Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 1, pp 239–245 | Cite as

Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil

  • Safinaz KarabayirliEmail author
  • Kadriye Serife Ugur
  • Ruveyda Irem Demircioglu
  • Bunyamin Muslu
  • Burhanettin Usta
  • Huseyin Sert
  • Nebil Ark
Rhinology

Abstract

To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 µg/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 µg/kg/h infusion during operation. In group R (n = 25), 1 µg/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25–0.50 µg/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9–10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9–10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.

Keywords

Dexmedetomidine Remifentanil Functional endoscopic sinus surgery Controlled hypotension 

Notes

Compliance of ethical standards

Conflict of interest

All authors declared no conflicts of interest. There was not any financial support.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Baker AR, Baker AB (2010) Anaesthesia for endoscopic sinus surgery. Acta Anaesthesiol Scand 54(7):795–803CrossRefPubMedGoogle Scholar
  2. 2.
    Ulualp SO (2008) Complications of endoscopic sinus surgery: appropriate management of complications. Curr Opin Otolaryngol Head Neck Surg 16(3):252–259CrossRefPubMedGoogle Scholar
  3. 3.
    Eberhart LH, Folz BJ, Wulf H, Geldner G (2003) Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 113(8):1369–1373CrossRefPubMedGoogle Scholar
  4. 4.
    Ahn HJ, Chung SK, Dhong HJ et al (2008) Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anaesth 100(1):50–54CrossRefPubMedGoogle Scholar
  5. 5.
    Mohseni M, Ebneshahidi A (2011) The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial. J Anesth 25(4):614–617CrossRefPubMedGoogle Scholar
  6. 6.
    Eberhart LH, Kussin A, Arndt C et al (2007) Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery. Rhinology 45(1):72–78PubMedGoogle Scholar
  7. 7.
    Yoo HS, Han JH, Park SW, Kim KS (2010) Comparison of surgical condition in endoscopic sinus surgery using remifentanil combined with propofol, sevoflurane, or desflurane. Korean J Anesthesiol 59(6):377–382CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chaaban MR, Baroody FM, Gottlieb O, Naclerio LM (2013) Blood loss during endoscopic sinus surgery with propofol or sevoflurane. JAMA Otolaryngol Head Neck Surg 139(5):510–514CrossRefPubMedGoogle Scholar
  9. 9.
    Degoute CS (2007) Controlled hypotension: a guide to drug choice. Drugs 67(7):1053–1076CrossRefPubMedGoogle Scholar
  10. 10.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 50(1):1–12PubMedGoogle Scholar
  11. 11.
    Lund VJ, Kennedy DW (1995) Quantification for staging sinusitis. In: Kennedy DW (ed) International Conference on Sinus Disease: Terminology, Staging, Therapy. Ann Otol Rhinol Laryngol 104(Suppl 167):17–21Google Scholar
  12. 12.
    Paris A, Tonner PH (2005) Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol 18(4):412–418CrossRefPubMedGoogle Scholar
  13. 13.
    Carollo DS, Nossaman BD, Ramadhyani U (2008) Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 21(4):457–461CrossRefPubMedGoogle Scholar
  14. 14.
    Tufanogullari B, White PF, Peixoto MP et al (2008) Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg 106(6):1741–1748CrossRefPubMedGoogle Scholar
  15. 15.
    Gurbet A, Basagan-Mogol E, Turker G et al (2006) Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth 53(7):646–652CrossRefPubMedGoogle Scholar
  16. 16.
    Ngwenyama NE, Anderson J, Hoernschemeyer DG, Tobias JD (2008) Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents. Paediatr Anaesth 18(12):1190–1195PubMedGoogle Scholar
  17. 17.
    Durmus M, But AK, Dogan Z et al (2007) Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol 24(5):447–453CrossRefPubMedGoogle Scholar
  18. 18.
    Ayoglu H, Yapakci O, Ugur MB et al (2008) Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth 20(6):437–441CrossRefPubMedGoogle Scholar
  19. 19.
    Richa F, Yazigi A, Sleilaty G, Yazbeck P (2008) Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol 25(5):369–374CrossRefPubMedGoogle Scholar
  20. 20.
    Guven DG, Demiraran Y, Sezen G et al (2011) Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol 120(9):586–592PubMedGoogle Scholar
  21. 21.
    Goksu S, Arik H, Demiryurek S et al (2008) Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol 25(1):22–28CrossRefPubMedGoogle Scholar
  22. 22.
    Bloor BC, Ward DS, Belleville JP, Maze M (1992) Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 77(6):1134–1142CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Safinaz Karabayirli
    • 1
    Email author
  • Kadriye Serife Ugur
    • 2
  • Ruveyda Irem Demircioglu
    • 1
  • Bunyamin Muslu
    • 1
  • Burhanettin Usta
    • 1
  • Huseyin Sert
    • 1
  • Nebil Ark
    • 2
  1. 1.Department of Anesthesiology and Reanimation, Faculty of MedicineTurgut Ozal UniversityEmek, AnkaraTurkey
  2. 2.Department of Otolaryngology and Head and Neck Surgery, Faculty of MedicineTurgut Ozal UniversityAnkaraTurkey

Personalised recommendations