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Sun D, Liang Y, Yang F, Liu L, Mao X, Xu X. Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS. Front Med (Lausanne) 2024; 11:1344661. [PMID: 38741764 PMCID: PMC11089246 DOI: 10.3389/fmed.2024.1344661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The purpose of this study is to develop and evaluate a nomogram that is capable of predicting poor operative visibility during functional endoscopic sinus surgery. Method To identify potential risk factors, patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS) between January 2019 and December 2022 were selected from our hospital's electronic medical record system. Data on general patient information, clinical manifestations, clotting-related test indices, Lund-Machay score of sinuses CT scanning, Lund-kennedy score of nasal endoscopies, anesthesia methods, intraoperative blood pressure and heart rate, and Boezaart bleeding score were collected. Minimum absolute convergence and selection operator (LASSO) regression, as well as multivariate logistic regression, were used to determine the risk factors. A nomogram was developed in order to predict poor operating visibility during FESS, and its performance was evaluated utilizing both the training and verification datasets via various measures including receiver operating characteristic (ROC) curve analysis, area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis. Results Of the 369 patients who met the inclusion criteria, 88 of them exhibited POV during FESS. By deploying LASSO and multivariate logistic regression analyses, six risk factors were identified and used to construct a nomogram for predicting POV during FESS. These factors include prothrombin time (PT), prothrombin activity (PTA), Lund-Mackay score (LMS), Lund-Kennedy score (LKS), anesthetic method, and intraoperative hypertension. The AUC of the training set was found to be 0.820 while that of the verification set was 0.852. The Hosmer-Lemeshow goodness-of-fit test and calibration curve analysis revealed good consistency between predicted and actual probabilities. Also, the decision curve demonstrated that the nomogram had a high degree of clinical usefulness and net benefit. Conclusion The constructed nomogram has a strong ability to predict the poor intraoperative field in patients with chronic rhinosinusitis, which can help preoperative judgment of high-risk patients and provide evidence for perioperative management and preoperative plan formulation.
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Affiliation(s)
- Deping Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Clinical College of Chongqing Medical University, Chongqing, China
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Khetpal S, Dahoud F, Partownavid P, Roostaeian J. Permissive Hypotension in Rhinoplasty: A Literature Review of Therapeutics and Associated Outcomes. Aesthetic Plast Surg 2023; 47:2632-2638. [PMID: 36877227 DOI: 10.1007/s00266-023-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND/PURPOSE Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty. METHODS A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature. RESULTS Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled. CONCLUSION Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sumun Khetpal
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA
| | - Fadi Dahoud
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA
| | - Parisa Partownavid
- Department of Anesthesiology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jason Roostaeian
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA.
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Kim DH, Lee J, Kim SW, Hwang SH. The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis. Clin Exp Otorhinolaryngol 2020; 14:200-209. [PMID: 32847341 PMCID: PMC8111392 DOI: 10.21053/ceo.2020.00584] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES A systematic review of the literature was conducted to evaluate hypotensive agents in terms of their adverse effects and associations with perioperative morbidity in patients undergoing nasal surgery. METHODS Two authors independently searched databases (Medline, Scopus, and Cochrane databases) up to February 2020 for randomized controlled trials comparing the perioperative administration of a hypotensive agent with a placebo or other agent. The outcomes of interest for this analysis were intraoperative morbidity, operative time, intraoperative bleeding, hypotension, postoperative nausea/vomiting, and postoperative pain. Both a standard pairwise meta-analysis and network meta-analysis were conducted. RESULTS Our analysis was based on 37 trials. Treatment networks consisting of six interventions (placebo, clonidine, dexmedetomidine, beta-blockers, opioids, and nitroglycerine) were defined for the network meta-analysis. Dexmedetomidine resulted in the greatest differences in intraoperative bleeding (-0.971; 95% confidence interval [CI], -1.161 to -0.781), intraoperative fentanyl administration (-3.683; 95% CI, -4.848 to -2.518), and postoperative pain (-2.065; 95% CI, -3.170 to -0.960) compared with placebo. The greatest difference in operative time compared with placebo was achieved with clonidine (-0.699; 95% CI, -0.977 to -0.421). All other agents also had beneficial effects on the measured outcomes. Dexmedetomidine was less likely than other agents to cause adverse effects. CONCLUSION This study demonstrated the superiority of the systemic use of dexmedetomidine as a perioperative hypotensive agent compared with the other five tested agents. However, the other agents were also superior to placebo in improving operative time, intraoperative bleeding, and postoperative pain.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junuk Lee
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gollapudy S, Gashkoff DA, Poetker DM, Loehrl TA, Riess ML. Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol- vs Desflurane-Based Anesthesia. Otolaryngol Head Neck Surg 2020; 163:835-842. [PMID: 32450733 DOI: 10.1177/0194599820921863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery. STUDY DESIGN Prospective, randomized, controlled trial. SETTING Academic teaching hospital and Veterans Affairs hospital in the United States. SUBJECTS AND METHODS Seventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α = .05. RESULTS There were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min-1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg-1 min-1; P = .01). The bleeding score correlated positively with height (P = .014) and the Lund-MacKay score (P = .013). Bilateral vs unilateral surgery led to longer surgery duration (P = .001) and recovery room time (P = .004). CONCLUSION When remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.
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Affiliation(s)
- Suneeta Gollapudy
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Drake A Gashkoff
- Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Todd A Loehrl
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Matthias L Riess
- Anesthesiology, TVHS VA Medical Center, Nashville, Tennessee, USA.,Departments of Anesthesiology and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sadek AA, Mostafa M, Abdel-Monem T. Metoprolol Significantly Improves Visual Clarity and Hemodynamic Parameters during Functional Endoscopic Sinus Surgery. Biomed Hub 2020; 4:1-8. [PMID: 31993421 PMCID: PMC6985881 DOI: 10.1159/000497045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives The success of functional endoscopic sinus surgery (FESS) depends on the visual clarity of the surgical field, which is understudied. Controlled hypotension has many advantages for FESS including reduction in blood loss and improved quality of the surgical field. This study determined whether the use of β-blockers as a premedication could improve the operative field in FESS. Methods : Sixty patients aged from 18 to 50 years, undergoing septoplasty and FESS were included in this prospective, randomized, double-blind, placebo-controlled study. Patients were randomly assigned to receive either metoprolol (100 mg, group 1) or a placebo (a vitamin tablet, group 2) 60 min before surgery. Results The average blood loss and surgery duration were not significantly higher in the placebo group. The surgical field was graded using the Fromme-Boezaart scale, and it was significantly clearer (p < 0.001) in metoprolol group. The mean arterial blood pressure was significantly lower in the metoprolol group after 30 min of induction until the end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in those who received metoprolol from before induction of anesthesia up to the end of surgery. Conclusion : Metoprolol significantly improves visual clarity and hemodynamics during FESS. We would recommend the use of metoprolol in FESS and septoplasty.
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Affiliation(s)
- Ahmed A Sadek
- Otorhinolaryngology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mokhtar Mostafa
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Tarek Abdel-Monem
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Minia University, Minia, Egypt
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de Vasconcellos SJDA, do Nascimento-Júnior EM, de Aguiar Menezes MV, Tavares Mendes ML, de Souza Dantas R, Martins-Filho PRS. Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 144:816-823. [PMID: 30098161 DOI: 10.1001/jamaoto.2018.1381] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty. Objective To investigate the results of tranexamic acid use to reduce intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty. Data Sources and Study Selection For this systematic review of randomized clinical trials, searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017. Key words included tranexamic acid, rhinoplasty, and nasal surgical procedures. The following elements were used to define eligibility criteria: (1) population: patients undergoing rhinoplasty surgery; (2) intervention and controls: tranexamic acid vs placebo solution or no-treatment control group; (3) outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events; and (4) study type: randomized clinical trials. Data Extraction and Synthesis Two reviewers extracted data and assessed study quality according to the Cochrane guidelines for randomized clinical trials. Treatment effects were defined as weighted mean difference (WMD) and 95% CIs. The strength of evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation rating system. Main Outcomes and Measures Intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis. To calculate the effect sizes, means and SDs were obtained for each study group and outcome of interest. Results Five studies comprising 276 patients were included in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years. Four studies comprising 246 patients estimated the amount in intraoperative bleeding as a primary outcome and were included in the meta-analysis. Eyelid edema and ecchymosis were evaluated as outcomes in 2 studies. Tranexamic acid was associated with reduced bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P = .01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I2 = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I2 = 56%) administration. Eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08. No cases of thromboembolic events were reported. Conclusions and Relevance Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.
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Erdivanlı B, Erdivanlı ÖÇ, Şen A, Özdemir A, Tuğcugil E, Dursun E. Comparison of Metoprolol and Tramadol with Remifentanil in Endoscopic Sinus Surgery: A Randomised Controlled Trial. Turk J Anaesthesiol Reanim 2018; 46:424-433. [PMID: 30505604 DOI: 10.5152/tjar.2018.28999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/18/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. Methods In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg-1 metoprolol and 1 mg kg-1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 μg kg-1 remifentanil following anaesthesia induction, followed by 0.25-0.5 μg kg-1 min-1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. Results A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). Conclusion Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases.
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Affiliation(s)
- Başar Erdivanlı
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Özlem Çelebi Erdivanlı
- Department of Otorhinolaryngology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ahmet Şen
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Abdullah Özdemir
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ersagun Tuğcugil
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Engin Dursun
- Department of Otorhinolaryngology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
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Soltani Mohammadi S, Maziar A, Saliminia A. Comparing Clonidine and Lidocaine on Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Controlled Hypertensive Patients: A Randomized, Double-Blinded Clinical Trial. Anesth Pain Med 2016; 6:e34271. [PMID: 27247914 PMCID: PMC4885122 DOI: 10.5812/aapm.34271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemodynamic fluctuations in response to laryngoscopy and tracheal intubation and their potential hazards have been well-recognized, especially in hypertensive patients. Many drugs in various combinations have been used to attenuate these adverse responses. OBJECTIVES We conducted a study to compare lidocaine with clonidine on the attenuation of hemodynamic responses to laryngoscopy and tracheal intubation, in controlled hypertensive patients undergoing general anesthesia. PATIENTS AND METHODS Eighty-six patients of American society of anesthesiologists (ASA) class II, who were aged 18 to 65-years-old and were scheduled for elective surgeries under general anesthesia, were included. The patients were randomly divided into two equal groups. The clonidine group received 0.2 mg oral clonidine 90 minutes before surgery and the lidocaine group received a placebo tablet at the same time. All patients in both groups were anesthetized with the same technique, including: intravenous fentanyl 3 mcg/kg, sodium thiopental 5 mg/kg, and atracurium 0.5 mg/kg. The lidocaine group received 1.5 mg/kg lidocaine but the clonidine group received the same volume of saline ninety seconds before intubation. Hemodynamic parameters were recorded before intubation and 1, 3, 5, and 10 minutes after endotracheal intubation. RESULTS There were no significant differences between the two groups' hemodynamic parameters, including heart rate and systolic, diastolic, and mean arterial blood pressures at the measured points. There were also no significant differences within each group in hemodynamic responses at the measured points (P > 0.05). Twenty patients in the clonidine and three patients in the lidocaine group complained of mouth dryness (P = 0.001). Fourteen patients in the clonidine and four patients in the lidocaine group had bradycardia (P = 0.008). Nineteen patients in the clonidine and six patients in the lidocaine group had orthostatic hypotension (P = 0.002). CONCLUSIONS There were no statistical differences between oral clonidine and intravenous lidocaine regarding attenuation of hemodynamic responses after tracheal intubation in controlled hypertensive patients, although the rate of complications including mouth dryness, bradycardia, and orthostatic hypotension was significantly higher in the clonidine group before induction of anesthesia.
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Affiliation(s)
- Sussan Soltani Mohammadi
- Department of Anesthesiology, Critical Care and Pain Medicine, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Sussan Soltani Mohammadi, Department of Anesthesiology, Critical Care and Pain Medicine, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fax: +98-21-88633039, E-mail:
| | - Alireza Maziar
- Department of Anesthesiology, Critical Care and Pain Medicine, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Saliminia
- Department of Anesthesiology, Critical Care and Pain Medicine, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mahgoobifard M, Mirmesdagh Y, Imani F, Najafi A, Nataj-Majd M. The analgesic efficacy of preoperative oral Ibuprofen and acetaminophen in children undergoing adenotonsillectomy: a randomized clinical trial. Anesth Pain Med 2014; 4:e15049. [PMID: 24660156 PMCID: PMC3961035 DOI: 10.5812/aapm.15049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 01/07/2023] Open
Abstract
Background: Adenotonsillectomy is one of the most common surgical procedures in children. Several complications and morbidities are common after nasal surgeries and the most common is pain. Several techniques have been employed to reduce the severity of postoperative pain. One of the preoperative techniques is pre-emptive analgesia through preventive central hypersensitization. This technique is performed by applying analgesic methods before the onset of nociceptive stimuli, consequently decreasing postoperative analgesics requirements. Objectives: Preoperative oral drug administration for pain analgesia is performed in several methods. The aim of this study was to compare the analgesic effects of preoperatively administration of oral acetaminophen and ibuprofen. Patients and Methods: In a double-blinded, randomized placebo-controlled study, sixty 4-12 years old ASA I or II children scheduled for elective adenotonsillectomy, were assigned to receive either acetaminophen 15 mg/kg, ibuprofen 10 mg/kg or placebo 30 minutes before the operation. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), upon arrival to the post anesthetic care unit (PACU) and ward. Findings were analyzed by SPSS version 17 using variance analysis and Tukey’s test. Results: The average pain intensities were significantly lower in acetaminophen group based on the CHEOPS in both PACU and ward compared to ibuprofen or placebo groups; but there was no difference in pain intensity between the ibuprofen and placebo groups. Pain intensity in PACU in Acetaminophen group was 7.05 ± 0.64 vs. 8.38 ± 1.20 in placebo group and 8.14 ± 0.85 in ibuprofen group, pain intensity in ward in the acetaminophen group was 6.0.87 ± 0.85in the acetaminophen group, vs. 8.04 ± 1.02 in placebo group, and 7.78 ± 0.78 in ibuprofen group. Conclusions: This study showed that administration of oral acetaminophen 30 minutes preoperatively, resulted in significantly lower pain intensity in children undergoing adenotonsillectomy in PACU and ward, compared to ibuprofen and placebo.
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Affiliation(s)
- Maziar Mahgoobifard
- Department of Anesthesiology and Children and Adolescent Health Research Center, Ali-Ebne Abitaleeb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Yalda Mirmesdagh
- Heart Value Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Nataj-Majd
- Research Development Center of Arash Woman's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Masoomeh Nataj-Majd, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2177883283, Fax: +98-2177883196, E-mail:
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Marzban S, Haddadi S, Mahmoudi Nia H, Heidarzadeh A, Nemati S, Naderi Nabi B. Comparison of surgical conditions during propofol or isoflurane anesthesia for endoscopic sinus surgery. Anesth Pain Med 2013; 3:234-8. [PMID: 24282774 PMCID: PMC3833048 DOI: 10.5812/aapm.9891] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 04/14/2013] [Accepted: 06/27/2013] [Indexed: 11/16/2022] Open
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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Affiliation(s)
- Shideh Marzban
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Soudabeh Haddadi, Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-1312238306-8, Fax: +98-1312227409, E-mail:
| | | | - Abtin Heidarzadeh
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Hassani V, Movassaghi G, Goodarzi V, Safari S. Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. Anesth Pain Med 2013; 2:115-8. [PMID: 24244920 PMCID: PMC3821130 DOI: 10.5812/aapm.6442] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/20/2012] [Accepted: 08/05/2012] [Indexed: 12/28/2022] Open
Abstract
Background Induction of anesthesia and endotracheal intubation often creates a period of hemodynamic instability in hypertensive patients. Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines. Objectives This trial aimed to evaluate and compare the efficacy of fentanyl and fentanyl plus lidocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation in hypertensive patients. Patients and Methods We conducted a prospective, randomized, double-blind trial in 37 patients with hypertension in the Rasoul-Akram Hospital, Tehran, Iran, from March to December 2011. The patients were randomly divided into two groups (fentanyl group and fentanyl plus lidocaine group). The fentanyl group received 2 mcg/kg and the fentanyl plus lidocaine group received 1.5mg lidocaine and 2mcg/kg fentanyl. Hemodynamic variables were recorded at baseline, after giving inductive anesthetic agents, and 1, 3 and 5 minutes after performing endotracheal intubation. Results We evaluated 37 patients including 15 males (40.54%) and 22 females (59.46%), with a mean age of 56.08 ± 10.85 years. There were no significant differences between the two groups regarding; heart rate, systolic blood pressure and diastolic blood pressure before induction, 3 minutes before intubation and 1, 3 and 5 minutes after intubation. Conclusions Fentanyl and fentanyl plus lidocaine effectively decreased the hemodynamic response to tracheal intubation, however, neither fentanyl nor fentanyl plus lidocaine, could inhibit all hemodynamic responses, moreover fentanyl plus lidocaine was not more effective than fentanyl alone.
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Affiliation(s)
- Valiallah Hassani
- Department of Anesthesiology, Rasoul-Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Minimally Invasive Surgery Research Center, Rasoul-Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Gholamreza Movassaghi
- Department of Anesthesiology, Hasheminezhad Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Vahid Goodarzi
- Department of Anesthesiology, Rasoul-Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Corresponding author: Vahid Goodarzi, Department of Anesthesiology, Rasoul-Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Tel.: +98-2166915196, Fax: +98-2166509059, E-mail:
| | - Saeid Safari
- Department of Anesthesiology, Rasoul-Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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