Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2014.01.008
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: randomized clinical study

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Akcan Akkaya; Umit Yasar Tekelioglu; Abdullah Demirhan; Murat Bilgi; Isa Yildiz; Tayfun Apuhan; Hasan Kocoglu

http://dx.doi.org/10.1016/j.bjane.2014.01.008 Braz J Anesthesiol, vol.64, n6, p.406-412, 2014
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Abstract

Background and objectives: Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. Method: 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50 mg kg−1 over 10 min and maintained at 15 mg kg−1 h−1; in Group D, dexmedetomidine was given at 1 mcg kg−1 10 min before induction and maintained at 0.6 mcg kg−1 h−1. Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. Results: Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. Conclusions: Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

Keywords

Endoscopic sinus surgery, Magnesium, Dexmedetomidine, Hypotension

Resumo

Justificativa e objetivo: Uma quantidade, mesmo pequena, de sangramento durante a cirurgia endoscópica pode alterar o campo endoscópico e dificultar o procedimento. Várias técnicas, incluindo hipotensão induzida, podem minimizar o sangramento durante a cirurgia endoscópica. O objetivo deste estudo foi comparar a qualidade da visibilidade cirúrgica, os parâmetros hemodinâmicos, a dor no período pós-operatório e outros efeitos do sulfato de magnésio, um agente hipotensor, com os da dexmedetomidina, inicialmente desenvolvida para sedação em curto prazo em unidade de terapia intensiva, mas que também é um sedativo agonista alfa-2. Métodos: Foram alocados 60 pacientes entre 18 e 45 anos em dois grupos: Grupo M (magnésio) e Grupo D (dexmedetomidina). No Grupo M, sulfato de magnésio foi administrado pré-indução a uma dose de carga de 50 mg kg−1 por 10 minutos e mantida com 15 mg kg−1 h−1; no Grupo D, dexmedetomidina foi administrada a uma dose de 1 mcg kg−1 10 minutos antes da indução e mantida com 0,6 mcg kg−1 h−1. No período intraoperatório, foram registrados os parâmetros hemodinâmicos e respiratórios e a avaliação do campo cirúrgico com uma escala de seis pontos. Durante o período pós-operatório foram registrados os valores da escala numérica de 11 pontos para avaliar a dor, a escala de sedação de Ramsay, a escala de avaliação de náusea/vômito, o perfil dos efeitos adversos e pruridos. Resultados: O Grupo D apresentou redução significativa da frequência cardíaca e do escore na escala de avaliação do campo cirúrgico intraoperatório. A média do tempo cirúrgico foi de 50 minutos e o Grupo M apresentou um número maior de cirurgias prolongadas. Não houve diferença significativa em outros parâmetros. Conclusão: Por causa da reducção da taxa de sangramento e da frequência cardíaca em cirurgia endoscópica e dos impactos positivos sobre a duração da cirurgia, consideramos dexmedetomidina como melhor opção que o sulfato de magnésio

Palavras-chave

Cirurgia endoscópica sinusal, Sulfato de Magnésio, Dexmedetomidina, Hipotensão

References

Drozdowski A, Sieskiewicz A, Siemiatkowski A. Reduction of intraoperative bleeding during functional endoscopic sinus surgery. Anaesthesiol Intensive Ther. ;XLIII:47-43.

Milonski J, Zielinska-Blizniewska H, Golusinski W. Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. ;270:2050-2045.

Sieskiewicz A, Olszewska E, Rogowski M. Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: a preliminary investigation. Ann Otol Rhinol Laryngol. ;115:494-490.

Kastl KG, Betz CS, Siedek V. Control of bleeding following functional endoscopic sinus surgery using carboxy-methylated cellulose packing. Eur Arch Otorhinolaryngol. ;266:1243-1239.

Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. ;96:731-727.

Na HS, Chung YH, Hwang JW. Effects of magnesium sulphate on postoperative coagulation, measured by rotational thromboelastometry. Anaesthesia. ;67:869-862.

Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. ;62:133-118.

Richa F, Yazigi A, Sleilaty G. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. ;25:374-369.

Paranjpe J. Dexmedetomidine: expanding role in anesthesia. Med J DY Patil Univ. ;6:13-5.

Goksu S, Arik H, Demiryurek S. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. ;25:28-22.

Guven DG, Demiraran Y, Sezen G. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. ;120:586-592.

Ayoglu H, Yapakci O, Ugur MB. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth. ;20:437-441.

Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nursing. ;14:804-798.

Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. ;42:373-376.

Pavlin JD, Colley PS, Weymuller EA. Propofol versus isoflurane for endoscopic sinus surgery. Am J Otolaryngol. ;20:101-96.

Manola M, De Luca E, Moscillo L. Using remifen-tanil and sufentanil in functional endoscopic sinus surgery to improve surgical conditions. ORL J Otorhinolaryngol Relat Spec. ;67:83-86.

Albu S, Gocea A, Mitre I. Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngol Head Neck Surg. ;143:573-578.

Beule AG, Wilhelmi F, Kuhnel TS. Propofol versus sevoflu-rane: bleeding in endoscopic sinus surgery. Otolaryngol Head Neck Surg. ;136:45-50.

Ko S. Does choice of anesthetics affect intraoperative blood loss?. Korean J Anesthesiol. ;63:296-295.

Boonmak S, Boonmak P, Laopaiboon M. Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS). Cochrane Database Syst Rev. ;6:CD006623.

Yoo HS, Han JH, Park SW. Comparison of surgical condition in endoscopic sinus surgery using remifentanil combined with propofol, sevoflurane, or desflurane. Korean J Anesthesiol. ;59:382-377.

Abbasi H, Behdad S, Ayatollahi V. Comparison of two doses of tranexamic acid on bleeding and surgery site quality during sinus endoscopy surgery. Adv Clin Exp Med. ;21:780-773.

Atighechi S, Azimi MR, Mirvakili SA. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a preoperative single dose versus a 5-day course of corticosteroid. Eur Arch Otorhinolaryngol. ;270:2454-2451.

Chaaban MR, Baroody FM, Gottlieb O. Blood loss during endoscopic sinus surgery with propofol or sevoflurane: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. ;139:510-514.

Ahn HJ, Chung SK, Dhong HJ. Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anaesth. ;100:54-50.

Blackwell KE, Ross DA, Kapur P. Propofol for maintenance of general anesthesia: a technique to limit blood loss during endoscopic sinus surgery. Am J Otolaryngol. ;14:262-266.

Khosla AJ, Pernas FG, Maeso PA. Meta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery. Int Forum Allergy Rhinol. ;3:487-482.

Sieskiewicz A, Drozdowski A, Rogowski M. The assessment of correlation between mean arterial pressure and intraoperative bleeding during endoscopic sinus surgery in patients with low heart rate. Otolaryngol Pol. ;64:225-228.

Koinig H, Wallner T, Marhofer P. Magnesium sulphate reduces intra- and postoperative analgesic requirements. Anesthesia and analgesia. ;87:210-206.

Crozier TA, Radke J, Weyland A. Haemodynamic and endocrine effects of deliberate hypotension with magnesium sulphate for cerebral-aneurysm surgery. Eur J Anaesthesiol. ;8:115-121.

Wang H, Liang QS, Cheng LR. Magnesium sulfate enhances non-depolarizing muscle relaxant vecuronium action at adult muscle-type nicotinic acetylcholine receptor in vitro. Acta Pharmacol Sin. ;32:1454-1459.

Hans GA, Bosenge B, Bonhomme VL. Intravenous magnesium re-establishes neuromuscular block after spontaneous recovery from an intubating dose of rocuronium: a randomised controlled trial. Eur J Anaesthesiol. ;29:99-95.

Sanders GM, Sim KM. Is it feasible to use magnesium sulphate as a hypotensive agent in oral and maxillofacial surgery?. Ann Acad Med Singapore. ;27(6):785-780.

Ji F, Li Z, Nguyen H. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. ;127:1576-1584.

Elcicek K, Tekin M, Kati I. The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth. ;24:548-544.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. ;55:357-352.

Yavascaoglu B, Kaya FN, Baykara M. A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. ;25:519-517.

Jalonen J, Hynynen M, Kuitunen A. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. ;86:345-331.

Gomez-Rivera F, Cattano D, Ramaswamy U. Pilot study comparing total intravenous anesthesia to inhalational anesthesia in endoscopic sinus surgery: novel approach of blood flow quantification. Ann Otol Rhinol Laryngol. ;121:732-725.

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