Controlled Hypotension for Functional Endoscopic Sinus Surgery With Two Different Doses of Fentanyl

Abstract

Background and ObjectivesFunctional endoscopic sinus surgery (FESS) is a type of minimally invasive surgery done for acute and chronic sinus diseases or paranasal illnesses. The idea of FESS is to preserve the normal anatomy, which is non-obstructing and mucous membrane while removing tissue obstructing OMC (osteo metal complex) and facilitating drainage. The critical structures, including the brain, orbit, and carotid veins, the lack of adequate operating room, and bleeding that obscures endoscopic vision throughout the procedure may increase the likelihood of unfavorable surgical results. This study seeks to examine the hemodynamic effects of intubation and extubation as well as the impact of fentanyl infusion on lowering blood pressure during FESS procedures. Materials and MethodsSixty-eight patients from the American Society of Anesthesiologists classes 1 and 2 who were planned for functional endoscopic sinus operations were randomly split into two groups for this randomized prospective trial. Group 1 patient belonging to the fentanyl 2 mcg per kg bolus 30 minutes before induction followed by 2 mcg per kg per hr infusion for 90 minutes of surgery, and Group 2 patient belonging to fentanyl 1 mcg per kg bolus 30 minutes before induction followed by 1 mcg per kg per hr infusion for 90 minutes of surgery. The significance of the difference in quantitative measures was measured using the student-t test, and the Chisquare test was used to measure up the difference in proportion. Statistically significant was set at P<0.05. ResultsMean systolic blood pressure was higher in members of Group 2 than in Group 1. In contrast to Group 2, Group 1 had considerably better surgical field conditions, surgeon satisfaction on the AONO'S scale, postoperative nausea and vomiting, and a post-operative VAS Score during the first 24 hours. ConclusionPre-induction Fentanyl with infusion can effectively control hypotension during functional endoscopic sinus surgery.

Comparative study between remifentanil (or fentanyl) and dexmedetomidine for the analgesia of rhinoplasty: A meta-analysis of randomized controlled trials

“…Controlled hypotension is commonly used to reduce intraoperative bleeding and improve surgical vision, during which arterial blood pressure is lowered in a deliberate and controllable manner. [20][21][22] The characteristics of ideal agents for controlled hypotension should include easy administration, short-onset time, rapid recovery and elimination without toxic metabolites. [23] Fentanyl and dexmedetomidine were both potential in controlled hypotension.…”

“…Due to the synergistic effects of fentanil with other anesthetics, fentanil can be used to induce mild to moderate hypotension and controlled bradycardia. [22,24] As one specific alpha-2 adrenoreceptor agonist, dexmedetomidine hydrochloride has intrinsic analgesic and sedative properties coupled with sympatholytic effect. It is able to produce controlled blood pressure and improve the quality of surgical field.…”