Intranasal Dexmedetomidine as Adjuvant to Local Anaesthetic in Preparation of Nasal Passage for Functional Endoscopic Sinus Surgery: Randomized Controlled Trial
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Abstract
Background: Intraoperative stress response and ongoing bleeding at surgical site especially in areas like head and neck can cause serious adverse reactions and affect the postoperative outcome. This study compared the effect of intranasally administered dexmedetomidine (dexmed) in combination with local anesthesia (LA) and local anesthetic alone on quality of surgical field, surgical bleeding and haemodyanamic parameters during functional endoscopic sinus surgery (FESS).
Methods: Roller gauge strips dipped in dexmedetomidine were used for nasal packing. Sixty patients undergoing FESS were randomly allocated to receive either intranasal Dexmedetomidine with LA (D group) or intranasal LA alone (L group) via nasal packing 15 min before surgery. The primary objective was to study the quality view of surgical field through the endoscope and the blood loss that occurred while raising the nasal mucosal flap. The secondary objective was to study the intraoperative hemodynamic profile and anesthetic and analgesic requirement during surgery.
Results: Surgical field quality, Blood loss, hemodynamic profile and satisfaction scores of patients and surgeons were significantly better (P< 0.05) in dexmed group.
Conclusion: Patients receiving intranasal dexmed with LA for FESS had better surgical field, surgeon’s satisfaction and minimal hemodynamic fluctuations with lesser blood loss as well as better postoperative comfort and analgesia.
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[2] Wormald PJ. Endoscopic Sinus Surgery Anatomy, Three Dimensional Reconstruction and Surgical Technique. 3td edition. New York: Thieme; 2005. The surgical field in endoscopic sinus surgery; 7–12.
[3] Eghbal A, Modir H, Moshiri E, Khalili M, Barsari FZ, Mohammadbeigi A. Hypotensive effect of labetalol and dexmedetomidine blood loss and surgical conditions in functional endoscopic sinus surgery: A double-blind randomized clinical trial. Formosan Journal of Surgery. 2018; 51(3).
[4] Das A, Chhaule S, Bhattacharya S, Basunia SR, Mitra T, Halder PS, et al. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J Anaesth. 2016;10(3): 276-82.
[5] 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.
[6] Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y. Effectivness of dexmedetomidine in reducing bleeding during spetoplasty and tympanoplasty operations. J Clin Anesth. 2008; 20:437–41.
[7] Hrishi A, Lionel K, Nair P. A Novel Use of a Novel Drug: Preoperative Nasal Preparation with Dexmedetomidine for Transnasal Transsphenoidal Neurosurgery Approach in Skull Base Neurosurgery. Indian Journal of Neurosurgery 2017; 06(03): 170-175
[8] Botha JA, Mudholkar P. The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. Crit Care Resusc. 2004; 6: 253-257.
[9] Baradaranfar MH, Dadgarnia MH, Mahmoudi H, Behniafard N, Atighechi S, Zand V, et al. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iran J Otorhinolaryngol. 2017; 29(91):69-74.
[10] Flint, Paul W, Phelps T. Cummings Otolaryngology head & neck surgery. 5th edition. Philadelphia: Elsevier; 2010.
[11] Akkaya A, Tekelioglu UY, Demirhan A, Bilgi M, Yildiz I, Apuhan T, et al. Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: Randomized clinical study. Rev Bras Anestesiol. 2014; 64:406–12.
[12] Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope. 2003; 113:1369–73.
[13] Cincikas D, Ivaskevicius S. Application of controlled arterial hypotension in endoscopic rhino-surgery. Medicina (Kaunas) 2003; 39:852–9.
[14] Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008; 25(1):22–8.
[15] Praveen DV, Pushparani A, Anand K, Sundaraperumal B. Comparison of dexmedetomidine with nitroglycerinefor hypotensive anaesthesia in functional endoscopic sinus surgery. Indian Journal of Clinical Anaesthesia. 2016;3(3):380–92.
[16] Peden CJ, Cloote AH, Stratford N, Prys Roberts C. The effect of intravenous dexmedetomidine premedication on the dose of requirements of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia. 2001; 56:408–13.
[17] Baker AR, Baker AB. Anaesthesia for endoscopic sinus surgery. Acta Anaesthesiol Scand. 2010; 54:795–803.
[18] Gu X, Tan X, Chen J, Wang J, Lu Y, Zhang L. The clinical effect of dexmedetomidine combined with parecoxib sodium on sedation, antianxiety and prevention of intubation stress in patients undergoing functional endoscopic sinus surgery: a randomised controlled trial. BMC Anesthesiol. 2020; 20(1):166.
[19] Parvizi A, Haddadi S, Faghih Habibi A, Nemati S, Akhtar N, Ramezani H. Dexmedetomidine Efficacy in Quality of Surgical Field During Endoscopic Sinus Surgery. Iran J Otorhinolaryngol. 2019; 31(106):281-288.
[20] Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. 2011;120(9):586–92.
[21] Nassef MA, G A. Effect of adding of dexmedetomidine to local anesthesia in external dacryocystorhinostomy patients. J Egypt Ophthalmol.
[22] Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. 2008; 25(5):369–74.
[23] Gopalakrishna KN, Dash PK, Chatterjee N, Easwer HV, Ganesamoorthi A. Dexmedetomidine as an anesthetic adjuvant in patients undergoing transsphenoidal resection of pituitary tumor. J Neurosurg Anesthesiol. 2015; 27(03):209–215.
[24] Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: a wonder drug? Indian J Anaesth. 2011; 55(04): 323–324
[25] Yang JJ, Li WY, Jil Q, Wang ZY, Sun J, Wang QP, et al. Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine-containing solutions of lidocaine produces profound hypotension. Acta Anaesthesiol Scand. 2005; 49(10):1471-6.
[2] Wormald PJ. Endoscopic Sinus Surgery Anatomy, Three Dimensional Reconstruction and Surgical Technique. 3td edition. New York: Thieme; 2005. The surgical field in endoscopic sinus surgery; 7–12.
[3] Eghbal A, Modir H, Moshiri E, Khalili M, Barsari FZ, Mohammadbeigi A. Hypotensive effect of labetalol and dexmedetomidine blood loss and surgical conditions in functional endoscopic sinus surgery: A double-blind randomized clinical trial. Formosan Journal of Surgery. 2018; 51(3).
[4] Das A, Chhaule S, Bhattacharya S, Basunia SR, Mitra T, Halder PS, et al. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J Anaesth. 2016;10(3): 276-82.
[5] 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.
[6] Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y. Effectivness of dexmedetomidine in reducing bleeding during spetoplasty and tympanoplasty operations. J Clin Anesth. 2008; 20:437–41.
[7] Hrishi A, Lionel K, Nair P. A Novel Use of a Novel Drug: Preoperative Nasal Preparation with Dexmedetomidine for Transnasal Transsphenoidal Neurosurgery Approach in Skull Base Neurosurgery. Indian Journal of Neurosurgery 2017; 06(03): 170-175
[8] Botha JA, Mudholkar P. The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. Crit Care Resusc. 2004; 6: 253-257.
[9] Baradaranfar MH, Dadgarnia MH, Mahmoudi H, Behniafard N, Atighechi S, Zand V, et al. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iran J Otorhinolaryngol. 2017; 29(91):69-74.
[10] Flint, Paul W, Phelps T. Cummings Otolaryngology head & neck surgery. 5th edition. Philadelphia: Elsevier; 2010.
[11] Akkaya A, Tekelioglu UY, Demirhan A, Bilgi M, Yildiz I, Apuhan T, et al. Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: Randomized clinical study. Rev Bras Anestesiol. 2014; 64:406–12.
[12] Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope. 2003; 113:1369–73.
[13] Cincikas D, Ivaskevicius S. Application of controlled arterial hypotension in endoscopic rhino-surgery. Medicina (Kaunas) 2003; 39:852–9.
[14] Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008; 25(1):22–8.
[15] Praveen DV, Pushparani A, Anand K, Sundaraperumal B. Comparison of dexmedetomidine with nitroglycerinefor hypotensive anaesthesia in functional endoscopic sinus surgery. Indian Journal of Clinical Anaesthesia. 2016;3(3):380–92.
[16] Peden CJ, Cloote AH, Stratford N, Prys Roberts C. The effect of intravenous dexmedetomidine premedication on the dose of requirements of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia. 2001; 56:408–13.
[17] Baker AR, Baker AB. Anaesthesia for endoscopic sinus surgery. Acta Anaesthesiol Scand. 2010; 54:795–803.
[18] Gu X, Tan X, Chen J, Wang J, Lu Y, Zhang L. The clinical effect of dexmedetomidine combined with parecoxib sodium on sedation, antianxiety and prevention of intubation stress in patients undergoing functional endoscopic sinus surgery: a randomised controlled trial. BMC Anesthesiol. 2020; 20(1):166.
[19] Parvizi A, Haddadi S, Faghih Habibi A, Nemati S, Akhtar N, Ramezani H. Dexmedetomidine Efficacy in Quality of Surgical Field During Endoscopic Sinus Surgery. Iran J Otorhinolaryngol. 2019; 31(106):281-288.
[20] Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. 2011;120(9):586–92.
[21] Nassef MA, G A. Effect of adding of dexmedetomidine to local anesthesia in external dacryocystorhinostomy patients. J Egypt Ophthalmol.
[22] Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. 2008; 25(5):369–74.
[23] Gopalakrishna KN, Dash PK, Chatterjee N, Easwer HV, Ganesamoorthi A. Dexmedetomidine as an anesthetic adjuvant in patients undergoing transsphenoidal resection of pituitary tumor. J Neurosurg Anesthesiol. 2015; 27(03):209–215.
[24] Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: a wonder drug? Indian J Anaesth. 2011; 55(04): 323–324
[25] Yang JJ, Li WY, Jil Q, Wang ZY, Sun J, Wang QP, et al. Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine-containing solutions of lidocaine produces profound hypotension. Acta Anaesthesiol Scand. 2005; 49(10):1471-6.
| Files | ||
| Issue | Vol 10 No 1 (2024): Winter |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i1.14772 | |
| Keywords | ||
| Dexmedetomidine Functional endoscopic sinus surgery (FESS) Local anesthetics | ||
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How to Cite
1.
Kale J, Panse N, Gangathade P, Shete A. Intranasal Dexmedetomidine as Adjuvant to Local Anaesthetic in Preparation of Nasal Passage for Functional Endoscopic Sinus Surgery: Randomized Controlled Trial. Arch Anesth & Crit Care. 2023;10(1):49-54.
