piperidines and Paranasal-Sinus-Diseases

The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed.. There are mixed data as to whether traditional inhalation anesthesia or total intravenous anesthesia is superior with respect to better surgical fields and decreased blood loss. A review of the literature tends to favor total intravenous anesthesia. Cerebral oximetry and transcranial Doppler ultrasound are emerging techniques to monitor cerebral perfusion during deliberate hypotension.. Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.

Topics: Airway Management; Anesthesia; Anesthesia Recovery Period; Anesthetics, Inhalation; Anesthetics, Intravenous; Endoscopy; Female; Follow-Up Studies; Humans; Male; Paranasal Sinus Diseases; Patient Positioning; Piperidines; Propofol; Remifentanil; Rhinitis; Sinusitis; Treatment Outcome

Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding.. A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care.. A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups.. The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

Topics: Anesthetics, Intravenous; Antihypertensive Agents; Blood Loss, Surgical; Clonidine; Double-Blind Method; Endoscopy; Female; Hemodynamics; Humans; Male; Middle Aged; Paranasal Sinus Diseases; Piperidines; Remifentanil; Treatment Outcome

Topics: Adult; Anesthetics, General; Blood Pressure; Bloodless Medical and Surgical Procedures; Cohort Studies; Female; Heart Rate; Humans; Male; Methyl Ethers; Middle Aged; Middle Cerebral Artery; Natural Orifice Endoscopic Surgery; Paranasal Sinus Diseases; Piperidines; Regional Blood Flow; Remifentanil; Sevoflurane; Young Adult