Our study aims to evaluate and compare the effectiveness of oral versus intravenous Tranexamic acid on surgical field bleeding in endoscopic sinus surgery. Methods A prospective, randomized, controlled trial enrolled 159 participants (ASA I-II, both sex and age 18–40 years) undergoing FESS who were equally randomized into 3 groups. Group O received 2 gm of TXA orally 2 hours before surgery, Group I received 15 mg/kg of IV TXA slowly after induction of anesthesia, and Group C didn’t receive any. Intraoperative surgical field bleeding was assessed by the Wormald grading scale and Surgeon satisfaction on a 5-point Likert scale. At 24 hours post-operatively, the incidence of nasal bleeding, PONV, and D-dimer level were recorded. Results Showed significantly higher surgical field score, duration of surgery, recovery time, and postoperative (24 hours) D-dimer in group-C (p-value <0.001) with no difference between groups-I and O, while surgeon satisfaction was significantly lower in group-C (p-value <0.001) with no difference between groups-I and O. No differences regarding hemodynamic parameters, postoperative bleeding, pain, and PONV were found. Conclusions Oral TXA was safe, cheap, and as effective as IV TXA regarding surgical field visualization, surgeon satisfaction, and operative time during FESS; with limited adverse effects and no evidence of thromboembolic complications.

Comparison of the efficacy of hot saline irrigation and tranexamic acid on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery: a systematic review and meta-analysis

Link of Video Abstract: https://youtu.be/wEp6PioGVqw Background: Hot saline irrigation and tranexamic acid are techniques used to control bleeding during functional endoscopic sinus surgery (FESS). Hot saline irrigation and tranexamic acid can help control bleeding originating from microvascular located in the nasal cavity and paranasal sinuses. This study aims to compare the efficacy of these two techniques on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery. Methods: This study is an intervention meta-analysis, the research formulated based on the population, intervention, comparison, outcome, and study design (PICOS). Articles were searched from five databases, including PubMed Central and publisher websites, Cochrane Library, ResearchGate, SAGE Journals, and Web of Science. There were no publication year or publication status restrictions on the selected research articles, and the date of the last search was up to February 2023. The efficacy of hot saline irrigation as a bleeding control method compared to tranexamic acid was assessed based on Boezaart surgical field score, intraoperative bleeding, and duration of surgery in functional endoscopic sinus surgery (FESS). Results: A total of 532 research articles were identified, and fifteen articles that met the inclusion and exclusion criteria were selected. Hot saline irrigation p-value p=0.0002 and for tranexamic acid p=&lt;0.00001 based on Boezaart score. Hot saline irrigation p= 0.0001 and tranexamic acid had a p= 0.0002 based on the Intraoperative blood loss, but the standardized mean difference in the hot saline irrigation group was smaller compared to the tranexamic acid topical group. Hot saline irrigation p=0.06 and tranexamic acid p=0.13 for duration of surgery. Conclusion: This meta-analysis showed that the administration of tranexamic acid or hot saline irrigation could significantly reduce duration of surgery, intraoperative blood loss and improved surgical feld quality compared with room temperature saline irrigation. There is no statistically significant difference between tranexamic acid topical and hot saline irrigation.

Dexmedetomidine versus remifentanil for controlled hypotension under general anesthesia: A systematic review and meta-analysis.

This meta-analysis aimed to analyze and compare the efficacy and safety of remifentanil and dexmedetomidine applied respectively for controlled hypotension under general anesthesia. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, SinoMed, Wanfang, and VIP databases, as well as dissertations and conference papers, to obtain randomized controlled trials comparing remifentanil and dexmedetomidine applied respectively for controlled hypotension before August 23, 2021. The primary outcomes included hemodynamic profiles, surgical field score, and blood loss. Extubation time, sedation and pain score at the PACU, and perioperative adverse events were the secondary outcomes. Nine randomized controlled trials with 543 patients (272 in the dexmedetomidine group and 271 in the remifentanil group) were eventually included. This meta-analysis indicated no significant difference between dexmedetomidine and remifentanil in terms of surgical field score, blood loss, minimum values of mean arterial pressure (MD 0.24 with 95% CI [-1.65, 2.13], P = 0.80, I2 = 66%) and heart rate (MD 0.42 [-1.33, 2.17], P = 0.64, I2 = 40%), sedation scores at the PACU (MD -0.09 [-0.69, 0.50], P = 0.76, I2 = 92%), and incidence of bradycardia (OR 2.24 [0.70, 7.15], P = 0.17, I2 = 0%). Compared with remifentanil, dexmedetomidine as the controlled hypotensive agent showed a lower visual analogue score at the PACU (MD -1.01 [-1.25, -0.77], P<0.00001, I2 = 0%) and incidence of shivering (OR 0.22 [0.08, 0.60], P = 0.003, I2 = 0%), nausea, and vomiting (OR 0.34 [0.13, 0.89], P = 0.03, I2 = 0%). However, extubation time was shorter in the remifentanil group (MD 3.34 [0.75, 5.93], P = 0.01, I2 = 90%). In conclusion, dexmedetomidine and remifentanil are both effective in providing satisfactory controlled hypotension and surgical conditions. Dexmedetomidine is better in easing postoperative pain at the PACU and reducing the occurrence of shivering, nausea, and vomiting. Meanwhile, remifentanil is a fast-track anesthesia with a shorter extubation time. Given the limitations of this meta-analysis, further studies are needed for a more definitive comparison of the efficacy and safety of dexmedetomidine and remifentanil.

Efficacy of oral diltiazem on the intraoperative bleeding in functional endoscopic sinus surgery

BackgroundThis study aimed to evaluate the effect of oral diltiazem premedication on blood loss during functional endoscopic sinus surgery (FESS). Study designRandomized, controlled, double-blind study. SettingsUniversity Hospital. PatientsThe study included forty patients aged 18-60 years, with an ASA grade of I-II, scheduled for FESS. InterventionsPatients were randomized into two groups. Group I (n = 20) received preoperative oral diltiazem tablets, and Group II (n=20) received a placebo. MeasurementsThe primary outcome was intraoperative blood loss (total and rate of loss). The secondary outcomes were the surgical field score and hemodynamic parameters. ResultsThe rate of blood loss was significantly lower in group I than in group II (P = 0.023). The surgical field was better in group I than in group II (P < 0.001). No hemodynamic adverse effects were reported in both groups . ConclusionOral diltiazem premedication can improve intraoperative surgical field visualization in functional endoscopic sinus surgeries without any hemodynamic adverse effects.

Preserving Spontaneous Breathing Without Intubation and Endotracheal Intubation with One Lung Ventilation in Single-hole Thoracoscopic Bulla Suture

Objective: To explore the situation of patients and the compare the effect between two methods, which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the single-hole thoracoscopic bulla suture. Method: 42 patients who received single-hole thoracoscopic pulmonary bullae suture in our hospital from January 2020 to December 2021 were selected as the study subjects, including 19 patients who underwent endotracheal intubation and one lung ventilation as the control group and 23 patients who underwent single-hole thoracoscopic pulmonary bullae suture without intubation as the study group. The relevant indexes, postoperative general conditions, complications and pneumothorax recurrence of the two groups were analyzed and observed. Results: In the control group, the scores of anesthesia time (points), resuscitation time (points), surgical visual field score (points), surgical time (points), and surgical bleeding volume (points) were 20.8 ± 4.6, 19.9 ± 7.9, 1.7 ± 0.5, 44.9 ± 7.9, and 11.4 ± 2.4 respectively. In the study group, the scores of anesthesia time (points), resuscitation time (points), surgical visual field score (points), surgical time (points), and scores of surgical bleeding (points) were 17.9 ± 4.3, 15.4 ± 3.4, 1.9 ± 0.4, 48.4 ± 7.1, 10.9 ± 2.2, respectively. There was no statistical difference in surgical visual field score, surgical time and surgical bleeding whereas there was a statistical difference between anesthesia time and resuscitation time. In the control group after operation, VAS score at 6 hours after operation, SaO2 (%) after operation, PaCO2 (mmHg) after operation, drainage volume (ML) after operation, feeding time (H) after operation, retention time of thoracic tube after operation (H), WBC (109) on the first day after operation, hospitalization time (d), and total hospitalization cost (RMB 1000) were 2.1 ± 0.7, 98.2 ± 1.4, 42.4 ± 4.9, 139.1 ± 23.1, 6.9 ± 1.6, 37.1 ± 5.4, 7.9 ± 2.1, 6.6 ± 1.3, and 2.6 ± 0.3 respectively. As for the study group, the VAS score at 6 hours after operation, SaO2 (%) after operation, PaCO2 (mmHg) after operation, drainage volume (ML) after operation, feeding time (H) after operation, retention time of thoracic tube after operation (H), WBC (109) on the first day after operation, hospitalization time (d), and total hospitalization cost (RMB 1000) were 1.9 ± 0.4, 97.9 ± 1.2, 42.8 ± 5.1, 151.8 ± 21.9, 4.3 ± 1.4, 15.3 ± 2.6, 5.2 ± 2.3, 4.2 ± 1.2, and 1.8 ± 0.4 respectively. Among them, there were no significant differences in visual analog scale (VAS) score at 6 hours after operation, SaO2 after operation and PaCO2 after operation between the two groups, but there were significant differences in other factors. The complication rate of the control group was 36.84%, which was significantly higher than that of the study group (4.35%), with statistical difference. The recurrence rate of the control group was 21.05%, which was not significantly different from that of the study group (4.35%). Conclusion: The single-hole thoracoscopic bullae suture without intubation can reduce the anesthesia time and resuscitation time of patients, reduce the hospitalization cost of patients, reduce the treatment burden, shorten the first feeding time, and reduce the complication rate of patients. Therefore, it is worthy of clinical promotion.

Pretreating cavernous sinus with hemostatic agent injection molding during endoscopic endonasal pituitary surgery: technical note

To clarify the technical pearls of cavernous sinus molding technique with hemostatic agent injection during endoscopic endonasal pituitary surgery. All patients pretreated with cavernous sinus hemostatic agent injection molding technique for hemostasis in endoscopic endonasal surgery for pituitary adenoma resection between November 2017 and June 2021 were included. A small incision was made in the cavernous sinus wall before intracavernous manipulation. The hemostatic agent was injected with gentle pressure. It spread along the venous channels and established partial molding of the cavernous sinus. Intraoperative bleeding, surgical field score, and complications were evaluated. Thirty-eight patients with pituitary adenoma requiring cavernous sinus manipulation were pretreated with this technique. Technically, the tailored thin blunt metal tube with its 1cm head end bended up 45° were the best instrument to accomplish injection. Multi-spot injections were preferred to control different compartments of the cavernous sinus, which both had a better effect in bleeding control and helped to reduce the influence of trigemino-cardiac reflex. Postoperative complications, including temporal lobe edema, hemorrhage, and exophthalmos were not observed. Pretreating cavernous sinus with hemostatic agent injection molding technique during endoscopic endonasal pituitary surgery is a practical, effective and safe method for intracavernous bleeding control.

The Effect of Mechanical Bowel Preparation on the Surgical Field in Laparoscopic Gynecologic Surgeries: A Prospective Randomized Controlled Trial

Purpose To evaluate the effects of mechanical bowel preparation (MBP) on the intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery in patients undergoing elective laparoscopic gynecological surgeries. Methods The patients randomized to a MBP group and a no preparation (NMBP) group. The senior surgeon remained blinded to the bowel regimen used by the patient. Intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery were evaluated using a numeric rating scale (NRS). Results We enrolled 120 patients, of whom 109 completed the study, with 51 and 58 patients in the MBP and NMBP groups, respectively. The intraoperative visualization of the surgical field, intestinal load, and NRS scores for overall ease of surgery were better in the NMBP group (p = .03, p = .048, and p = .022, respectively). The results of the assessments also revealed no significant differences in surgical field visualization, ease of bowel handling, overall ease of surgery, or the time that patients experienced passage of flatus between obese (BMI > 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) patients in the two groups. Conclusions The current study revealed that MBP did not improve the intraoperative visualization of the surgical field or the overall ease of surgery. Moreover, MBP had no benefit when operating on patients who had a high BMI. Therefore, we do not recommend routine MBP before laparoscopic gynecological surgeries.

Deep versus Moderate Neuromuscular Blockade in Gynecologic Laparoscopic Operations: Randomized Controlled Trial.

Background: To investigate whether deep neuromuscular blockade (NMB) improves surgical conditions and postoperative pain compared to moderate block, in patients undergoing gynecologic laparoscopic surgery. Methods: A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients, who were randomly assigned to one of the following two groups: patients in the first group received deep NMB (PTC 0-1) and in the other, moderate NMB (TOF 0-1). Primary outcomes included assessing the surgical conditions using a four-grade scale, ranging from 0 (extremely poor) to 3 (optimal), and patients’ postoperative pain was evaluated with a five-grade Likert scale and the analgesic consumption. Results: 144 patients were analyzed as follows: 73 patients received deep NMB and 71 moderate NMB. Mean surgical field scores were comparable between the two groups (2.44 for moderate vs. 2.68 for deep NMB). Regarding postoperative pain scores, the patients in the deep NMB experienced significantly less pain than in the group of moderate NMB (0.79 vs. 1.58, p < 0.001). Moreover, when the consumption of analgesic drugs was compared, the moderate NMB group needed more extra opioid analgesia than the deep NMB group (18.3% vs. 4.1%, p = 0.007). From the secondary endpoints, an interesting finding of the study was that patients on deep NMB had significantly fewer incidents of subcutaneous emphysema. Conclusions: Our data show that, during the performance of gynecologic laparoscopic surgery, deep NMB offers no advantage of operating filed conditions compared with moderate NMB. Patients may benefit from the deep block as it may reduce postoperative pain.

English

BACKGROUND Bleeding during functional endoscopy sinus surgery (FESS) remains a main consideration. Even a small amount of blood may disturb the endoscopic view, increasing the likelihood of complications. So, we decided to compare the effects of clonidine and atenolol as oral premedication for hypotensive anaesthesia in patients undergoing FESS under general anaesthesia. The purpose of this study was to analyse and compare the efficacy of oral atenolol versus oral clonidine as premedication under general anaesthesia for induced hypotension in patients undergoing a functional endoscopic sinus surgery. METHODS The study included total 100 patients of age (18 – 60 years) [American Society of Anaesthesiologists (ASA grade I and II)] who were randomly divided into two groups of 50 each. Group - A (n = 50), a non-labelled clonidine tablet PO was given to the patients in the clonidine group in the dose of 2 mcg/kg at 7 pm the day before surgery and 4 mcg/kg two hours before surgery. Group - B (n = 50), a non-labelled atenolol 25 mg tablet was given PO to the patients in the atenolol group at 7 pm the day before surgery and also 2 hours before surgery. Induction and maintenance of general anaesthesia was performed by the same standard protocol for both groups. Hemodynamic effects [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), quality of surgical field, intraoperative complications, and post anaesthetic discharge score system (PADSS)] were recorded and statistically analysed. RESULTS The hemodynamic stability and good quality surgical field was obtained in both the groups. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. CONCLUSIONS We conclude that both oral clonidine and atenolol premedication provides superior and predictable perioperative hemodynamic control, reduces the requirement of hypotensive agents, and produces acceptable recovery characteristics. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. KEYWORDS Atenolol, Clonidine, Functional Endoscopic Sinus Surgery (FESS)

Surgical Field Quality in Trans-Nasal Endoscopic Surgeries Using Lignocaine Infusion and Dexmedetomidine Infusion. A Prospective Randomized Control Study.

Trans-nasal endoscopic surgery (TNES) is a helpful diagnostic and therapeutic modality in otorhinolaryngology surgeries and requires controlled hypotension for better visualization of the surgical field. Recent literature shows evidence of intravenous Lignocaine infusion to produce the controlled hypotension. The study aims to assess and compare the effects of Lignocaine (LIG) and Dexmedetomidine (DEX) infusion with respect to surgical field quality. 101 Consenting adult patients undergoing elective TNES were double-blinded, randomly allocated in one of the two groups and received either DEX infusion of 0.5ug/kg/hr (n = 51) or LIG infusion of 1.5mg/kg/h (n = 50) after a loading dose. Surgical field score (SVF) as the primary outcome and secondary outcomes such as variations in hemodynamic parameters, the requirement for rescue agents and total blood loss were recorded. Both the groups were comparable with respect to patient demographics, total duration of anesthesia and surgery. SVF scores were significantly better in the LIG group during the first 105min of the surgery (p < 0.05). In response to intubation, hemodynamic parameters were lower in LIG group. The requirement of other adjuvant drugs, total blood loss (166.40ml vs. 251.17ml) and extubation time were also significantly lower in the LIG group. The study concludes that intravenous Lignocaine gives a better surgical field in the first 105min of surgery, comparable hemodynamics and decreased blood loss in patients undergoing TNES as compared to Dexmedetomidine infusion. Hence its role as an agent for controlled hypotension during TNES surgery is promising.

Effect of gauze placement soaked with adrenaline at suprabullar recess on hemostasis during endoscopic sinus surgery: A randomized controlled trial.

Topical application of vasoconstrictors is necessary for endoscopic sinus surgery (ESS) for a bloodless surgical view and reduced intraoperative bleeding. We aimed to verify the effectiveness of gauze placement soaked with adrenaline at suprabullar recess, where the anterior ethmoidal artery exists, on hemostasis during ESS. A randomized, double-blinded trial was carried out for 26 patients receiving ESS. At the beginning of the surgery, gauze soaked with 2% lidocaine with or without 1:10 000 adrenaline was placed at the suprabullar recess for 8 minutes. Estimated blood loss, surgical field score, and operation time were compared between the two groups. Estimated blood loss and surgical field score were significantly smaller in the adrenaline group than in the no adrenaline group. Operation time was not significantly different between the two groups. Gauze placement soaked with adrenaline at suprabullar recess reduces estimated blood loss and clears the surgical field during ESS.

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

BackgroundDeliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin- versus labetalol-induced hypotension on peripheral perfusion.MethodsThe present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55–65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss.ResultsForty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2–2.5] versus 1.5 [IQR 1–2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings.ConclusionNitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.Trial registrationThe study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.

The effect of magnesium sulfate on surgical field during endoscopic sinus surgery: A meta-analysis of randomized controlled trials.

Introduction:The benefits of magnesium sulfate for surgical field during endoscopic sinus surgery remain controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery. This meta-analysis is performed using the random-effect model.Results:Four RCTs and 404 patients are included in the meta-analysis. Overall, compared with control group endoscopic sinus surgery, magnesium sulfate has remarkably positive impact on surgical field scores (MD = −1.76; 95% CI = −2.33 to −1.18; P < .00001), and intraoperative blood loss (MD = −89.09; 95% CI = −163.20 to −14.97; P = .02), but shows no markedly effect on surgery duration (MD = −7.08; 95% CI = −21.38 to 7.22; P = .33), fentanyl (MD = −0.64; 95% CI = −1.97 to 0.70; P = .35), and vecuronium (MD = −3.64; 95% CI = −10.99 to 3.70; P = .33).Conclusions:Magnesium sulfate exerts positive impact on surgical field and blood loss reduction for endoscopic sinus surgery.

Comparison of controlled hypotension using dexmedetomidine and esmolol combined with general anesthesia: a Meta-analysis

Objective To assess the advantages and disadvantages of using dexmedetomidine(Dex) or esmolol (Esm) respectively in controlling hypotension during general anesthesia in operation by Meta-analysis. Methods We searched all randomized controlled trial(RCT) relating to controlled hypotension with Dex or Esm during general anesthesia in online database of PubMed, EMBASE, Medline, Cochrane Library, Web of Science, CBM, CKNI, Wangfang Data Resource and VIP. The quality of trials was strictly assessed according to the Cochrane Collaboration manual. RevMan 5.3 software was used for data analysis. Results Ten RCT with 568 cases were included. Meta-analysis showed that there were no significant statistically differences between the two groups on the achievement ratio of controlled hypotension [risk ratio (RR)=1.04, 95%(confidence interva, CI) (1.00, 1.08)], the number of patients with surgical field score≤2 [RR=1.01, 95%CI (0.94, 1.09)] and the surgical field scores [weighted mean difference (WMD)=-0.12, 95%CI (-0.28, 0.03)] (P>0.05). Dex group needed less dose of fentanyl in operation [WMD=-38.85, 95%CI (-49.66, -28.05)], but the time to first analgesic request [WMD=29.89, 95%CI (22.61, 37.17)] and recovery time [WMD=4.11, 95%CI (2.57, 5.66)] in this group were longer. Also there is less incidence of postoperative nausea or vomiting in Dex group [RR=0.41, 95%CI (0.18, 0.93)] (P<0.05). Conclusions Dex and Esm are both safe drugs for controlling hypotension during general anesthesia in operation. Dex may have better effect on reducing general anesthetics in operation, reducing pain of post-operation and decreasing incidence of postoperative nausea or vomiting happened on patients. But it may lead to delay of regaining conscious of patients. Key words: Dexmedetomidine; Esmolol; Controlled hypotension; Meta-analysis

Randomized Open-Labelled Comparative Evaluation of the Efficacy of Nitroglycerine, Esmolol and Dexmedetomidine in Producing Controlled Hypotension in Spine Surgeries.

Aim:This study was designed to evaluate the efficacy of nitroglycerine (NTG), esmolol, and dexmedetomidine (DEX) as hypotensive agents in decreasing intraoperative blood loss by producing controlled hypotension in posterior spine surgeries.Materials and Methods:Sixty patients aged 18–60 years, the American Society of Anesthesiologists physical status Classes I and II of either gender, were randomly assigned into three groups to receive either: NTG (0.01%) at the rate of 3–10 μg.kg-1.min-1 after positioning without a prior loading dose in Group N, esmolol 500 μg.kg-1 loading dose over 1 min before induction of anesthesia followed by 50–300 μg.kg-1.min-1 infusion in Group E, and DEX 1 μg.kg-1 over 10 min before induction followed by 0.2–0.7 μg.kg-1.h-1. infusion in Group D to maintain mean arterial blood pressure (MAP) between 60 and 65 mmHg. The three groups were compared for the achievement of target MAP, intraoperative blood loss, reversibility of hypotensive state, quality of surgical field, emergence time, and postextubation sedation score.Statistical Analysis:Analysis of variance was used for intergroup analysis, and for multiple comparisons, Bonferroni post hoc test was applied. P < 0.05 was considered statistically significant.Results:Patients in Group D and Group E achieved the target MAP with better heart rate control as compared to Group N. The intraoperative blood loss was significantly lesser in Group D (P < 0.001). The time to hypotension reversal and emergence time was prolonged in Group D (P < 0.001). The mean quality of surgical field score was statistically insignificant among the three groups. The mean Ramsay Sedation Scores were significantly higher in Group D compared to Groups N and E at 20th and 40th min postextubation (P < 0.001) with no significant intergroup difference at 60th min postextubation (P = 0.130).Conclusion:Continuous infusion of DEX is an effective and safe method of producing controlled hypotension by achieving the target MAP, minimizing blood loss, and maintaining superior hemodynamics in comparison with NTG and esmolol in posterior spine surgeries.

Clinical assessment of diode laser-assisted endoscopic intrasphenoidal vidian neurectomy in the treatment of refractory rhinitis.

For chronic rhinitis that is refractory to medical therapy, surgical intervention such as endoscopic vidian neurectomy (VN) can be used to control the intractable symptoms. Lasers can contribute to minimizing the invasiveness of ENT surgery. The aim of this retrospective study is to compare in patients who underwent diode laser-assisted versus traditional VN in terms of operative time, surgical field, quality of life, and postoperative complications. All patients had refractory rhinitis with a poor treatment response to a 6-month trial of corticosteroid nasal sprays and underwent endoscopic VN between November 2006 and September 2015. They were non-randomly allocated into either a cold instrument group or a diode laser-assisted group. Vidian nerve was excised with a 940-nm continuous wave diode laser through a 600-μm silica optical fiber, utilizing a contact mode with the power set at 5W. A visual analog scale (VAS) was used to grade the severity of the rhinitis symptoms for quality of life assessment before the surgery and 6months after. Of the 118 patients enrolled in the study, 75 patients underwent cold instrument VN and 43 patients underwent diode laser-assisted VN. Patients in the laser-assisted group had a significantly lower surgical field score and a lower postoperative bleeding rate than those in the cold instrument group. Changes in the VAS were significant in preoperative and postoperative nasal symptoms in each group. The application of diode lasers for vidian nerve transection showed a better surgical field and a lower incidence of postoperative hemorrhage. Recent advancements in laser application and endoscopic technique has made VN safer and more effective. We recommend this surgical approach as a reliable and effective treatment for patients with refractory rhinitis.

Optimisation of intramuscular dosage of dexmedetomidine for hypotensive anesthesia in functional endoscopic sinus surgery- a prospective randomized double blind study

Background of the study: Dexmedetomidine, a selective alpha-2 agonist which is being used widely in anesthesia and critical care practice. It has both sedative and analgesic property. The studies on intravenous usage of dexmedetomidine are numerous but not with intramuscular route. With this background we conducted a study on optimisation of intramuscular dosage of dexmedetomidine in patients undergoing functional endoscopic sinus surgery. Aim and objectives:To optimize the dosage of intramuscular dexmedetomidine in patients undergoing functional endoscopic sinus surgery for providing bloodless field for the surgeon. Materials and methods: We enrolled a total of 50 patients who have planned to undergo functional endoscopic sinus surgery under general anesthesia. After randomization, group D1 patients received intramuscular dexmedetomidine at the dosage of 0.5mcg/kg and group D2 1mcg/kg respectively. Hemodynamic parameters like blood pressure (MAP) and heart rate were recorded at regular intervals. The surgical field score was done by the operating ENT surgeon using Boerzaart scale. The targeted mean arterial blood pressure was kept between 55-65mmHg. The other parameters like additional requirement of opioid, usage of other vasodilators, time to emergence along with other side effects were noted peri-operatively. Results:After statistical analysis, the mean duration of surgery in both groups were 92±21.8 and 85±22.15 minutes respectively. The targeted mean arterial blood pressure was achieved in the patients who have received 1mcg/kg of dexmedetomidine (Group D2) intramuscularly. The surgeon felt satisfied with bloodless operating field in the patients who received 1mcg/kg of dexmedetomidine. Conclusion:From our study we concluded that 1mcg/kg of dexmedetomidine will be the adequate intramuscular dose for both premedication and hypotensive agent in functional endoscopic sinus surgery.

Oral nifedipine as a premedication for induced hypotension in functional endoscopic sinus surgery (FESS)

ObjectiveTo evaluate the effects of oral nifedipine as pretreatment, quality of surgical field and amount of hypotensive agent during functional endoscopic sinus surgery (FESS) under general anesthesia.MethodsSixty patients ASA I or II scheduled for FESS were randomly allocated into two equal groups. Oral nifedipine 20 mg was given one hour before induction of anesthesia (nifedipine) group and placebo. In the other group (control), all the patients received standard anesthesia and monitoring. Nitroglycerin (GTN) was administrated in a dose of 2 μg/kg/min after induction of anesthesia till it achieved a target mean arterial blood pressure (MAP) of 50–60 mmHg, followed by a continuous i.v. infusion (1 μg/kg/min) intraoperative when needed. Hemodynamic variables were recorded at baseline preoperatively, intraoperatively and till the end of operation. The surgical field score was assessed by average category scale (ACS) and intraoperative blood loss and amount of GTN was estimated. Emergence time and total recovery from anesthesia (Aldrete score ⩾9) were recorded.ResultsThere were no statistically significant differences between two groups with respect to the amount of blood loss and scores for a bloodless surgical field. Emergence time and time needed to achieve 9 of modified Aldrete score were significantly shorter in Control group than nifedipine group (4.46 ± 1.25 min and 7.46 ± 2 min versus 8 ± 1.62 min and 9.5 ± 2.41 min, respectively) (P < 0.01). MAP during hypotensive period showed no statistically significant difference (p > 0.05) but at 5 and 10 min after stoppage of hypotensive anesthesia, at the end of surgery and after recovery, MAP was significantly lower in nifedipine group than Control group (p < 0.01). Heart rate (HR) during hypotensive period showed no statistically significant difference (p > 0.05). At 5 and 10 min after stoppage of hypotensive anesthesia, at end of surgery and after recovery, HR was significantly lower in nifedipine group than Control group (p < 0.001). The amount of GTN used in nifedipine group was significantly lower than Control group (p < 0.001).ConclusionAdministration of a single preoperative dose of nifedipine (20 mg) can significantly reduce the blood loss during FESS and improves the visualization of the operative field and it also lowers the amount of GTN needed to achieve target hypotension.