Oral clonidine: an effective adjuvant in functional endoscopic sinus surgery

Authors

  • Amit Kumar Ray Department of Anaesthesiology and Critical Care Medicine, R.G. Kar Medical College. Kolkata, West Bengal, India
  • Anjana Basu Ghosh Dastidar Department of Anaesthesiology and Critical Care Medicine, R.G. Kar Medical College. Kolkata, West Bengal, India
  • Bani P. M. Hembrom Department of Anaesthesiology, Midnapore Medical College, Midnapore, West Bengal, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20174779

Keywords:

Controlled hypotension, Dexmedetomidine, Nasal endoscopic surgery, Oral clonidine

Abstract

Background: A comparative study to evaluate the efficacy of intravenous Dexmedetomidine as a hypotensive agent in comparison to oral Clonidine in Endoscopic Nasal Surgery or Functional Endoscopic Sinus Surgery (FESS).

Methods: Forty patients ASA I or II scheduled for Endoscopic Nasal Surgery were equally randomly assigned to receive either dexmedetomidine 1μg/Kg over 10 min before induction of anesthesia followed by 0.5μg/Kg/h infusion during maintenance (Group D), or oral Clonidine (Group C) 2µg/kg with minimal water 1 hour prior starting of surgery. Rescue bolus doses of Propofol (10mg/dose) were given to maintain mean arterial blood pressure (MAP) between (50-70mmHg). General anesthesia was maintained with Isoflurane 1%-2%. The surgical field was assessed using Average Category Scale. Hemodynamic variables (MAP and HR) were recorded at 10 minutes interval.

Results: Both group C and group D reached the desired MAP (50-70mmHg) with no intergroup differences in HR but a statistically significant lower MAP was noticed in group C. The quality of the surgical field in the range of MAP (50-70mmHg) were 2-3 as per average category Scale with significantly lower score in Group C. Mean intraoperative propofol consumption was significantly higher in group D than C group.

Conclusions: Both Dexmedetomidine or oral clonidine with isoflurane are safe agents for controlled hypotension, but oral clonidine provides lower MAP and better surgical field. Compared with Dexmedetomidine, oral clonidine offers the advantage of less consumption of propofol.

References

Mohseni M, Ebneshahidi A. The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial. J Anesth. 2011;25:614-7.

Ahn HJ, Chung SK, Dhong HJ, Kim HY. Comparison of surgical conditions during propofol or sevoflurane anesthesia for endoscopic sinus surgery. Br J Anaesthesia. 2008;100:50-4.

Schmelling WT, Kampine JP, Roerig DL, Warltier DC. The effect of the stereoisomers of the α2‑adrenergic agonist dexmedetomidine on systemic and coronary haemodynamics in conscious dogs. Anesthesiology. 1991;75:499‑511.

Fromme GA, MacKenzie RA, Gould AB Jr, Lund BA, Offord KP. Controlled hypotension for orthognatic surgery. Anesth Analg. 1986;65:683-6.

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.

Cincikas D, Ivaskevicius S. Application of controlled arterial hypotension in endoscopic rhino -surgery. Medicina (Kaunas). 2003;39:852-9.

Langer SZ. Presynaptic regulation of the release of catecholamines. Pharmacol Rev. 1980;32:337-62.

McCallum JB, Boban N, Hogan Q, Schmeling WT, Kampine JP, Bosnjak ZJ. The mechanism of alpha-2 adrenergic inhibition of sympathetic ganglionic transmission Anesth Analg. 1998;87:503-10.

Sies´kiewicz 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. 2010;64(4):225-8.

Boezzart AP, van der Merve J, Coetzee A. Comparison of sodium nitroprusside and esmolol induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42:373-6.

Nair S, Collins M, Hung P, Rees G, Close D, Wormald PJ. The Effect of β‐Blocker Premedication on the Surgical Field During Endoscopic Sinus Surgery. The Laryngoscope. 2004 Jun 1;114(6):1042-6.

Simpson P. Perioperative blood loss and its reduction: the role of the anaesthetist. BJA: British Journal of Anaesthesia. 1992 Nov 1;69(5):498-507.

Hall DL, Rezvan E, Tatakis DN, Walters JD. Oral clonidine pretreatment prior to venous cannulation. Anesthesia progress. 2006 Jun;53(2):34-42.

Kamibayashi T, Maze M. Perioperative use of alfa-2 adrenergic agonists. Curr Opin Anaesth. 1996;9:323-7.

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Published

2017-10-25

How to Cite

Ray, A. K., Ghosh Dastidar, A. B., & Hembrom, B. P. M. (2017). Oral clonidine: an effective adjuvant in functional endoscopic sinus surgery. International Journal of Basic & Clinical Pharmacology, 6(11), 2631–2634. https://doi.org/10.18203/2319-2003.ijbcp20174779

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Original Research Articles