Controlled Hypotension in Endoscopic Sinus Surgery with Dexmedetomidine as Adjunct: A Report of Two Cases
Keywords:
Adrenergic alpha‑2 receptor agonist, controlled hypotension, minimally invasive surgical procedures, otolaryngologyAbstract
The success of endoscopic surgery in otolaryngology largely depends on the surgical field, where the presence of significant bleeding is a critical factor. Bleeding obscures surgical planes and the recognition of anatomical landmarks becomes quite difficult. Various manoeuvers and drugs have been used for optimization of the surgical field. Conventionally, beta blockers and sodium nitroprusside have been used to control the intraoperative blood pressure. Newer agents such as remifentanil and adrenergic alpha‑2 agonists such as clonidine and dexmedetomidine are also being tried. We report two cases of endoscopic sinus surgery (ESS) where dexmedetomidine infusion as adjunct to propofol infusion and inhalational anesthesia with sevoflurane [minimum alveolar concentration (MAC) 0.5‑0.8] were utilized for providing an optimal surgical field.Downloads
Downloads
Published
How to Cite
Issue
Section
References
Stankiewicz JA. Complications of endoscopic intranasal ethmoidectomy.Laryngoscope 1987;97:1270‑3.
Nair S, Collin M, Hung P, Rees G, Close D, Wormald PJ. The effect of beta‑blocker premedication on the surgical field during endoscopic sinus surgery. Laryngoscope 2004;114:1042‑6.
Boezaart AP, van der Merwe J, Coetzee AR. Comparison of sodium nitroprusside‑ and esmolol‑ induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42:373‑6.
Boezaart AP, van der Merwe J, Coetzee AR. Re: Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 2001;13:319‑20.
Degoute CS. Controlled hypotension: A guide to drug choice. Drugs 2007;67:1053‑76.
Wormald PJ, van Renen G, Perks J, Jones JA, Langton‑Hewer CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 2005;19:514‑20.
Scheinin M, Pihlavisis M. Molecular pharmacology of alpha 2 adrenoceptor agonists. In: Scholz J, Tonner PH, editors. Bailliere’s Best Practice and Research: Clinical Anesthesiology‑ Alpha 2 Adrenoceptors Agonists in Anesthesia and Intensive Care. London, Baillere Tindall; 2000. p. 247‑60.
Shams T, El Bahnasawe NS, Abu‑Samra M, El‑Masry R. Induced hypotension for functional endoscopic sinus surgery: A comparative study of Dexmedetomidine versus Esmolol. Saudi J Anaesth 2013;7:175‑80.
Lee J, Kim Y, Park C, Jeon Y, Kim D, Joo J, et al. Comparison between dexmedetomidine and remifentanil for controlled hypotension and recovery in endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2013;122:421‑6.