EFFECT OF DEXMEDETOMIDINE ON BLEEDING DURING ENDOSCOPIC NASAL SURGERY: A DOUBLE BLIND, RANDOMIZED, CLINICAL STUDY
Indira Kumari, M.D., *Sandeep Sharma, M.D., Karthik Surendran, M.D., Udita Naithani, M.D., Shekhar Suman Saxena, M.B.B.S. and Ravish Yadav, M.B.B.S.
Background and Aims: In Functional Endoscopic Sinus Surgery (FESS), hypotensive anaesthesia is becoming increasingly popular now a days. This study evaluated the effect of Dexmedetomidine in minimising surgical blood loss, on intraoperative haemodynamics as well as its effect on reducing isoflurane requirement during FESS. Material and Methods: in this study 48 patients undergoing FESS were divided into two groups. Group C / Control Group (n=24) received bolus of 100 ml normal saline over 10 mins followed by placebo infusion @ 0.2 mcg/kg/hr whereas Group D / Dexmedetomidine Group (n=24) received dexmedetomidine as a loading dose of 1mcg/kg over 10 min followed by maintenance infusion of 0.2 mcg/kg/hr. The Primary outcome measure was to see the efficacy of dexmedetomidine in providing bloodless surgical field in terms of bleeding score whereas secondary outcome measures were its effect on haemodynamic variables as well as reduction in dose requirements of isoflurane. The qualitative data was presented as number (Proportion) and compared with Chi square test. Quantitative variables were expressed as mean +/- standard deviation and were compared using students ‘f’ test. The statistical analysis of data was performed with MS Excel, SPSS 16.0. Results: The mean bleeding score was significantly lower in dexmedetomidine group as compared to control group(0.47 +/- 0.5 v/s 1.02 +/- 0.51 , P < 0.05). The MAP were statistically comparable intraoperatively in both the groups whereas heart rate decreased significantly in group D (p < 0.05) from 30 to 120 mins intraoperatively. The mean overall requirement of isoflurane concentration (vol %) was significantly lower in Group D as compared to Group C (0.43 +/ - 0.19 v/s 0.92 +/- 0.23, P= 0.004). Conclusion: Controlled hypotension with Dexmedetomidine provided a bloodless surgical field for Endoscopic Sinus Surgeries as well as provide optimal intraoperative hemodynamics. It also reduced the requirement of isoflurane to produce controlled hypotension resulting in lesser sedation, faster recovery and discharge from post anaesthesia care unit.
Keywords: Endoscopic Sinus Surgery, Dexmedetomidine, Controlled Hypotension, Bleeding Score.
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