Intravenous Esmolol Infusion Improves Surgical Fields during Sevoflurane-Anesthetized Endoscopic Sinus Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

Shen, Ping‐Hung; Weitzel, Erik K; Lai, Jen-Tsung; Wormald, Peter‐John; Ho, Cheesang

doi:10.2500/ajra.2011.25.3701

Cited by 29 publications

(21 citation statements)

References 25 publications

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“…Our findings show the similar positive effects on hemodynamics during surgery and recovery, but remifentanil had better condition during surgery and recovery. [17] All these findings show that, however, remifentanil had similar effects on hemodynamics compare to different anesthetic agents but reported that remifentanil as an opioid with the shortest onset and offset due to its metabolism by a specific tissue and plasma esterase and have better surgical field condition.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

2016

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Objective:This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery.Methods:In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0.5–2.0 mg/min and in the second group, remifentanil with dose of 0.5–1 μg/kg started and then 0.25–0.5 μg/kg/min were prescribed. Hemodynamic parameters during anesthesia and recovery time, surgeon and patient satisfaction, and recovery time were measured and recorded.Findings:Hemodynamics variable were comparable between two groups at different times of the study. The mean of bleeding and the frequency of side effects were higher in labetalol group (P = 0.033 and P < 0.0001, respectively). The median of surgeon satisfaction score in remifentanil group was statistically higher in labetalol group (P < 0.0001). Recovery time, fluid requirement, and pain score in labetalol group reported significantly more than remifentanil group. Richmond Agitation–Sedation Scale status at time points in the postanesthetic care unit showed differences between groups.Conclusion:With infusion of labetalol and remifentanil after a bolus dose we can induce effective controlled hypotension under general anesthesia. Remifentanil is a short-acting narcotic drug; then, patient satisfaction was better and recovery time was shorter. From the economic aspect, labetalol prefers to remifentanil.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

2016

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“…[ 1 ] FESS is better to be performed under controlled hypotensive technique (mean arterial pressure [MAP] between 60 and 70 mmHg); this can improve surgical field and decrease the operation time. [ 2 ] Several medications have been used to provide controlled hypotension such as inhalational volatile agents,[ 3 ] remifentanil,[ 4 ] clonidine,[ 5 ] dexmedetomidine,[ 6 ] nitroglycerine,[ 7 ] esmolol,[ 8 ] intravenous lidocaine,[ 9 ] and magnesium sulfate. [ 10 11 12 ]…”

Section: Introductionmentioning

confidence: 99%

Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: A randomized controlled study

Hamed

2018

Anesth Essays Res

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Background:Intraoperative bleeding impairs surgical field visibility during functional endoscopic sinus surgery (FESS); several methods have been used to decrease blood loss and improve surgical field, one of them is usage of hypotensive anesthetic agents.Aim:We intended to compare magnesium sulfate with lidocaine, regarding their efficiency in inducing controlled hypotension and providing a better surgical field exposure during FESS and the influence of their usage on extubation time.Settings and Design:This study design was a prospective randomized controlled double-blinded clinical study.Patients and Methods:Eighty adult patients with patients' physical status ASA Classes I and II, aged 20–50 years scheduled for FESS were randomly divided into two study groups; each group contains 40 patients: Group L received lidocaine 2 mg/kg/h with maximum of 200 mg/h starting at induction of anesthesia and continuing until the end of surgery and Group M received an iv bolus of magnesium sulfate 50mg/kg in a total of 100ml saline over 10 min followed by infusion of 15mg/kg/h until the end of surgery; patients were observed for the quality of the surgical field, blood loss, and extubation time.Statistical Analysis Used:Student's t-test or Mann–Whitney's U, Chi-square, or Fisher's exact tests were used.Results:Group L showed a significant decrease in blood loss (P = 0.01), better surgical field clarity (P = 0.002), and shorter extubation time (P = 0.001) than Group M, but there was no statistically significant difference between the two study groups as regards hemodynamics.Conclusion:We concluded that both magnesium sulfate and lidocaine successfully induced controlled hypotension in patients undergoing FEES, but lidocaine provided better surgical field clarity and shorter extubation time.

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“…15 Beta-blockers, on the other hand, have been shown to be of advantage because they decrease blood pressure by lowering cardiac output rather than systemic vascular resistance. 14 …”

Section: Introductionmentioning

confidence: 99%

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

Kelly

Gollapudy

Riess

et al. 2012

Int Forum Allergy Rhinol

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Background Adequate surgical field visualization is imperative for successful outcomes in endoscopic sinus surgery (ESS). The type of anesthetic administered can alter a patient’s hemodynamics and impact endoscopic visualization during surgery. We review the current evidence regarding the effect of total intravenous anesthesia (TIVA) compared to inhalational anesthesia (INA) on visualization of the surgical field during ESS. Methods A systematic review of the literature was performed. Ovid MEDLINE, Scopus, and Cochrane databases were searched from 1946 to January 2012. Citations from the primary search were reviewed and filtered to identify all relevant abstracts in English. Articles meriting full review included prospective controlled trials enrolling adult patients undergoing ESS that were randomized to a group receiving INA or TIVA with outcome measures focused on surgical field visualization. ‘Results Seven eligible trials fulfilled inclusion criteria. Four of the seven articles demonstrated a statistically significant improvement in surgical field grade during ESS when receiving TIVA compared with INA. However, detailed INA concentrations were often not provided. High levels of INA may have been administered; therefore, side effects of INA rather than effects of an ideal INA administration were possibly represented. Analgesic administration also varied widely among the anesthetic groups further complicating interpretation of study results. The lack of power and the heterogeneity of the studies precluded a formal meta-analysis. Conclusions Although several studies reported that TIVA improve surgical conditions in ESS, however there are significant limitations. These findings prevent any definite recommendation at this point, emphasizing the need for further high quality studies.

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Intravenous Esmolol Infusion Improves Surgical Fields during Sevoflurane-Anesthetized Endoscopic Sinus Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

Abstract: Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

Cited by 29 publications

References 25 publications

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: A randomized controlled study

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

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