Soma Ganesh Raja NEETHİRAJAN, Nivash CHANDRASEKARAN, Aruna PARAMESWARİ

Fonksiyonel Endoskopik Sinüs Cerrahilerinde Optimum Cerrahi Koşulları Sağlamada Kontrollü Hipotansiyon için Deksmedetomidinin Etkinliği: Çift Kör Randomize Kontrollü Çalışma

Amaç: Fonksiyonel endoskopik sinüs cerrahileri sırasında, intraoperatif görüşte azalmaya ve optik sinir ve internal karotid arter gibi vital yapılarda hasar riskinde artmaya neden olan kanama, kontrollü hipotansiyon ile etkin kontrol gerektirir. Bu çalışmada amacımız, fonksiyonel endoskopik sinüs cerrahilerinde (FESS) deksmedetomidinin kontrollü hipotansiyon için kullanıldığında kan kaybını azaltmadaki etkinliğini değerlendirmektir. Yöntem: Elektif FESS planlanan, Amerikan Anesteziyologlar Derneği - ASA sınıf I ve II, demografik özellikler bakımından benzer 92 hasta, deksmedetomidin 1 μ kg sa-1 ilk 10 dk, sonrasında 0.5 μ kg sa-1 infüzyon (Grup A) veya eşit volümde salin infüzyonu aldı (Grup B). Hemodinamik değişiklikler, intraoperatif kurtarıcı ilaç tüketimi, intraoperatif kan kaybı, derlenme zamanı, postoperatif sedasyon ve ağrı skorları kaydedildi. Bulgular: Deksmedetomidin grubundaki hastalarda, daha düşük intraoperatif ortalama arteriyel kan basıncı, kalp hızı, postoperatif daha iyi sedasyon ve ağrı skorları ile birlikte kan kaybında (p=0.000) belirgin bir azalma vardı. Ortalama intraoperatif kurtarıcı ilaç tüketimi B grubundaki hastalarda belirgin olarak daha yüksekti. A grubundaki hastalarda ekstübasyon süresi (9.04 dk), B grubundaki hastalara göre anlamlı olarak yüksekti (5.07 dk) (p=0.000). Sonuç: Deksmedetomidin, FESS sırasında kontrollü hipotansiyon ile kan kaybını azaltan, daha iyi sedatif ve analjezik özellikler ile ideal cerrahi alan sağlayan optimal etkili bir ajandır.

Effectiveness of Dexmedetomidine for Controlled Hypotension in Providing Optimum Surgical Conditions for Functional Endoscopic Sinus Surgeries: A Double-Blinded Randomized Controlled Trial

Objective: Bleeding resulting in impaired intraoperative visibility and increased risk of injury tovital structures such as optic nerve and internal carotid artery requires effective control withcontrolled hypotension during functional endoscopic sinus surgeries. Our aim in this study is toassess the effectiveness of dexmedetomidine in reducing blood loss during functional endoscopicsinus surgeries (FESS) when it is used for controlled hypotension.Method: Ninety-two American Society of Anesthsiologists - ASA class I and II patients of comparable demographic profile, scheduled for elective FESS received either injectable dexmedetomidine (1 μk g hr-1) for the first 10 minutes and then 0.5 μ kg hr-1 as infusion (Group A) or equalvolume of saline infusion (Group B). The hemodynamic changes, utilization of intraoperativerescue medication, intraoperative blood loss, emergence time, postoperative sedation and painscores were recorded.Results: Patients in the dexmedetomidine group had a remarkable reduction in blood loss(p=0.000) with lesser intraoperative mean arterial blood pressure, heart rate, better sedation andpain scores postoperatively. The mean intraoperative rescue medication consumption wasremarkably higher in patients of group B. Extubation time in group A patients was significantlyhigher (9.04 minutes) than in group B patients (5.07 minutes) (p=0.000).Conclusion: Dexmedetomidine is an optimal effective agent that reduces blood loss by controlledhypotension during FESS providing ideal surgical field with better sedative and analgesic properties

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