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      Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

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          Abstract

          Background

          The Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.

          Objectives

          In this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.

          Patients and Methods

          In a single–blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol – remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.

          Results

          There were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon’s satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).

          Conclusions

          The amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.

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          Most cited references16

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          The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery.

          A number of previous studies have tried to assess the effects of hypotension on the surgical field during endoscopic sinus surgery. These studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of beta-blockers as a pre-medication could improve the operative field in endoscopic sinus surgery. A prospective, randomized, double-blinded, placebo-controlled trial. Eighty patients undergoing endoscopic sinus surgery who fit the inclusion and exclusion criteria were randomly assigned to receive either a beta-blocker, Metoprolol (group 1), or a placebo tablet (group 2) 30 minutes before surgery. A standard anesthetic protocol was followed. At the commencement of surgery and at regular 15-minute intervals the surgical field, blood loss, heart rate, blood pressure, and isoflurane concentration were assessed. There was a significant difference in overall mean heart rate between the placebo and beta-blocker groups (P <.0001). In the entire group, surgical grade correlated with heart rate (r = 0.36, P <.05) but not with mean arterial blood pressure. Mean surgical grade was similar between the placebo and beta-blocker groups, but early in the study a significantly better surgical field was recorded in the beta-blocker group (P <.001). Surgical grade was significantly better in those with a mean heart rate of less than 60 beats per minute (P <.02). Although "optimum" conditions were present in the patients receiving beta-blocker, the authors thought that the grading system was not discriminating enough to demonstrate a significant difference between the groups. The crucial finding in the study was the correlation between heart rate and surgical grade in the entire group. During endoscopic sinus surgery surgery, anesthetic manipulations should be directed at maintaining a low heart rate.
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            Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery.

            Endoscopic sinus surgery (ESS) is often affected by intra-nasal bleeding, which can be influenced by various anaesthetics and preoperative conditions. This study compared the surgical condition and the amount of intra-nasal bleeding between patients given sevoflurane/remifentanil (SR) and propofol/remifentanil (PR) anaesthesia. ASA I or II patients undergoing ESS were randomly assigned to group SR (n=20) or group PR (n=20). The extent of the preoperative surgical lesion was classified as high (> 12) and low Lund-Mackay (LM) (< or = 12) scores according to the computed tomography findings. The amount of intraoperative blood loss was calculated from the patients' haemoglobin (Hb) and the amount of blood in the suction canister. The surgeons rated the visibility of the surgical field on a numeric rating scale (NRS). In the high-LM score patients, the median (1st/3rd quartiles) blood loss for the SR and PR groups was 135 (121/222) and 19 (8/71) ml h(-1), respectively (P<0.01), and the mean (SD) of NRS was 5.8 (2.3) and 2.3 (1.0), respectively (P<0.05). However, in patients with low-LM score, both blood loss and NRS scores were not different between groups SR and PR. In the high-LM score patients, PR anaesthesia results in less blood loss and a better surgical conditions for ESS than SR anaesthesia.
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              Anaesthesia for endoscopic sinus surgery.

              Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative beta blockade is associated with better operating conditions than when vasodilating agents are used. Tight control of CO(2) does not affect the surgical view. The use of a laryngeal mask may be associated with improved surgical conditions and a smoother emergence. It provides airway protection equivalent to that provided by an endotracheal tube in well-selected patients, but offers less protection from gastric regurgitation. Post-operatively, multimodal oral analgesia provides good pain relief, while long-acting local anaesthetics have been shown not to improve analgesia.
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                Author and article information

                Journal
                Anesth Pain Med
                Anesth Pain Med
                10.5812/aapm
                Kowsar
                Anesthesiology and Pain Medicine
                Kowsar
                2228-7523
                2228-7531
                01 September 2013
                September 2013
                : 3
                : 2
                : 234-238
                Affiliations
                [1 ]Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
                Author notes
                [* ]Corresponding author: Soudabeh Haddadi, Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-1312238306-8, Fax: +98-1312227409, E-mail: So_haddadia@ 123456yahoo.com .
                Article
                10.5812/aapm.9891
                3833048
                e6a69e76-196e-4819-8d82-c348fa1c18db
                Copyright © 2013, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 December 2012
                : 14 April 2013
                : 27 June 2013
                Categories
                Research Article

                anesthesia, general,propofol,endoscopy,hemorrhage
                anesthesia, general, propofol, endoscopy, hemorrhage

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