Pre-induction fentanyl dose-finding study for controlled hypotension during functional endoscopic sinus surgery

Abstract

Background and Aims: Fentanyl can facilitate controlled intraoperative hypotension by its sympatholytic effect in patients undergoing functional endoscopic sinus surgery (FESS). We investigated the effects of different doses of pre-induction fentanyl on controlled hypotension profile during FESS. Methods: This prospective, randomised study included 120 patients randomly allocated to three groups (40 each) based on administration of pre-induction fentanyl; 2 μg/kg group, 3 μg/kg group and 4 μg/kg group. The primary objective was to assess effect on intraoperative heart rate and mean arterial pressure. Use of additional hypotensive agents, surgical field condition and surgeon satisfaction were also analysed. Results: Controlled hypotension was achieved adequately in all participants. Patients belonging to fentanyl 4 μg/kg group had significantly lower heart rate for the duration of controlled hypotension intraoperatively versus fentanyl 2 μg/kg group ( P < 0.05). Trinitroglycerin [TNG] and metoprolol were administered to 3 [7.5%] and 9 [22.5%] patients respectively in the fentanyl 3 μg/kg group, and to 3 [7.5%] and 5 [12.5%] patients respectively in the 4 μg/kg group, compared to 14 [35%] and 20 [50%] in the fentanyl 2 μg/kg group, respectively (TNG, P < 0.001). Surgical field conditions and surgeon satisfaction scores were significantly superior in fentanyl 3 μg/kg and 4 μg/kg groups than in fentanyl 2 μg/kg group. Conclusion: Pre-induction fentanyl 3 μg/kg and 4 μg/kg group showed superior controlled hypotension facilitation than 2 μg/kg fentanyl during FESS in terms of measurable haemodynamic endpoints and favourable operative conditions, surgeon's satisfaction and sparing of additional hypotensive agents.

Is hypotensive anaesthesia guided by invasive intraarterial monitoring required for orthognathic surgery? – A retrospective review of anaesthetic practice and intraoperative blood loss in orthognathic surgery in a tertiary hospital

“…[ 17 ] Also, agents commonly used to produce controlled hypotension may have side effects like vasodilatation, tachyphylaxis, sedation, delayed recovery, heart blocks, and rebound hypertension. [ 18 19 ] This could explain why almost 83% of the anaesthetists in our study did not apply hypotensive anaesthesia in view of safety concerns, despite the proven benefit of reduction of blood loss. However, the population studied in our study is a unique one in which the majority of patients were young (mean age of 23.6 years) and healthy (ASA class 1,72.5%) with orthognathic surgery being performed as an elective case (100%).…”

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

“…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.…”

Does Desmopressin Reduce Intraoperative Bleeding in Patients Who Undergo Nasal Surgery? A Systematic Review and Meta-Analysis

“…However, these methods have potential complications, such as direct mucosal damage from cauterization, and serious adverse effects, including cardiac ischemia, delayed recovery, rebound hypertension, emboli in the cerebral circulation, and permanent brain damage from blood pressure reduction [2,3]. The use of desmopressin, a synthetic form of the human hormone arginine vasopressin, has been suggested as a potential solution to reduce or even avoid the adverse effects of bleeding during nose surgery.…”