Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study

Fazel, Mohammad Reza; Ahmadi, Zeynab Sadat; Akbari, Hossein; Abam, Fahimeh

doi:10.1186/s13037-020-00264-4

Cited by 5 publications

(1 citation statement)

References 35 publications

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“…Nustatyta, kad geresni rezultatai pasiekiami deksmedetomidiną skiriant 0,5 μg/kg/h, lyginant su 0,2 μg/kg/h. Skiriant medikamento didesnę dozę, užtikrinamas mažesnis kraujavimas operacijos metu ir geresnis pooperacinio skausmo valdymas [29]. Išvados 1.…”

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Kraujavimo Valdymas Funkcinių Endoskopinių Sinusų Operacijų Metu

Navickaitė,

Savinova,

Borodičienė

2023

Health Sciences

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Funkcinė endoskopinė sinusų operacija atliekama siekiant pašalinti patologiškai pakitusią sinusų gleivinę ar darinius. Chirurgams išvengti gyvybei grėsmingų komplikacijų, susijusių su kaukolės pamato chirurgija, labai svarbus geras operacinio lauko matomumas. Operacijos metu (prieš ar per anesteziją) siekiant sumažinti gerai vaskuliarizuotos gleivinės gausų kraujavimą, naudojami įvairių grupių vaistai. Šios integruotos literatūros apžvalgos tikslas − apibūdinti kraujavimo valdymo endoskopinių sinusų operacijų alternatyvas. Paieška buvo atlikta PubMed duomenų bazėje, kuri apėmė klinikinius tyrimus, susijusius su sistemiškai ir lokaliai veikiančiais vaistais ir jų veiksmingumu kontroliuojant kraujavimą iš sinusų gleivinės. Literatūros apžvalgoje pateikiami tyrimai bei rezultatai vertinami gerai. Atlikti tyrimai su preparatais rodo teigiamos dinamikos ženklus, operuojant pacientus, tačiau lyginant vaistus, ne visi yra vienodai efektyvūs. Atsižvelgiant į šiame tyrime pateiktas analizes, daroma išvada, jog tam tikros tiriamos vaistų grupės pagerina kraujavimo kontrolę operacijų metu ir operacinio lauko matomumą chirurgams.

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Kraujavimo Valdymas Funkcinių Endoskopinių Sinusų Operacijų Metu

Navickaitė,

Savinova,

Borodičienė

2023

Health Sciences

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Dexmedetomidine and surgical field visibility in nasal surgery: A systematic review and meta-analysis

Warner,

Munhall,

Nguyen

et al. 2024

Journal of Perioperative Practice

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Introduction: Nasal and sinus surgery, especially using endoscopy, relies upon adequate haemostasis to be safe and effective. Often other haemostatic methods, such as cautery are not viable, and other methods must be employed. This study examines the effectiveness of dexmedetomidine in controlled hypotension and for surgical field visibility in endoscopic sinus surgery and other nasal surgeries. Review Methods: A literature search was conducted in PubMed, Scopus, CINAHL and Central for randomised controlled trials using dexmedetomidine for controlled hypotension in adult patients undergoing endoscopic sinus surgery or other nasal surgery. Meta-analysis of mean differences and single means were performed. Results: Of 935 identified studies, 31 met the inclusion criteria. A statistically significant difference in Fromme–Boezaart surgical field visibility scores was found comparing dexmedetomidine to placebo (p < 0.00001) and propofol (p < 0.0001), but not other agents. A significant difference in intraoperative blood loss volume was found compared with placebo (51.5mL, p < 0.00001) and propofol (13.6mL, p < 0.0001), but not other agents. Conclusion: Dexmedetomidine demonstrated significantly improved surgical field visibility and blood loss volume compared with placebo and propofol, but not other agents. Dexmedetomidine is viable and useful for controlled hypotension in nasal surgery. Choice of controlled hypotension agent should follow patient and procedure-specific considerations.

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Effects of intravenous dexmedetomidine on perioperative haemodynamics and quality of emergence in patients undergoing head and neck surgery following general anaesthesia—a comparative randomized, double-blind placebo-controlled study

Nair

Gladston

et al. 2022

Ain-Shams J Anesthesiol

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Background Dexmedetomidine is a widely used alpha-2 adrenoreceptor agonist in perioperative patient care. Its postsynaptic activation of the receptors in the central nervous system is responsible for reduced neuronal firing with resultant sedation, anxiolysis, analgesia, hypotension and bradycardia leading to effective stress response attenuation seen during laryngoscopy and orotracheal intubation. Major head and neck surgeries demand nasotracheal intubation which is more stressful than orotracheal as it traverses through the nasopharynx which is very pain-sensitive. This is to protect the airway in the immediate postoperative period from oedema or haematoma in the oral cavity or neck. Though its stress response attenuation, haemodynamic stability during the intraoperative period following orotracheal intubation has been well studied, its role in the prevention of emergence delirium and tube tolerance following nasotracheal intubation in major head and neck surgery is not found in the literature. Our aim was to evaluate whether dexmedetomidine effectively attenuates the stress response following nasotracheal intubation, perioperative haemodynamic fluctuations and quality of emergence in patients undergoing head and neck oncosurgeries. Methods A total of 150 patients were randomly assigned to one of the two groups; group D (dexmedetomidine group) and group S (control group with saline). Group D patients received a bolus dose of dexmedetomidine 1 μg/kg in 10 ml saline over 10 mts before induction of GA followed by an infusion at 0.4 μ/kg/h during surgery. Statistical analysis was done using SPSS version 11.0 (SPSS Ltd., Chicago, IL). Categorical data were represented using frequencies and percentages. Continuous variables were represented using mean and standard deviation. The association between categorical variables was assessed using the chi-square or Fisher’s exact test, and continuous variables following normality assumption with respect to the two groups were assessed using an independent sample t-test. P value < 0.05 was considered to be statistically significant. Results Patients in the D group showed statistically significant attenuation of heart rate (P < 0.05) and blood pressure (P < 0.05) throughout the surgical period compared to saline. Also, there was a significant reduction in blood loss (P = 0.042), cough score (P = 0.001) and sedation score (P = 0.001) in the D group. Conclusions We conclude that a bolus dose of dexmedetomidine 1 μg/kg given 10 min before induction of anaesthesia followed by an infusion at 0.4 μg/kg/h during surgery effectively attenuates the haemodynamic responses during nasotracheal intubation and provides smooth emergence as evidenced by reduced coughing, agitation and arousable sedation without respiratory depression which facilitates tube tolerance following major head and neck oncosurgeries. Blood loss was also found to be significantly reduced.

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Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study

Cited by 5 publications

References 35 publications

Kraujavimo Valdymas Funkcinių Endoskopinių Sinusų Operacijų Metu

Kraujavimo Valdymas Funkcinių Endoskopinių Sinusų Operacijų Metu

Dexmedetomidine and surgical field visibility in nasal surgery: A systematic review and meta-analysis

Effects of intravenous dexmedetomidine on perioperative haemodynamics and quality of emergence in patients undergoing head and neck surgery following general anaesthesia—a comparative randomized, double-blind placebo-controlled study

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