phentolamine on event related potentials and cognitive functions in patients undergoing septoplasty: a randomized controlled trial

BACKGROUND

Postoperative cognitive dysfunction is a noteworthy complication of deliberate hypotensive anesthesia. The aim of this work was to compare the effect of deliberate hypotensive anesthesia using nitroglycerine versus phentolamine on event-related potentials and cognitive function in patients undergoing septoplasty surgery.

METHODS

This prospective randomized controlled trial was conducted on 80 patients indicated for septoplasty under general anesthesia; 40 patients received intra-operative Nitroglycerine and 40 patients received intra-operative Phentolamine. Cognitive assessment (using Paired Associate Learning test (PALT) and Benton Visual Retention test (BVRT)) and P300 recording were done for all included patients pre-operatively and one week postoperatively.

RESULTS

The scores of PALT and Benton BVRT significantly declined one week following surgery in both Nitroglycerine and Phentolamine groups. There was no statistically significant difference between Nitroglycerine and Phentolamine groups in the postoperative decline in either PALT or BVRT (P-value = 0.342, 0.662 respectively). The values of P300 latency showed a significant delay one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but in Nitroglycerine group, the delay is significantly higher than in Phentolamine group (P-value = 0.003). The values of P300 amplitude significantly decreased one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but there was no statistically significant difference between Nitroglycerine and Phentolamine groups (P-value = 0.099).

CONCLUSION

Phentolamine is preferred over nitroglycerin in deliberate hypotensive anesthesia because it has less harmful effect on cognitive function than nitroglycerin.

Well leg compartment syndrome postorthognathic surgery under hypotensive anesthesia and reverse Trendelenburg position: a case report and literature review

INTRODUCTION

Well leg compartment syndrome is a rare postoperative condition that occurs as a result of non-traumatic ischemic insult. It has similar pathophysiology to compartment syndrome; however, no definitive etiology is identified. Several risk factors such as patient position, leg position, young age, and high BMI for the development of this condition are considered.

CASE REPORT

A 30 years old male smoker and overweight, underwent mandibular and maxillary osteotomies in reverse Trendelenburg position. He developed a WLCS post-operative and treated with fasciotomy.

CONCLUSION

Increased Awareness of this rare occurrence and predisposition aids in understanding and prompt management. This article provides a rare case that has occurred in reverse Trendelenburg position with less obvious risk factors than typically reported in the literature.