Prophylaktische Analgesie bei endoskopischen Nasennebenhöhleneingriffen - Hämodynamik, Operationsbedingungen, Streßantwort -

Jacobi, Klaus; Rickauer, Andreas J

doi:10.1055/s-1999-10822

Cited by 8 publications

(3 citation statements)

References 10 publications

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“…A series of major complications such as bleeding during surgery, orbital hematoma, cerebrospinal fluid fistula, and intracranial injury were reported (4). As bleeding reduces the visibility in the operative field and increases the risk of injury to the optic nerve, orbita, middle cranial fossa and internal carotid artery, sufficient control of intraoperative bleeding is essential (5). Administration of vasoconstrictors like adrenaline or a beta-blocker to the nasal passages, reverse Trendelenburg position, controlled hypotension or steroid therapy were suggested (6).…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine versus Remifentanil for Controlled Hypotensive

Özcan¹,

Özyurt²,

Saraçoğlu³

et al. 2012

Turk J Anesth Reanim

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Objective: During functional endoscopic sinus surgery (FESS), sufficient control of bleeding is essential in order to increase the visibility in the operative field and reduce the risk of injury to the optic nerve or internal carotid artery. However, choosing the ideal agent is still a controversial topic. The aim of this study is to compare the effects and possible side effects of remifentanil and dexmedetomidine for controlled hypotension in FESS.Methods: Fifty ASA I-II patients, aged between 18-60 years, undergoing elective FESS, were included. Patients were randomly assigned into two groups (n=25) as Group R (remifentanil infusion, 0.25 mcg kg -1 h -1 ) and Group D (dexmedetomidine infusion, 0.2-0.7 mcg kg -1 min -1 ). The duration of anesthesia, surgery and controlled hypotension, total drug doses, dryness of the surgical area, recovery time, side effects, liver and kidney function analyses were recorded. Results:There was no statistically significant difference between the groups in operation time, duration of anesthesia and controlled hypotension time. Group R and D were similar in average SpO 2 , dryness, arterial blood pressure, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine at all measurement times. Heart rate was lower in Group D than Group R at the time of extubation and 5, 10, 15, 20, 30. min after extubation (p<0.05). Mean recovery time of Group D was longer than Group R (p<0.001).Conclusion: Based on the side effect scores, visualisation results of surgical area, liver or renal functions; both dexmedetomidine and remifentanil provided adequate, safe, controlled hypotensive anesthesia. However, dexmedetomidine was associated with significantly longer recovery time period compared with remifentanil.Amaç: Fonksiyonel endoskopik sinüs cerrahisi (FESS) sırasında kanamanın kontrol altına alınması; cerrahi alandaki görüşün artması ile birlikte, optik sinir veya internal karotis arteri gibi önemli yapıların yaralanması riskini de azaltmaktadır. Ancak, bu amaç için ideal ajan seçimi tartışmalı bir konu olmaya devam etmektedir. Bu çalışmada, FESS için kontrollü hipotansiyon uygulamalarında remifentanil ile deksmedetomidinin etkinlikleri ile gelişebilecek yan etkilerinin karşılaştırılmaası amaçlanmıştır.Yöntemler: Çalışmaya, elektif FESS cerrahisi geçirecek, ASA I-II, 18-60 yaş arasında 50 hasta dahil edildi. Hastalar randomize olarak, Grup R (remifentanil infüzyonu, 0,25 mcg kg -1 s -1 , n=25) ve Grup D (deksmedetomidin infüzyonu, 0,2-0,7 mcg kg -1 dk -1 ) olarak iki gruba ayrıldı. İlaç enjeksiyonundan, hedeflenen kan basıncının oluşmasına kadar geçen süre, anestezi ve cerrahi süreleri, verilen toplam ilaç miktarı, cerrahi sahanın kuruluğu, derlenme süresi, yan etkiler ile karaciğer ve böbrek işlevlerine ait değerler kaydedildi. Bulgular: Gruplar arasında anestezi, cerrahi işlem süresi ve kontrollü hipotansiyon süresi bakımından istatistiksel olarak anlamlı fark yoktu. Ortalama periferik oksijen satürasyonu, cerrahi sahanın kuruluğu, kan basınçları,...

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Section: Introductionmentioning

confidence: 99%

Dexmedetomidine versus Remifentanil for Controlled Hypotensive

Özcan¹,

Özyurt²,

Saraçoğlu³

et al. 2012

Turk J Anesth Reanim

View full text Add to dashboard Cite

show abstract

“…Prophylactic analgesia has long been tried to control the perioperative stress response, hence stable hemodynamics and good surgical visibility leading to improved surgeon's satisfaction score. [ 21 ] In our study, we had chosen a target MAP 60–70 mmHg to provide the best surgical conditions without the risk of tissue hypoperfusion depending on a review of literature conducted by Barak et al . [ 22 ] with an MAP of 50–65 mmHg during major maxillofacial surgeries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative flupirtine in ambulatory functional endoscopic sinus surgery: A prospective, double-blind, randomized controlled trial

et al. 2017

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Background:Functional endoscopic sinus surgery (FESS) is the mainstay therapeutic management for nasal pathologies. We evaluated flupirtine, a centrally acting analgesic, for producing perfect perioperative conditions in FESS for adults in a day-care setting.Materials and Methods:Sixty-two patients (25–40 years) scheduled for FESS under general anesthesia were randomly divided into Group F (n = 31) receiving preoperative flupirtine (100 mg) and Group C (n = 31) receiving identical-looking placebo capsule per oral 60 min before induction of anesthesia. Perioperative Nasal bleeding and surgeon's satisfaction score during operation; amount and number of patients receiving fentanyl, propofol, and esmolol infusion for analgesia; maintenance of desired bispectral index (BIS) and deliberate hypotension, respectively. Postanesthesia Care Unit (PACU) and hospital stay, hemodynamic parameters, and side effects were all recorded for each patient.Results:Significantly, less number of patients and less dosage of esmolol were required (P = 0.0040 and 0.0001, respectively) in Group F as compared to that in Group C. Again, number of patients requiring fentanyl and dosage of the same drug was significantly lower in Group F. Dose of propofol for the maintenance of BIS was significantly lower in Group F. However, the duration of controlled hypotension was almost similar in both groups. Group F patients suffered significantly less nasal bleeding and surgeon's satisfaction score was also high in this group. Discharge time from PACU and hospital was similar between two groups without any appreciable side effects.Conclusion:Flupirtine as a premedication found to be providing more favorable perioperative hemodynamic conditions, analgesia and thus allowing less nasal bleeding as well as more surgeons’ satisfaction score.

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“…Generally, the capillary is the substrate of an uncomplicated mucosal bleeding during paranasal sinus surgery. Relevant exogenous influencing factors arise, among others, due to the different anesthesiological procedures and pharmaceuticals, intraoperative stress stimuli as well as subclinical individual or drug-induced differences of the platelet function or rather the local blood coagulation [128], [129], [130], [131]. …”

Section: “Minor” Complicationsmentioning

confidence: 99%

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

Hosemann

Draf

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc06; ISSN 1865-1011

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Prophylaktische Analgesie bei endoskopischen Nasennebenhöhleneingriffen - Hämodynamik, Operationsbedingungen, Streßantwort -

Abstract: N2O-supplemented intravenous anesthesia is suitable for functional endoscopic sinus procedure without any further need for induced hypotension; sufentanil seems to be superior in regard to hemodynamic stability, surgical conditions, and psychomotor recovery.

Cited by 8 publications

References 10 publications

Dexmedetomidine versus Remifentanil for Controlled Hypotensive

Dexmedetomidine versus Remifentanil for Controlled Hypotensive

Evaluation of preoperative flupirtine in ambulatory functional endoscopic sinus surgery: A prospective, double-blind, randomized controlled trial

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

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