Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia

Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established.Aim of the work: To evaluate outcome of functional endoscopic sinus su...

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Autores principales:	Mostafa Ahmed, Mahmoud Elsayed, Nabil Sarhan, Mohamed Fathallah
Formato:	article
Lenguaje:	EN
Publicado:	Al-Azhar University, Faculty of Medicine (Damietta) 2019
Materias:	esmolol hypotensive anesthesia hypotensive total intravenous anesthesia intraoperative bleeding operative field visibility Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/fb5056bb621e4c86a45e61fc080a6575
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spelling	oai:doaj.org-article:fb5056bb621e4c86a45e61fc080a65752021-12-02T13:53:21ZSurgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia2636-41742682-378010.21608/ijma.2019.16039.1023https://doaj.org/article/fb5056bb621e4c86a45e61fc080a65752019-10-01T00:00:00Zhttps://ijma.journals.ekb.eg/article_50484_326c91c82710916a132c6a1aa8c53f1a.pdfhttps://doaj.org/toc/2636-4174https://doaj.org/toc/2682-3780Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established.Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA].Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery.Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was non-significant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA.Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.Mostafa AhmedMahmoud ElsayedNabil SarhanMohamed FathallahAl-Azhar University, Faculty of Medicine (Damietta)articleesmolol hypotensive anesthesiahypotensive total intravenous anesthesiaintraoperative bleedingoperative field visibilityMedicine (General)R5-920ENInternational Journal of Medical Arts, Vol 1, Iss 2, Pp 110-118 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	esmolol hypotensive anesthesia hypotensive total intravenous anesthesia intraoperative bleeding operative field visibility Medicine (General) R5-920
spellingShingle	esmolol hypotensive anesthesia hypotensive total intravenous anesthesia intraoperative bleeding operative field visibility Medicine (General) R5-920 Mostafa Ahmed Mahmoud Elsayed Nabil Sarhan Mohamed Fathallah Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
description	Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established.Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA].Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery.Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was non-significant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA.Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.
format	article
author	Mostafa Ahmed Mahmoud Elsayed Nabil Sarhan Mohamed Fathallah
author_facet	Mostafa Ahmed Mahmoud Elsayed Nabil Sarhan Mohamed Fathallah
author_sort	Mostafa Ahmed
title	Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
title_short	Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
title_full	Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
title_fullStr	Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
title_full_unstemmed	Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia
title_sort	surgical field visibility during functional endoscopic sinus surgery: esmolol-induced hypotensive anesthesia versus hypotensive total intravenous anesthesia
publisher	Al-Azhar University, Faculty of Medicine (Damietta)
publishDate	2019
url	https://doaj.org/article/fb5056bb621e4c86a45e61fc080a6575
work_keys_str_mv	AT mostafaahmed surgicalfieldvisibilityduringfunctionalendoscopicsinussurgeryesmololinducedhypotensiveanesthesiaversushypotensivetotalintravenousanesthesia AT mahmoudelsayed surgicalfieldvisibilityduringfunctionalendoscopicsinussurgeryesmololinducedhypotensiveanesthesiaversushypotensivetotalintravenousanesthesia AT nabilsarhan surgicalfieldvisibilityduringfunctionalendoscopicsinussurgeryesmololinducedhypotensiveanesthesiaversushypotensivetotalintravenousanesthesia AT mohamedfathallah surgicalfieldvisibilityduringfunctionalendoscopicsinussurgeryesmololinducedhypotensiveanesthesiaversushypotensivetotalintravenousanesthesia
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Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia

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