281 results on '"Hypotensive anesthesia"'
Search Results
52. Induced Hypotension in Functional Endoscopic Sinus Surgery: A Comparative Study of Dexmedetomidine and Esmolol
- Author
-
Laba Kumar Nayak, Partha S Mohapatra, Baladev P Sahu, and Krishna Mishra
- Subjects
Sedation ,Analgesic ,hypotensive anesthesia ,esmolol ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Otolaryngology ,0302 clinical medicine ,Anesthesiology ,medicine ,Dexmedetomidine ,Induced Hypotension ,business.industry ,sedation score ,General Engineering ,dexmedetomidine ,fess ,Functional endoscopic sinus surgery ,emergence time ,hemodynamic stability ,Esmolol ,Blood pressure ,rebound hypertension ,postoperative analgesic demand ,Anesthesia ,Preventive Medicine ,Hemodynamic stability ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction Functional endoscopic sinus surgery (FESS) is one of the common surgical procedures requiring hypotensive anesthesia; many agents have been tried to reduce the amount of blood loss. This study aims at comparing the efficacy of two agents for providing deliberate hypotension. Objectives The aim of this study was to evaluate the efficacy of esmolol and of dexmedetomidine and compare which one of the two is a better agent to produce induced hypotension during FESS. Materials and methods This was a comparative study conducted in a tertiary care hospital in Odisha, India. There were two study groups with 30 participants each who were given either esmolol or dexmedetomidine (group E and group DEX, respectively). Results Esmolol is an anti-hypertensive agent with better hemodynamic stability. The amount of drug and dose requirement was low in group DEX. The emergence time, sedation score, and time to first analgesic request were found to be highly statistically significant in group DEX. Conclusion Dexmedetomidine was found to be a better agent at controlling intra-operative blood pressure than esmolol and had beneficial effects on recovery from anesthesia and analgesia.
- Published
- 2021
53. The use of peripheral perfusion index as a predictor for patient’s response to deliberate hypotension during functional endoscopic sinus surgery. A prospective observational study
- Author
-
S. Abdullah, Ahmed Mukhtar, Neamat I. Abdel rahman, Abeer Ahmed, and Mohamed Abdulatif
- Subjects
Anesthesiology and Pain Medicine ,Peripheral perfusion ,Hypotensive anesthesia ,business.industry ,Anesthesia ,Medicine ,Observational study ,sense organs ,Functional endoscopic sinus surgery ,skin and connective tissue diseases ,business ,Vasomotor tone - Abstract
Background: Peripheral perfusion index (PPI) reflects changes in the vasomotor tone. The aim of this observational study is to explore the potentials of the PPI as a predictor of the response to ni...
- Published
- 2019
54. Kорелација помеѓу средниот артериски притисок (МАР) и мозочната сатурација (rSO2) кај пациенти подложени на хипотензивна општа анестезија при септо- и ринопластика
- Author
-
Silvana Kraleva, Ivana Klisevska Ilcevska, Radmila Trajkova, and Biljana Shirgoska
- Subjects
Mean arterial pressure ,030309 nutrition & dietetics ,hypotensive anesthesia ,Sevoflurane ,рино/септопластика ,03 medical and health sciences ,Basal (phylogenetics) ,0302 clinical medicine ,хипотензивна анестезија ,мозочна оксигенација ,Medicine ,In patient ,030212 general & internal medicine ,rhinoseptoplasty ,0303 health sciences ,општа анестезија ,business.industry ,brain oxygenation ,General Medicine ,Brain Hypoxia ,general anesthesia ,Hypotensive anesthesia ,Anesthesia ,Anesthetic ,business ,Saturation (chemistry) ,medicine.drug - Abstract
Hypotensive anesthesia is such anesthetic technique where during general anesthesia the patient's mean arterial pressure is decreased by more than 20% of its preoperative value. Motivation: To prevent the occurrence of brain hypoxia during hypotensive anesthesia in patients undergoing septo- and rhinoplastic surgery. Aims: To determine the average values of brain saturation in awaken patients; to find the correlation between the mean arterial pressure and brain saturation during moderate hypotension, and to analyze the adverse reactions postoperatively. Materials and methods: Twenty (ASA 1) patients, anaesthetised in moderate hypotensive general anesthesia with Remifentanyl and Sevoflurane were enrolled in the study. They were observed at five times interval (T1-5): MAP, HR and rSO2, and a correlation between the parameters was determined. Results: A moderate hypotension was achieved in T4 (MAP = 69.05 ± 7.09). The average baseline values of brain saturation from 73.30 ± 5.44% to the left, 75.30 ± 5.18% to the right brain hemisphere were obtained. The curve of brain saturation had an upward trend, a peak that coincided with an introduction to anesthesia, in a further course with a downward trend. We found a mild to moderate positive correlation between MAP and rSO2 during hypotensive anesthesia, but throughout the entire period there was a higher rSO2 than the basal initial value. Conclusion: Moderate hypotension and stable mean arterial pressure (MAP) contribute to stable brain saturation (rSO2)., Хипотензивната анеÑтезија е таква анеÑтезиолошка техника при која Ñредниот артериÑки при- тиÑок на пациентот Ñе намалува за повеќе од 20% од неговата предоперативна вредноÑÑ‚. Мотив: да Ñе Ñпречи појава на хипоокÑија на мозокот при употреба на хипотензивна анеÑтезиолошка техника кај пациенти подложни на Ñепто/риноплаÑтика. Цели на трудот: да Ñе утвр Хипотензивната анестезија е таква анестезиолошка техника при која средниот артериски притисок на пациентот се намалува за повеќе од 20% од неговата предоперативна вредност. Мотив: да се спречи појава на хипооксија на мозокот при употреба на хипотензивна анестезиолошка техника кај пациенти подложни на септо/ринопластика. Цели на трудот: да се утврди просечната вредност на мозочната сатурација кај будни пациенти, да се одреди корелацијата на средниот артериски притисок и мозочната сатурација при умерена хипотензија, и да се анализираат постоперативните несакани ефекти. Материјали и методи: во студијата беа вклучени 20 пациенти, АСА 1, водени со умерена хипотензивна анестезија предизвикана со ремифентанил и севофлуран. Во пет временски интервали (Т1-Т5) се следеа параметрите: MAP, HR, rSO2 и се одреди нивната корелација. Резултати: умерена хипотензија се постигна во Т4 (МАР=69,05±7,09). За просечна базална вредност на мозочната сатурација се утврдија: 73,30 ± 5,44% за левата и 75,30±5,18% за десната мозочна хемисфера. Кривата на мозочната сатурација покажуваше нагорен тренд и пик кој се совпаѓаше со воведот во анестезија, а во понатамошниот тек тенденција кон опаѓање. Се најде слаба до умерена позитивна корелација помеѓу MAP и rSO2 во текот на хипотензивната анестезија, а во целиот тек на мерењето rSO2 беше повисоко од базалната вредност. Заклучок: умерената хипотензија и стабилниот среден артериски притисок придонесуваат за стабилна мозочна сатурација.
- Published
- 2019
55. Induced hypotensive anesthesia by using premedication Atenolol in comparison to intraoperative Nitroglycerin during Functional Endoscopic Sinus Surgery (FESS)
- Author
-
Abdulwadood Yousif, Abdalrahman Talal Mahmoud, and Najm Abdullah Hussein
- Subjects
Hypotensive anesthesia ,business.industry ,Anesthesia ,medicine ,General Materials Science ,Premedication ,Functional endoscopic sinus surgery ,Atenolol ,business ,Nitroglycerin ,medicine.drug - Published
- 2019
56. Comparative Study between Nitroglycerine, Magnesium Sulfate and Dexmedetomidine to Induce Hypotension During Functional Endoscopic Sinus Surgery (FESS).
- Author
-
Fahmy, Adel Mekhael, Salam, Ehab HamedAbdel, Aziz, Mai MohsenAbdel, and Taleb, Egyphillines EmadeldinRizk
- Subjects
- *
MAGNESIUM sulfate , *ENDOSCOPIC surgery , *DEXMEDETOMIDINE , *HYPOTENSION , *DRUG therapy , *INTRAVENOUS anesthesia , *INHALATION anesthesia - Abstract
Background: Functional Endoscopic Sinus Surgery (FESS) has been employed as a surgical intervention to treat chronic rhinosinusitis in patients with no response to drug therapy, during which the surgical vision may be greatly reduced by a small amount of bleeding. There by, the intraoperative controlled hypotension can improve the visibility. While excessive bleeding intraoperative cause serious complications in the postoperative period, including eye socket infections, visual acuity damage, meningeal infections, and other. Objective: Induced hypotension limits intra operative (IO) blood loss provides better visibility of the surgical field and diminishes the incidence of major complications during Functional Endoscopic Sinus Surgery (FESS). We aimed at comparing Nitroglycerine; Magnesium Sulfate and Dexmedetomidine for inducing controlled hypotension and evaluate narcotic used, mac of inhalational anesthesia, and Ramsay Sedation Scale (RSS) in the recovery and pre-anesthetic time in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Patients and Methods: This study was conducted on 75 patients who underwent elective functional endoscopic sinus surgery (FESS) who matched the inclusion criteria and were randomly allocated into 3 groups each containing 25 patients. The first group received loading dose of dexmedetomidine 1lg/kg infused over 10 min before induction of anesthesia then 0.7 lg/ kg/h via syringe pump, second group received nitroglycerine infusion at a dose of 2lg/kg/min according to the response started after induction, intubation, positioning and sterilization of the patient and third group received a loading dose of magnesium sulfate 40 mg/kg over 10 minutes followed by an infusion 15mg/kg/h via syringe pump. Results: The result of our study showed that dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Conclusion: Dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Dexmedetomidine also showed shorter duration of surgery with less blood loss and favorable frommer score with more surgeon satisfaction. Dexmedetomidine showed longest time to 1st analgesic rescue in PACU comparing with magnesium sulfate and nitroglycerine. So, it’s advised to use dexmedetomidine to induce hypotension than magnesium sulfate and nitroglycerine. However, dexmedetomidine should be used with caution as it caused hypotension and bradycardia, t had sedative effect with low aldert score comparing with nitroglycerine and magnesium sulfate. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
57. Cost Effective Technique of Shoulder Arthroscopy Without the Use of Epinephrine in Irrigation Solution
- Author
-
Brian Chung, Samuel Polinsky, William B. Stetson, Stephanie A. Morgan, and Nicole J. Hung
- Subjects
Blood pressure control ,Orthopedic surgery ,030222 orthopedics ,Shoulder arthroscopy ,medicine.medical_specialty ,business.industry ,030229 sport sciences ,Arthroscopic procedure ,Cost savings ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Epinephrine ,Hypotensive anesthesia ,medicine ,Technical Note ,Orthopedics and Sports Medicine ,Shoulder joint ,Inflow cannula ,business ,RD701-811 ,medicine.drug - Abstract
Arthroscopic surgery of the shoulder joint and the subacromial space requires adequate visualization to be effectively performed. Visual clarity is essential to perform a safe and successful arthroscopic procedure. The major determinants to provide visualization in the subacromial space and the glenohumeral joint include adequate inflow (dependent on the dimension of the inflow cannula), flow rate versus pressure, pump system versus gravity, the use of electrocautery and radiofrequency devices, blood pressure control and hypotensive anesthesia, and the type of irrigation solution used with or without the use of epinephrine. In 2012, the cost of a 30-mL (30-mg) vial of epinephrine was $6 (adrenalin/epinephrine injection, USP, Par Pharmaceuticals), and approximately 3 to 4 bottles would be used on average for a single shoulder arthroscopy. In 2019, the same 30-mL bottle of epinephrine cost $237, a nearly 40-fold increase. The purpose of our study is to describe the various factors and techniques that can be used to maintain visual clarity in shoulder arthroscopy without the use of epinephrine in the irrigation solution and the cost savings associated without the use of epinephrine., Technique Video Video 1 Shoulder arthroscopy requires adequate visualization to be effectively performed. Visual clarity is essential to perform a safe arthroscopic shoulder procedure. In particular, bleeding in the subacromial space and the glenohumeral joint is an ever-present impediment to visualization. The major determinants to provide visualization are shown in this video. A couple of the key determinants include adequate inflow, flow rate versus pressure, the type of pump system used, and most importantly, blood pressure control and hypotensive anesthesia, along with the irrigation solution with or without the use of epinephrine. Visualization requires a properly functioning optical system of an arthroscopic lens, camera, and video equipment. Adequate joint distension is maintained by a pump system that delivers and maintains a clear medium into the joint. A pump pressure of 40 mm Hg is recommended as long as the systolic blood pressure is near 90 mm Hg, which provides adequate hydrostatic pressure on the capillaries to decrease bleeding. A proper arthroscopic cannula system is also key for shoulder arthroscopy. We recommend a 5.5-mm × 8.5-cm “J-lock” metal cannula system made by Smith and Nephew/Dyonics. The 5.5-mm cannula system provides an adequate inflow and flow rate through the arthroscope for adequate joint distension. With 3 portals being established, there is often no cannula placed in the anterior portal. This can sometimes lead to fluid outflow through this portal leading to bubbles or loss of visualization described as the Bernoulli Effect. Burkhart et al.3 described having his assistant place his finger over the portal. However, we recommend placing either a plastic or metal obturator into the portal to reduce or eliminate this effect. First, we demonstrate arthroscopic visualization of the glenohumeral joint in the lateral decubitus position, which we prefer. Again, we have adequate visualization viewing from posterior to anterior. The anterior-superior portal is hooked up to outflow, which is controlled by a clamp, and not to suction. Next, we visualize the subacromial space viewing from posterior to anterior. The shaver is placed through the anterior-superior portal, visualizing the rotator cuff and bursa down below. Adequate visualization is required, of course, in the subacromial space. Key is hypotensive anesthesia and the judicious use of the shaver versus the radiofrequency device to control bleeding. In 2012, the cost of a 30-mL vial of epinephrine was only $6. Seven years later, in 2019, that same 30-mL vial of epinephrine now costs $237. That is approximately a 390% increase in price over the past 7 years. Three or 4 bottles may be used during shoulder arthroscopy. We therefore discontinued the use of epinephrine in shoulder arthroscopy, saving over $900 per case, sometimes more depending on the duration of the case and number of vials used. Using the techniques described, we have found no problems with adequate visualization with shoulder arthroscopy, without the use of epinephrine. Attention to detail in all aspects of the surgical procedure is key in maintaining visual clarity.
- Published
- 2021
58. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery.
- Author
-
Kentaro Yamada, Yuichiro Abe, Shigenobu Satoh, Yasushi Yanagibashi, Takahiko Hyakumachi, and Takeshi Masuda
- Subjects
- *
EXTUBATION , *EPIDURAL abscess , *SPINAL cord abnormalities , *POSTOPERATIVE care , *OBESITY risk factors , *THERAPEUTICS - Abstract
Study Design. Matched case-control study. Objective. To identify factors other than a multilevel procedure that increase the risk of symptomatic postoperative spinal epidural hematoma (SEH). Summary of Background Data. Postoperative SEH is a potentially devastating complication of spinal surgery. Previous studies that reported risk factors for postoperative SEH all identified a multilevel procedure as a risk factor, but the other risk factors remain unclear. Methods. Patients who developed postoperative SEH requiring surgical evacuation were identified from database. Each patient was matched with 3 controls who underwent spinal decompression at the same number of levels in the same part of the spine by the same surgeon during the preceding or following year. Multiple logistic regression analysis was performed to identify the risk factors for postoperative SEH to obtain adjusted odds ratios with 95% confidence intervals. Clinical outcomes after evacuation were investigated separately divided with or without severe paralysis or time until the second surgery. Results. Postoperative SEH evacuation was performed after 32 of 8250 (0.39%) spinal decompression procedures. The incidence was significantly higher after thoracic procedures (2.41%) than after cervical (0.21%) or lumbar (0.39%) procedures. Multivariate analysis identified a 50 mm Hg or greater increase in systolic blood pressure after extubation (adjusted odds ratio: 3.22, 95% confidence interval: 1.22-8.51) and higher body mass index (adjusted odds ratio 1.15, 95% confidence interval: 1.01-1.31) as risk factors. Among 14 patients with severe paralysis due to postoperative SEH, those who underwent evacuation within 24 hours of the onset had a significantly better improvement in clinical outcome and Frankel grade than did those after 24 hours. Conclusion. A 50 mm Hg or greater increase in systolic blood pressure after extubation and high body mass index were identified as risk factors for SEH. Appropriate blood pressure control especially at the end of surgery is important for the prevention of postoperative SEH, particularly in obese patients. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
59. A comparison between nitroprusside and nitroglycerine for hypotensive anesthesia in ear, nose, and throat surgeries: A double-blind randomized study.
- Author
-
Mishra, Abhishek, Singh, Raj Bahadur, Choubey, Sanjay, Tripathi, Rajni K., and Sarkar, Arindam
- Subjects
- *
ANESTHESIA , *SODIUM nitroferricyanide , *ANESTHESIOLOGISTS , *THROAT surgery , *HYPOTENSION - Abstract
Context: Blood obscures the operative field and makes precise technique difficult, and to the anesthetist, when the volume of blood lost is large. Practice of induced hypotension in the otolaryngology is a common practice owing to its benefits in providing a better visibility and preventing blood loss. Aims: The aim was to compare controlled induced hypotension for facilitating surgical exposure, and reducing intraoperative blood loss using sodium nitroprusside and nitroglycerin in ear, nose, and throat surgeries under general anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: The study was carried out in 60 adults, American Society of Anesthesiologists grade I and II patients, allocated randomly in to three groups: group A was control group, group B patients received nitroprusside (0.5-10 µg/kg/min) and group C patients received nitroglycerine (1-10 µg/kg/min). Mean arterial pressure was maintained in the range of 50-60 mmHg. Statistical Analysis Used: Statistical Package for Social Sciences version 17.0 (ANOVA) followed by independent samples t-test and Chi-square test. Results: The results of the present study indicate that the use of controlled hypotension provides a better surgical field and reduces the blood loss. Of the two modalities under question, use of sodium nitroprusside gives the desired results in a significantly, shorter time as compared to nitroglycerin; however, the use of sodium nitroprusside must be carried out with caution as it has toxic effects. Conclusions: (1) The achievement of target level was quicker in sodium nitroprusside group as compared to nitroglycerin group. (2) Reflex tachycardia was the main side effect of the nitroglycerin group. (3) Rebound hypertension was the associated side effect of the sodium nitroprusside group. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
60. Comparative Study of Blood Loss, Quality of Surgical Field and Duration of Surgery in Maxillofacial Cases with and without Hypotensive Anesthesia.
- Author
-
Prasant, M C, Kar, Sanjay, Rastogi, Saurabh, Hada, Pratiksha, Ali, Fareedi Mukram, and Mudhol, Anupama
- Subjects
MAXILLOFACIAL surgery ,ANESTHESIA ,HYPOTENSION ,BLOOD loss estimation ,COMPARATIVE studies - Abstract
Background: Oral and maxillofacial surgeons are concern about the intraoperative bleeding because blood supply to face is very generous. Increased blood loss may lead to the need for transfusion of blood and blood products and hence patients are exposed to the risks associated with it. Hence, this study was undertaken to compare whether there is any significant difference in blood loss, surgical field and duration of surgery in patients undergoing maxillofacial surgeries with and without hypotensive anesthesia. Materials and Methods: The study was conducted on patients undergoing various maxillofacial surgeries. The patients were randomly divided into two groups, the study group and the control group. In the study group patients, induced hypotension was used in order to maintain systolic pressure of 80-90 mm Hg. In the control group patients, normotensive anesthesia was used. Estimation of blood loss (EBS), quality of the surgical field and duration of surgery was calculated for both groups in three types of surgical procedures. Statistical analysis was performed by using two-tailed Pearson correlation test. Results: EBS was found to be significantly less in all the surgical procedures carried out under hypotensive anesthesia (P < 0.05). The quality of the surgical field was better in cases with induced hypotension, but there was no significant difference in duration of the procedures with and without induced hypotension. Conclusion: Our study shows that hypotensive anesthesia can be safely used in almost all maxillofacial surgical procedures with reduced blood loss and improved surgical field. [ABSTRACT FROM AUTHOR]
- Published
- 2014
61. Controlled hypotension during neuraxial anesthesia is not associated with increased odds of in-hospital common severe medical complications in patients undergoing elective primary total hip arthroplasty - A retrospective case control study
- Author
-
Alejandro Gonzalez Della Valle, Meghan A. Kirksey, Jiabin Liu, Jacques T. YaDeau, Huong T. Do, Haoyan Zhong, and Danya DeMeo
- Subjects
Male ,Databases, Factual ,Arthroplasty, Replacement, Hip ,Myocardial Infarction ,Blood Pressure ,Total Hip Arthroplasty ,Hypotension, Controlled ,Vascular Medicine ,0302 clinical medicine ,Postoperative Complications ,030202 anesthesiology ,Anesthesiology ,Medicine and Health Sciences ,Anesthesia ,Myocardial infarction ,Stroke ,Aged, 80 and over ,030222 orthopedics ,Multidisciplinary ,Pharmaceutics ,Acute kidney injury ,Middle Aged ,Hospitals ,Treatment Outcome ,Elective Surgical Procedures ,Medicine ,Female ,Hypotension ,Anatomy ,Research Article ,Mean arterial pressure ,Science ,Cardiology ,Surgical and Invasive Medical Procedures ,Odds ,Arthroplasty ,03 medical and health sciences ,Musculoskeletal System Procedures ,Drug Therapy ,Hypotensive Anesthesia ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Case-control study ,Biology and Life Sciences ,Kidneys ,Odds ratio ,Renal System ,medicine.disease ,Blood pressure ,Case-Control Studies ,business - Abstract
Introduction The use of controlled hypotension during neuraxial anesthesia for joint arthroplasty is controversial. We conducted a large institutional database analysis to assess common in-hospital complications and mortality of patients undergoing primary total hip arthroplasty (THA) under controlled hypotension and neuraxial anesthesia. Methods We conducted a large retrospective case control study of 11,292 patients who underwent primary THA using neuraxial anesthesia between March 2016 and May 2019 in a single institution devoted to musculoskeletal care. The degree and duration of various mean arterial pressure (MAP) thresholds were analyzed for adjusted odds ratios with composite common severe complications (in-hospital myocardial infarction, stroke, and/or acute kidney injury) as the primary outcome. Results Sixty-eight patients developed common severe complications (0.60%). Patients with complications were older (median age 75.6 vs 64.0 years) and had a higher American Society of Anesthesiologists (ASA) classification (45.6% vs 17.6% ASA III). The duration of hypotension at various MAP thresholds (45 to 70 mm Hg) was not associated with increasing odds of common severe medical complications. Conclusions Controlled hypotension (ranging from 45 to 70 mmHg) for a moderate duration during neuraxial anesthesia was not associated with increased odds of common severe complications (myocardial infarction, stroke, and/or acute kidney injury) among patients receiving neuraxial anesthesia for elective THA.
- Published
- 2021
62. Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties
- Author
-
Ozlem Celebi Erdivanli, Ozcan Erel, Zerrin Özergin Coşkun, Salim Neselioglu, Başar Erdivanlı, Medeni Arpa, Sule Batcik, İlkay Bahçeci, Leyla Kazancıoğlu, Hizir Kazdal, RTEÜ, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Kazancıoğlu, Leyla, Batçık, Şule, Arpa, Medeni, Erdivanlı, Başar, Özergin Coşkun, Zerrin, Erdivanlı, Özlem Coşkun, Bahçeci, İlkay, and Kazdal, Hızır
- Subjects
Adult ,Surgical stress ,Adolescent ,medicine.medical_treatment ,Total intravenous anesthesia ,Pilot Projects ,Young Adult ,Humans ,Medicine ,Homeostasis ,Anesthesia ,In patient ,General anaesthesia ,Disulfides ,Sulfhydryl Compounds ,Adverse effect ,Orthognathic surgery ,Balance (ability) ,chemistry.chemical_classification ,business.industry ,General Medicine ,Middle Aged ,Blood-loss ,Septoplasty ,Oxidative Stress ,chemistry ,Hypotensive anesthesia ,Oxidative stress ,Thiol ,Female ,business - Abstract
Objective: We aimed to investigate the effects of hypotensive anesthesia on oxidative stress with serum thiol/disulfide balance in patients undergoing elective septoplasty procedures under general anesthesia. Methods: Seventy-two patients between the ages of 18-60, with a physical condition I –II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anesthesia, patients were divided into the groups as Hypotensive Anesthesia (n = 40) and Normotensive Anesthesia (n = 32). Serum thiol/disulfide levels were measured by the method developed by Erel & Neşelioğlu. Results: The native thiol and total thiol values of both groups measured at the 60th minute intraoperatively were significantly lower than the preoperative values (both p < 0.01). Intraoperatively, at the 60th minute, there was no significant difference in terms of post-native thiol and post-total thiol levels between hypotensive and normotensive anesthesia groups (p = 0.68, and p = 0.81, respectively). Age > 40 years and female gender were found to have a significant effect on dynamic oxidative stress (p = 0.002, and p = 0.001, respectively). Conclusion: This pilot study has found that hypotensive anesthesia had no adverse effect on dynamic thiol/disulfide balance in elective surgeries.
- Published
- 2021
63. The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study
- Author
-
Doaa Abu Elkassim Rashwan, Samaa A. Kasem, and Mahmoud Hussein Bahr
- Subjects
Esmolol ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Postoperative Cognitive Dysfunction ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Blood pressure ,Hypotensive Anesthesia ,030202 anesthesiology ,Anesthesiology ,Anesthesia ,Anesthetic ,Heart rate ,medicine ,030212 general & internal medicine ,Dexmedetomidine ,business ,Postoperative cognitive dysfunction ,Research Article ,medicine.drug - Abstract
Objectives: Postoperative cognitive dysfunction (POCD) is multifactorial, which may be caused by anesthetic and surgical causes or cerebral injury. This study aimed to evaluate the effect of dexmedetomidine as a neuroprotective drug compared to esmolol on the prevalence of POCD in adult patients undergoing middle ear surgeries under hypotensive anesthesia. Methods: This study included male and female adult patients, according to American Society of Anesthesiology physical status (ASA) I, the patients who underwent middle ear surgeries under hypotensive anesthesia were randomly assigned to two groups that received esmolol and dexmedetomidine. The demographic data, heart rate, mean arterial blood pressure, duration of the surgery, evaluation of the surgical field, and the Mini-Mental State Examination (MMSE) (preoperatively and at 1, 6 and 24 hours postoperatively) were recorded. Results: There was a significant difference between the numbers of patients who had POCD in MMSE1: 12 cases in the esmolol group (41.37%) compared to three cases in the dexmedetomidine group (10.34%) (P = 0.016), in MMSE6: 10 cases in the esmolol group (34.48%) compared with two cases in the dexmedetomidine group (6.89%) (P = 0.023) and in MMSE24: seven cases in the esmolol group (24.13%) compared with one case in the dexmedetomidine group (3.44%) (P = 0.022), while the median and range of MMSE score were comparable between the two groups (P > 0.05). Conclusions: This study suggests that intraoperative use of dexmedetomidine as an adjuvant to hypotensive anesthesia reduces the incidence of POCD compared to esmolol.
- Published
- 2020
64. The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty
- Author
-
Enrique A. Goytizolo, Tom Schmidt-Braekling, Wenzel Waldstein, Nigel E. Sharrock, and Friedrich Boettner
- Subjects
Mean arterial pressure ,total knee arthroplasty ,Joint replacement ,medicine.medical_treatment ,lcsh:Medicine ,hypotensive anesthesia ,Hemoglobin levels ,Article ,03 medical and health sciences ,0302 clinical medicine ,Heart rate ,medicine ,hemoglobin levels ,030222 orthopedics ,Tourniquet ,business.industry ,lcsh:R ,030229 sport sciences ,General Medicine ,Perioperative ,Blood pressure ,blood transfusions ,Anesthesia ,Hemoglobin ,business ,blood-saving modality - Abstract
Introduction: Hypotensive epidural anesthesia (HEA) is used in total joint arthroplasty as a safe and effective blood-saving modality. In order to maintain the blood pressure and heart rate patients, receive 1000 to 1500 mL of lactated Ringer&rsquo, s solution during surgery. While HEA reduces the intraoperative blood loss, the effect of intravenous fluid loading on hemoglobin levels is not fully understood. The current study investigates the effect of HEA on perioperative hemoglobin levels. Materials and Methods: The study included 35 patients operated on by a single surgeon undergoing primary total knee arthroplasty under HEA. Intraoperatively, at least 300 mL of intravenous fluid were given every 15 min over the first 60 min after HEA. Blood samples were drawn before entering the operating room, after HEA, as well as after inflation of the tourniquet, every 15 min thereafter, as well as in the recovery room and on postoperative days one and two. In addition, fluid in- and outtake was recorded. Results: Patients received a mean 1275 mL during the 60 min of tourniquet time. The mean arterial pressure (MAP) 5 min after HEA dropped to 60 mmHg and reached a constant level of around 58 mmHg 15 min after HEA. The average hemoglobin level dropped from 13.9 g/dL prior to HEA, to 12.5 g/dL immediately after HEA (p <, 0.001). Intraoperatively the hemoglobin level dropped further and reached 11.8 g/dL at 60 min in the absence of blood loss. Conclusions: Hypotensive epidural anesthesia and the resulting fluid substitution resulted in an average hemoglobin drop of 2.1 g/dL within the first 60 min. This needs to be taken into account when evaluating the need for blood transfusions after primary joint replacement surgery under HEA.
- Published
- 2020
65. Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients.
- Author
-
Al-Sebaei, Maisa O
- Subjects
- *
BLOOD transfusion , *FEAR of blood , *BLOOD viscosity , *BLOOD loss estimation , *OSTEOTOMY - Abstract
Background Patients undergoing orthognathic procedures can require blood transfusions. The objectives of this study were to evaluate the predictors of intra-operative blood loss in patients undergoing orthognathic procedures and the transfusion rates and practices of our institution. Materials and methods This retrospective study included 92 patients who underwent the following four types of orthognathic procedures: Group 1, bimaxillary; Group 2, bimaxillary with bone grafts; Group 3, LeFort I osteotomies; and Group 4, LeFort I osteotomies with bone grafts. The intraoperative blood loss, operative time, age, gender and pre- and post-operative HGB and HCT were assessed. Results The mean blood loss for all groups was 650 ± 397.8 mL, and there were differences in blood loss between the four groups (p = 0.211). The mean operative time was 5 hours and 32 minutes. There were no differences in intra-operative blood loss between the genders or the BMI categories. The operative time was moderately correlated with the intra-operative blood loss (p < 0.001, r =0.332). Eighteen of the 92 patients (19.5%) received blood transfusions. The mean intra-operative blood loss was higher among the patients who received transfusions (p < 0.001). Conclusions The only predictor of intra-operative blood loss was operative time. The observed transfusion rate was higher than those that have been reported for similar procedures; thus, our institution needs to revisit our transfusion policy and use more time-efficient techniques in the operating room. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
66. Efficacy of different dexmedetomidine regimens in producing controlled hypotensive anesthesia during functional endoscopic sinus surgery.
- Author
-
Abel Rahman, Neamat I., Fouad, Eman A., Ahmed, Abeer, Youness, Abdel Rahman, and Wahib, Michael
- Abstract
Background The study was designed to assess the ability of dexmedetomidine in different regimens to produce controlled hypotensive anesthesia during functional endoscopic sinus surgery in adults and the need to add an additional hypotensive agent in the form of nitroglycerin to achieve the target MAP. Methods In this blinded randomized controlled trail, 45 Patients, aged from 18 to 50 years, ASA physical status I and II, underwent endoscopic sinus surgery were enrolled in the study. Before induction of GA, all patients received bolus dexmedetomidine 1 μ/kg iv more than 10 min. After induction, Patients were randomly allocated into three groups, group Dex-0.4, in which patients received dexmedetomidine infusion as 0.4 μg/kg/h, group Dex-0.8, in which patients received dexmedetomidine infusion as 0.8 μg/kg/h and group Dex-P, in which patients received saline infusion. The target MAP was 55–65 mmHg, if not achieved by the infused study drug, nitroglycerin infusion was added in a titrating manner started with 0.1 μg/kg/min and increased gradually till the target MAP is reached. The surgical field quality was assessed by using Fromme et al. bleeding score. Results The intraoperative MAP in group Dex-P and group Dex-0.8 was maintained within target range at all time intervals. In group Dex-0.4, the MAP showed fluctuation to fall below and increased above the target range at different time intervals. Unlike the other two groups, no nitroglycerin infusion was needed in group Dex-0.8. Fromme et al. bleeding score showed the lowest values in Dex-0.8 group and the highest values in group Dex-0.4. The differences between the three groups were statistically significant with ( P < 0.05). Conclusion Dexmedetomidine as bolus 1 μg/kg iv followed by iv infusion of 0.8 μg/kg/h or dexmedetomidine as pre-induction bolus 1 μg/kg iv followed by nitroglycerine iv infusion significantly decreased the mean arterial blood pressure to target values and provide satisfactory field quality. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
67. The Relationship Between Hypotension, Cerebral Flow, and the Surgical Field During Endoscopic Sinus Surgery.
- Author
-
Ha, Thanh Ngoc, van Renen, Robert Graham, Ludbrook, Guy L., Valentine, Rowan, Ou, Judy, and Wormald, Peter-John
- Abstract
Objectives/Hypothesis: Hypotensive anesthesia is often used in endoscopic sinus surgery (ESS) to improve surgical visibility; however, its safety and efficacy in this role are yet to be justified. This study aimed to evaluate the effect of hypotensive anesthesia on both real-time middle cerebral artery blood flow velocity (Vmca) and the severity of surgical bleeding in patients undergoing ESS. Study Design: Prospective, observational cohort study. Methods: Thirty-two patients undergoing hypotensive anesthesia for ESS at a single tertiary institution during February 2011 to July 2012 were recruited for the study. Transcranial Doppler ultrasonography measured periodic Vmca, which were time-matched for hemodynamic and respiratory factors. One-minute video segments corresponding with each Vmca reading were randomized and distributed to two blinded observers for bleeding assessment. Results: Three hundred and fifty-six data time points were recorded for systolic, diastolic, and mean arterial blood pressure (MAP), pulse rate, respiratory rate, end-tidal carbon dioxide concentration, Vmca, and bleeding assessment score (BAS). A direct relationship exists between MAP and Vmca (r = 0.77, P<.0001) as well as MAP and BAS (r = 0.36, P<.0001). MAP levels above 60 mm Hg maintained at least 50% of baseline Vmca flow in almost 90% of all time points. Conclusions: Hypotensive anesthesia is an effective method of controlling intraoperative bleeding during endoscopic sinus surgery; however the effect is clinically small in low MAP ranges. In otherwise healthy patients undergoing ESS with general anesthesia, reducing MAP to below 60 mm Hg may increase the risk of cerebral ischemia. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
68. Impact of perioperative lidocaine infusion and bis monitorization on remifentanil dosage in hypotensive anesthesia.
- Author
-
UZUN, S., YUCE, Y., ERDEN, A., and AYPAR, U.
- Abstract
BACKGROUND: Combination of local and regional anesthetic agents are widely used in emergency and surgical setting and the interaction between the medications used in general anesthesia and these local and/or regional anesthetic becomes a growing concern in current patient management system. The interaction between general anesthetic agents and the local anesthetic agents given epidurally, spinally, intravenously or intramuscularly and the effects of BIS monitorisation on combined propofol-remifentanil anesthesia are examined in several studies. In literature, there is no research investigating the effect of lidocaine infusion on remifentanil and anesthetic dosage used in hypotensive anesthesia. The aim of this study is to examine this effect. PATIENTS AND METHODS: We studied 39, ASA I-II patients undergoing elective transsphenoidal endoscopic hypophyseal adenoma excision procedure. After preoperative examination and informed consent of the patient, monitorisation with non invasive blood pressure measurement, electrocardiography, pulse oxymeter and Bispectral Index (BIS) was performed. 0.9% NaCl infusion was started via a 20 G route. Lidocaine (1%) was given as 1.5 mg.kg
-1 hour-1 infusion after 1.5 mg.kg-1 bolus dosage given in 10 minutes. Lidocaine infusion was started at the same time with anesthesia induction and was stopped after surgery. 0.9% NaCl was given as bolus dosage and as infusion in control group. Induction was maintained via propofol (1%) with 10 mg (1 ml) doses given in 5 seconds and it was applied in every 15 seconds until BIS < 45'. During maintenance of anesthesia desflurane-remifentaniloxygen (50%)-air (50%) mixture was used. Desflurane was titrated by BIS measurement between 40 and 5012 . Remifentanil infusion was started after propofol induction with 0.1 µg.kg-1 .min-1 dosage and it was titrated between 0.1-0.5 µg.kg-1 .min-1 levels. For intubation, rocuronium with 0.8 mg kg-1 dosage was given during induction. After the surgical procedure, it was antagonised with neostigmine and atropine. For postoperative analgesia 1 g paracetamole was given IV after the surgery within 15 minutes and it was reapplied with 1 gr doses in every 6 hours. After extubation, the pain of the patients was examined at 15. minute at the recovery room with VRS (VRS; 0-no pain, 1-slight pain, 2-moderate pain, 3-severe pain). If VRS was greater than 2, 50 mg dolantine was given IM. For prevention of nausea and vomitting, 8 mg ondansetron was given IV. Perioperative total doses of remifentanil, desflurane (ml) (anesthesia machine records) and lidocaine (mg) were recorded after the surgery. Perioperative hemodynamic parameters (systolic, diastolic, mean blood pressures, heart rates) were recorded after monitorisation (basal), after intubation, after the start of the surgery and after extubation. RESULTS: There were no statistically significant difference between two groups with respect to patient characteristics (age, gender, weight, length, Basal Mass Index = BMI) (p > 0.05). The duration of anesthesia and surgery were also not different statistically (p > 0.05). There were no statistically significant difference between two groups with respect to remifentanil dose (p > 0.05).There were no statistically significant difference between two groups with respect to eye opening and extubation times (p > 0.05). When usage rates and amounts of dolantine, paracetamole and novalgine were compared, we found no statistically significant difference between two groups (p > 0.05). Basal mean arterial blood pressure measurements of the patients and mean arterial blood pressure measurements of the patients after induction, after intubation, 1 minute, 5 minutes, 10 minutes, 15 minutes after discharge of surgery and after extubation showed no statistically significant difference (p > 0.05). Basal heart rate measurements and the heart rates after induction, after intubation, 1 minute, 5 minutes, 10 minutes, 15 minutes after discharge of surgery and after extubation showed no statistically significant difference (p > 0.05). Basal BIS measurements and BIS measurements after induction, after intubation, 1 minute, 5 minutes, 10 minutes, 15 minutes after discharge of surgery and after extubation showed no statistically significant difference (p > 0.05). CONCLUSIONS: We found no statistically significant difference between two groups about different parameters. But new investigations with different local anesthetic agents may show sigificant difference and usage of these local anesthetic agents may be advised. [ABSTRACT FROM AUTHOR]- Published
- 2014
69. Controlled hypotensive anesthesia in the beach-chair position under general anesthesia: Is it safe for shoulder arthroscopy?
- Author
-
Mehmet Anıl Süzer, Mehmet Burak Eskin, Mehmet Özgür Özhan, Bülent Atik, Ceyda Özhan Çaparlar, Metin Polat, Uğur Gönç, and Tıp Fakültesi
- Subjects
Shoulder arthroscopy ,Beach chair position ,Hypotensive anesthesia ,business.industry ,Anesthesia ,General Anesthesia ,Outpatient Surgery ,Medicine ,General Medicine ,business ,Beach-Chair Position ,Shoulder Arthroscopy - Abstract
Atik, Bülent (Balikesir Author), Aims: The beach-chair position (BCP) imposes a risk to cerebrovascular hypoperfusion due to deep hypotensive events (DHEs) which may progress to catastrophic neurological complications. However, a controlled hypotensive anesthesia (CHA) management is often required for arthroscopic shoulder surgery to reduce blood loss and to improve visibility of surgical field. The aim of this retrospective study was to evaluate CHA managements, DHEs, and complications in patients who underwent shoulder arthroscopy in the BCP under general anesthesia (GA) between years 2017 and 2019. Methods: After hospital's ethic committee approval was obtained, medical records of 72 adult patients were retrospectively reviewed. Primary outcome measures were the frequency of CHA management and the incidence of DHE. Secondary outcome measures were to determine the stages of surgery at which DHEs have developed and the complications. Results: CHA was required in 46 of total 72 patients (63.9%). Among those 46 patients, 31 (67.4%) had at least one DHE. A total of 82 DHEs were detected in 49 patients whereas mean arterial pressure limits were normal (±30% of baseline) in the remaining 23 (68.1% vs. 31.9%; p
- Published
- 2020
70. Incidence and associated factors for hypotension after spinal anesthesia during cesarean section at Gandhi Memorial Hospital Addis Ababa, Ethiopia
- Author
-
Bedru Jemal, Tewoderos Shitemaw, Luelayehu Akalu, and Temesgen Mamo
- Subjects
Physiology ,Social Sciences ,Blood Pressure ,Vascular Medicine ,0302 clinical medicine ,Anesthesiology ,Pregnancy ,Risk Factors ,030202 anesthesiology ,Medicine and Health Sciences ,Odds Ratio ,Psychology ,Anesthesia ,Multidisciplinary ,Pharmaceutics ,Incidence ,Incidence (epidemiology) ,Hospitals ,Physiological Parameters ,Obstetric Procedures ,Medicine ,Sensory Perception ,Female ,Hypotension ,Research Article ,Adult ,Adolescent ,Science ,Surgical and Invasive Medical Procedures ,Obstetric anesthesia ,Anesthesia, Spinal ,Young Adult ,03 medical and health sciences ,Drug Therapy ,Hypotensive Anesthesia ,Statistical significance ,medicine ,Humans ,Adverse effect ,Cesarean Section ,business.industry ,Body Weight ,Cognitive Psychology ,Biology and Life Sciences ,030208 emergency & critical care medicine ,Odds ratio ,medicine.disease ,Blood pressure ,Cognitive Science ,Perception ,Local and Regional Anesthesia ,Ethiopia ,Complication ,business ,Neuroscience - Abstract
Background Spinal anesthesia is a type of regional anesthesia that has been practicing for obstetric anesthesia since the beginning of the 20th century. Despite the simplicity and lower maternal mortality risk, compared to general anesthesia, spinal anesthesia is linked to different adverse effects, of which hypotension is the most common complication. The main aim of this study was to determine the incidence and associated factors of hypotension after spinal anesthesia during cesarean section. Method Institution-based cross-sectional study was conducted with 410 clients. The study was conducted on cesarean section under spinal anesthesia from 5th January to 30th April 2019, at the Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Both bivariable and multivariable logistic regression analysis were done on the associated factors. The level of statistical significance was represented at pT6 AOR = 2.230; 95%CI: (1.329–3.741), the time interval between spinal induction and skin incision > 6minutes AOR = 1.803; 95%CI: (1.044–3.114) and anesthetist experience AOR = 5.033(95%CI: 2.144–11.818) were also associated with hypotension. Conclusion The identified risk factors for hypotension, after spinal anesthesia are sensory height block, weight of the baby, the time interval between spinal induction and skin incision, baseline systolic blood pressure, and anesthetist experience.
- Published
- 2020
71. Controlled hypotensive anesthesia for endoscopic endonasal repair of cerebrospinal fluid rhinorrhea: A comparison between clevidipine and esmolol: Randomized controlled study
- Author
-
Essam F. Abdelgalel
- Subjects
030204 cardiovascular system & hematology ,law.invention ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Randomized controlled trial ,030202 anesthesiology ,law ,otorhinolaryngologic diseases ,Medicine ,Clevidipine ,Cerebrospinal fluid rhinorrhea ,Esmolol ,business.industry ,Cerebrospinal Fluid Rhinorrhea ,Anesthesiology and Pain Medicine ,Hypotensive anesthesia ,lcsh:Anesthesiology ,Anesthesia ,business ,Controlled hypotension ,medicine.drug - Abstract
Background: The aim of this study was to evaluate the efficacy of intravenous infusion of clevidipine or esmolol for producing controlled hypotension during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. Patients and methods: Fifty adult ASA I and II patients scheduled for endoscopic repair of CSF rhinorrhea were randomized into one of two groups. Group C (25 patients) received clevidipine 0.5 mcg/kg/min increased by 0.5 mcg/kg/min every 3–5 min to achieve the target mean arterial pressure (MAP) of 55–65 mmHg. Group E (25 patients) received esmolol infusion 50 mcg/kg/min increased by 50 mcg/kg/min every 3–5 min to achieve the target MAP. Surgical field Quality, blood loss, haemodynamic parameters, surgeons' satisfaction and adverse events were recorded. Results: Time to reach target MAP was significantly shorter in group C compared to group E. Number of patients needed nitroglycerine was significantly higher in group E compared to group C (8 versus 2 respectively). The nitroglycerine dose needed/patient in group E was significantly more compared to group C. Surgeon satisfaction score was significantly higher in group C compared to group E. More patients in group E developed bradycardia compared to group C. Mean arterial pressure was significantly lower in group C compared to group E after 5 and 10 min from the start of the studied drugs infusion while it was significantly higher in group C after 25 min from the start of the studied drugs. The heart rate (HR) was significantly lower in group E compared to group C 10 min after starting drugs infusion till the end of surgery. Conclusion: Both clevidipine and esmolol are effective for inducing controlled hypotension during endoscopic repair of CSF rhinorrhea. Clevidipine has the advantage of having shorter time to reach target MAP with less need of additional hypotensive agent and better surgeon satisfaction.
- Published
- 2018
72. Research and evidence about blood sparing in spine surgery
- Author
-
Szpalski, Marek, Gunzburg, Robert, Aebi, Max, Weiskopf, Richard, Szpalski, Marek, editor, Weiskopf, Richard B., editor, Gunzburg, Robert, editor, and Aebi, Max, editor
- Published
- 2005
- Full Text
- View/download PDF
73. Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery.
- Author
-
Mohammed, Mahmoud Hassan, Fahmy, Adel Mikhail, and Hakim, Karim Youssef Kamal
- Subjects
PREOPERATIVE period ,GABAPENTIN ,INTRAOPERATIVE monitoring ,HYPOTENSION ,POSTOPERATIVE care ,OPIOIDS ,ENDOSCOPIC surgery - Abstract
Abstract: Background: Functional Endoscopic sinus surgery (FESS) is a delicate and time consuming procedure; it is performed routinely under general anesthesia. Hypotensive techniques should be employed for best visualization of operative field. Gabapentin is a structural analog of gamma amino butyric acid. The aim of this study was to determine the analgesic efficacy of gabapentin and its role in deliberate hypotension during and after FESS. Methods: Eighty patients ASA physical status I–II patients were scheduled to undergo elective FESS under general anesthesia. Patients were randomly assigned to one of two groups using a computer-generated table. Patients in the control group (40 patients) received oral placebo capsules and the study group (40 patients) patients received oral gabapentin (Conventin 400mg; Evapharma Egypt) 1.2g 1h before surgery. Intraoperative, mean arterial blood pressure, infusion rates of the hypotensive agent (sodium nitroprusside) were recorded at 15min interval. Assessments of pain, opioid usage, and side effects were performed at 1h interval after arrival in the PACU. Results: Gabapentin group patients required significantly lower (p value <0.05) infusion rates and total doses of hypotensive agent (sodium nitroprusside) than the placebo group patients at all measured intervals. Postoperative assessment of pain scores revealed that gabapentin group recorded significantly lower mean values of VAS than the control group (p value <0.05). Conclusion: Oral gabapentin, 1200mg decreased dose requirements of intraoperative hypotensive agent (sodium nitroprusside) and postoperative morphine. In addition, patients receiving gabapentin had suffered less from opioid side effects (nausea, vomiting and urinary retention) than those receiving placebo. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
74. Low-dose but not high-dose prostaglandin E1 improves the histological outcome of severe forebrain ischemia in rats.
- Author
-
Miura, Yoshihide, Kanazawa, Kaoru, Yokoo, Noriko, Iizawa, Kazue, Okada, Masayuki, Oda, Shinya, and Nakane, Masaki
- Subjects
- *
PROSTAGLANDIN E1 , *PROSENCEPHALON , *ISCHEMIA , *LABORATORY rats , *SODIUM nitroferricyanide , *CEREBRAL ischemia - Abstract
Prostaglandin E1 (PGE1) has been shown to provide short-term neuroprotection against various types of brain ischemia in a dose-dependent manner in mice. However, these findings were obtained from experiments performed without any control over physiological parameters. We performed an outcome study where physiological parameters were controlled in an attempt to confirm the dose-dependant neuroprotective effects of PGE1. A rat model of severe forebrain ischemia was used. Two doses of PGE1 were administered during the pre-ischemic period, a low dose (LowPG group) and a high dose (HighPG group). Normotension was maintained in the LowPG group, while hypotension was induced in the HighPG group. In separate groups, normal saline (Control) or sodium nitroprusside (SNP) were infused to compare outcomes under similar blood pressure conditions. Histological outcomes in the hippocampal CA1 and entorhinal cortex were evaluated 5 days post-ischemia. HighPG resulted in hyperglycemia. The percentage of dead neurons in the hippocampal CA1 and entorhinal cortex were similar in the Control, SNP, and HighPG groups, the percentage being significantly attenuated in the LowPG group (CA1: Control = 92.8 ± 2.4%, LowPG = 85.0 ± 8.5%, HighPG = 95.3 ± 2.4%, and SNP = 96.4 ± 0.7%, P < 0.01; entorhinal cortex: Control = 73.8 ± 4.0%, LowPG = 53.2 ± 12.3%, HighPG = 72.1 ± 12.6%, and SNP = 76.5 ± 4.1%, P < 0.01). Pre-ischemic administration of low-dose PGE1 in rats provided neuroprotection against severe forebrain ischemia. A dose dependency was not observed with PGE1 dose and outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
75. Greater Peripheral Blood Flow but Less Bleeding With Propofol Versus Sevoflurane During Spine Surgery: A Possible Physiologic Model?
- Author
-
Albertin, Andrea, La Colla, Luca, Gandolfi, Azzurra, Colnaghi, Eleonora, Mandelli, Davide, Gioia, Giuseppe, and Fraschini, Gianfranco
- Subjects
- *
SPINAL surgery , *BLOOD flow , *ANESTHESIA , *LUMBAR vertebrae , *CONTROLLED hypotension , *HEMORRHAGE - Abstract
The article presents a study which compares the effects of sevoflurane and propofol on lumbar-paraspinal-muscles regional blood flow and bleeding when controlled hypotension is used. It revealed that peripheral blood flow was importantly greater in the propofol group before and during the hypotensive period. The study concluded that propofol induces less bleeding than sevoflurane during spine surgery and could be more showed to create hypotension during anesthesia.
- Published
- 2008
- Full Text
- View/download PDF
76. Hypotensive anesthesia with propofol and remifentanil: protective effect of alpha-tocopherol on renal function
- Author
-
Lubrano, Riccardo, Marandola, Maurizio, Antonucci, Adriana, Tellan, Guglielmo, Elli, Marco, Santulli, Maria, Lauria, Domenica, Giuliana, Guido, and Delogu, Giovanna
- Subjects
- *
VITAMIN E , *ANESTHESIA , *KIDNEY function tests , *GLOMERULAR filtration rate - Abstract
Abstract: Study objective: To determine the effect of α-tocopherol in patients receiving hypotensive anesthesia with propofol-remifentanil. Study design: Prospective, randomized study. Setting: University hospital. Patients: 66 ASA physical status I and II patients, aged 32 to 56 years, scheduled for nasal polypectomy. Interventions: Patients were allocated into two groups, the treatment and the control groups (T group and C group). T group received α-tocopherol 300 mg orally 5 to 6 hours before surgery. Measurements: Sampling times and measurements were done before hypotension (t0), 45 minutes after starting hypotension (t 1), 90 minutes after starting hypotension (t2), 45 minutes after recovery of normotension (t3), and 24 hours after surgery (t4). Renal function was assessed by testing glomerular and tubular functions: glomerular filtration rate, fractional excretion of sodium (FENA); fractional excretion of urea (FEUN); and urinary N-acetyl-1-β-D-glucosoaminidase (NAG) index (NAGi). Main results: Glomerular filtration rate values remained unchanged in all patient populations. Fractional excretion of sodium was within reference ranges in both groups at times t0, t1, and t2. At time t3, a significant FENA peak was observed. At this time, FENA was significantly higher in C group than T group (P < 0.001). FEUN time course was similar to the FENA trend. At time t4, FENA and FEUN returned to basal values. At time t3, NAGi was also increased without significant intergroup differences (P < 0.01, P < 0.001, and P < 0.01 vs times t0, t1, t2 in C group, respectively; P < 0.01, P < 0.01, and P < 0.001 vs times t0, t1, and t2 in T group, respectively). Conclusions: In patients without any renal disease, hypotensive anesthesia with propofol and remifentanil results in a transient tubular dysfunction, which appears to be minimized by the preoperative administration of α-tocopherol. [Copyright &y& Elsevier]
- Published
- 2008
- Full Text
- View/download PDF
77. Thromboseprophylaxe in der Hüftendoprothetik.
- Author
-
Böttner, F., Sculco, T. P., Sharrock, N. E., Westrich, G. H., and Steinbeck, J.
- Abstract
Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2001
- Full Text
- View/download PDF
78. Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol
- Author
-
Sabry Mohamed Amin and Mohamed Gamal Eldin Elmawy
- Subjects
Hypotensive anesthesia ,medicine.medical_specialty ,business.industry ,Beta-antagonist ,Cochlear implant surgery ,030208 emergency & critical care medicine ,Esmolol ,Surgery ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Blood pressure ,The alpha-2 agonists ,030202 anesthesiology ,Otology ,Anesthesia ,Heart rate ,Hypotensive drugs ,medicine ,Tramadol ,Dexmedetomidine ,Adverse effect ,business ,medicine.drug - Abstract
Background The field of cochlear implantation has been expanding rapidly and it has been hailed as one of the greatest advances in otology. The technique of anesthesia plays a crucial role in success of cochlear implant surgery as the anesthesiologist has to produce conditions which facilitate surgery by inducing bloodless operative field. Study objective To determine the efficacy of dexmedetomidine versus esmolol usage as an adjunct to induce controlled hypotension in children undergoing cochlear implant surgery. Design Clinical trial study. Setting Operating room in a university hospital. Patients 70 children aged 2–4 years scheduled for cochlear implant surgery under general anesthesia. Patients were randomly allocated according to drugs used into two equal groups (35 patients in each group). Interventions: Group (D): The patients in this group received a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by continuous infusion 0.2–0.5 ug/kg/h after induction of anesthesia but before surgery. Group (E): The patients in this group received a bolus dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion 100–300 ug/kg/min after induction of anesthesia but before surgery. Measurements Heart rate, Mean Arterial blood Pressure, Quality of surgical field, operative time, adverse events. Main results The quality of surgical field was comparable between both groups in all times of measurements. The time to first analgesic request was statistically significant longer in group (D) than in group (E) and the total tramadol consumption was statistically significant less in group (D) than in group (E). Conclusions In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.
- Published
- 2016
79. Optimisation of intramuscular dosage of dexmedetomidine for hypotensive anesthesia in functional endoscopic sinus surgery- a prospective randomized double blind study
- Author
-
Arivumani T A, Elango Dhanapal, Hemlata Kataiyar, and Swarnalingam Thangavelu
- Subjects
Double blind study ,Hypotensive anesthesia ,business.industry ,Anesthesia ,Medicine ,Functional endoscopic sinus surgery ,Dexmedetomidine ,business ,medicine.drug - Published
- 2016
80. Development of a prediction model for hypotension after induction of anesthesia using machine learning
- Author
-
Woohyun Jung, Sang-Hyun Kim, Sun Young Park, Ah Reum Kang, Jihyun Lee, Misoon Lee, and Jiyoung Woo
- Subjects
Male ,medicine.medical_treatment ,Blood Pressure ,Logistic regression ,Vascular Medicine ,Machine Learning ,Drug Delivery Systems ,0302 clinical medicine ,Anesthesiology ,030202 anesthesiology ,Medicine and Health Sciences ,Electronic Health Records ,Intubation ,Anesthesia ,Multidisciplinary ,Pharmaceutics ,Models, Cardiovascular ,Middle Aged ,Cholecystectomy, Laparoscopic ,Medicine ,Female ,Hypotension ,Research Article ,Adult ,Computer and Information Sciences ,Drug Administration ,Science ,Surgical and Invasive Medical Procedures ,Anesthesia, General ,Risk Assessment ,03 medical and health sciences ,Drug Therapy ,Hypotensive Anesthesia ,Artificial Intelligence ,Monitoring, Intraoperative ,Intubation, Intratracheal ,medicine ,Humans ,Infusion pump ,Arterial Pressure ,Artificial Neural Networks ,Aged ,Anesthetics ,Retrospective Studies ,Computational Neuroscience ,Receiver operating characteristic ,business.industry ,Tracheal intubation ,Biology and Life Sciences ,Computational Biology ,Bayes Theorem ,Confidence interval ,Mean blood pressure ,Blood pressure ,ROC Curve ,Feasibility Studies ,Neural Networks, Computer ,business ,030217 neurology & neurosurgery ,Neuroscience - Abstract
Arterial hypotension during the early phase of anesthesia can lead to adverse outcomes such as a prolonged postoperative stay or even death. Predicting hypotension during anesthesia induction is complicated by its diverse causes. We investigated the feasibility of developing a machine-learning model to predict postinduction hypotension. Naïve Bayes, logistic regression, random forest, and artificial neural network models were trained to predict postinduction hypotension, occurring between tracheal intubation and incision, using data for the period from between the start of anesthesia induction and immediately before tracheal intubation obtained from an anesthesia monitor, a drug administration infusion pump, an anesthesia machine, and from patients' demographics, together with preexisting disease information from electronic health records. Among 222 patients, 126 developed postinduction hypotension. The random-forest model showed the best performance, with an area under the receiver operating characteristic curve of 0.842 (95% confidence interval [CI]: 0.736-0.948). This was higher than that for the Naïve Bayes (0.778; 95% CI: 0.65-0.898), logistic regression (0.756; 95% CI: 0.630-0.881), and artificial-neural-network (0.760; 95% CI: 0.640-0.880) models. The most important features affecting the accuracy of machine-learning prediction were a patient's lowest systolic blood pressure, lowest mean blood pressure, and mean systolic blood pressure before tracheal intubation. We found that machine-learning models using data obtained from various anesthesia machines between the start of anesthesia induction and immediately before tracheal intubation can predict hypotension occurring during the period between tracheal intubation and incision.
- Published
- 2020
81. Capillary blood flow and arteriolovenular shunt in various organs in hypotensive states induced by nitroglycerine, nitroprusside, and nicardipine.
- Author
-
Yano, Hirofumi, Takaori, Masuhiko, Fukui, Akira, Kimura, Ken-ichi, and Fujita, Yoshihisa
- Abstract
The capillary blood flow of 14 organs was measured in dogs using the microsphere (9μm diameter) trapping method under hypotension induced by administration of either nitroglycerin (NTG), nitroprusside (SNP), or nicardipine (NIC). Simultaneously, blood flow through the arteriolovenular shunt in the brain, kidney, liver, mesenteric organs, skeletal muscles of the pelvic limb, and all organs in the body, except the lungs, were measured by collecting venous blood drained from the organs at 4.8 ml·min for 2 min. Capillary blood flow remained unchanged in most organs under hypotension with either NTG or SNP, but in increased in most organs, together with an increase in cardiac output, under hypotension with NIC. Arteriolovenular shunt tended to increase in four organs, with the exception of the liver, and increased in the whole body under hypotension with NTG. However, arteriolovenular shunt remained unchanged under hypotension with SNP. Arteriolovenular shunt increased in the mesenteric organs under hypotension with NIC, but decreased in the skeletal muscles of the pelvic limb. These results indicated that none of these hypotensive drugs impairs the nutrient supply to organs; further, NIC protects it much more since it does not increase the shunt flow through major organs. [ABSTRACT FROM AUTHOR]
- Published
- 1994
- Full Text
- View/download PDF
82. Comparative study on the cardio-respiratory change during prostaglandin E-induced hypotension in the patients in the supine and prone position.
- Author
-
Hirose, Munetaka, Yoda, Kengo, Sakai, Kazuo, Saitoh, Akiko, Nakagawa, Hiromi, Tanaka, Masaki, and Miyazaki, Masao
- Abstract
Prostaglandin E-induced hypotension (25% reduction from the preadministration level in mean arterial pressure) was applied to thirteen patients. Eight patients among them were operated in the supine position (group I) and other five in the prone position (group II). The maintenance dose of PGE was considerably lower in group II than in group I (0.067 μg·kg·min vs. 0.119 μg·kg·min). In group I, there was a significant increase in CI, with a significant decrease in SVRI and PVRI during PGEI-induced hypotension. Such a high dose of PGE1 (0.119 μg·kg·min) was considered to have a direct dilating action on the systemic resistance bed as well as on the pulmonary vasculature. It was considered that the suppression of hypoxic pulmonary vasoconstriction could be a mechanism to increase venous admixture during PGE-induced hypotension. In group II, there was no significant increase in CI, and no significant decrease in SVRI and PVRI. PGE-induced hypotension can be safely applied to the anesthetized patients, but we should be careful to apply it to the patients in the prone position, because lower dose of PGE can induce severe hypotension, which is not accompanied by the increase in CI as occures in the patients in the supine position. [ABSTRACT FROM AUTHOR]
- Published
- 1991
- Full Text
- View/download PDF
83. Cerebral oxygen saturation monitoring during hypotensive anesthesia in shoulder arthroscopy: A comparative study between dexmedetomidine and esmolol
- Author
-
Ashraf E El-Agamy, Khaled M. Maghawry, Wael Ibrahim Tahir, and Ayman F. Zein
- Subjects
medicine.medical_specialty ,Hypotensive anesthesia ,Esmolol ,Supine position ,Shoulder surgery ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Arthroscopy ,Cerebral oxygen saturation ,Cerebral oximetry ,Surgery ,lcsh:RD78.3-87.3 ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,Anesthesia ,medicine ,Dexmedetomidine ,business ,medicine.drug ,Oxygen saturation (medicine) - Abstract
Background Beach chair position (BCP) is used in arthroscopic shoulder operations for its advantages. The BCP together with deliberate hypotension used to decrease intraoperative blood loss during arthroscopic shoulder procedures, this may have risk to cause postoperative neurological insults. Dexmedetomidine and esmolol are used to induce deliberate hypotension. Near-infrared spectroscopy (NIRS) provides a non-invasive technique of continuous monitoring of regional cerebral tissue oxygen saturation (rScO 2 ). In this study we evaluate the prevalence of rScO 2 during hypotensive anesthesia induced by intra-operative infusion of either dexmedetomidine or esmolol in patients undergoing elective arthroscopic shoulder surgery in the BCP. Patients and methods Fifty patients scheduled for elective arthroscopic shoulder surgery under general anesthesia with hypotensive technique in BCP, randomly assigned into two equal groups, dexmedetomidine group (D Group) and esmolol group (E Group) according to the drug used for deliberate hypotension. MAP, HR, BIS and rS c O 2 were recorded before induction of anesthesia T 0 , post-induction of anesthesia T 1 as baseline, 5 min after BCP T 2 , 5 min after starting the studied drug T 3 , 30 min T 4 , 60 min T 5 , 90 min T 6 , 5 min after stopping the studied drug T 7 , 5 min after return to supine T 8 and after extubation T 9 . Results In D group there was significant decrease in Lt.rs c o 2 and Rt.rs c o 2 , at T2 to T7 compared to T1. In E group there was significant decrease in Lt.rs c o 2 and Rt.rs c o 2 at T2, to T7 compared to T1. In D group two patients had CDEs compared to five patients in E group. Conclusion In patients undergoing shoulder arthroscopic surgery under general anesthesia, the BCP significantly decreases rS c O 2 , with further slight decrease of rS c O 2 with dexmedetomidine and esmolol induced hypotension with no affection of postoperative cognitive function with both drugs. Dexmedetomidine and esmolol are safe drugs with better safety of dexmedetomidine over esmolol.
- Published
- 2015
84. The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty.
- Author
-
Schmidt-Braekling, Tom, Goytizolo, Enrique, Waldstein, Wenzel, Sharrock, Nigel, and Boettner, Friedrich
- Subjects
- *
TOTAL knee replacement , *TOURNIQUETS , *HEMOGLOBINS , *SURGICAL blood loss , *PHYSIOLOGIC salines , *EPIDURAL anesthesia - Abstract
Introduction: Hypotensive epidural anesthesia (HEA) is used in total joint arthroplasty as a safe and effective blood-saving modality. In order to maintain the blood pressure and heart rate patients, receive 1000 to 1500 mL of lactated Ringer's solution during surgery. While HEA reduces the intraoperative blood loss, the effect of intravenous fluid loading on hemoglobin levels is not fully understood. The current study investigates the effect of HEA on perioperative hemoglobin levels. Materials and Methods: The study included 35 patients operated on by a single surgeon undergoing primary total knee arthroplasty under HEA. Intraoperatively, at least 300 mL of intravenous fluid were given every 15 min over the first 60 min after HEA. Blood samples were drawn before entering the operating room, after HEA, as well as after inflation of the tourniquet, every 15 min thereafter, as well as in the recovery room and on postoperative days one and two. In addition, fluid in- and outtake was recorded. Results: Patients received a mean 1275 mL during the 60 min of tourniquet time. The mean arterial pressure (MAP) 5 min after HEA dropped to 60 mmHg and reached a constant level of around 58 mmHg 15 min after HEA. The average hemoglobin level dropped from 13.9 g/dL prior to HEA, to 12.5 g/dL immediately after HEA (p < 0.001). Intraoperatively the hemoglobin level dropped further and reached 11.8 g/dL at 60 min in the absence of blood loss. Conclusions: Hypotensive epidural anesthesia and the resulting fluid substitution resulted in an average hemoglobin drop of 2.1 g/dL within the first 60 min. This needs to be taken into account when evaluating the need for blood transfusions after primary joint replacement surgery under HEA. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
85. Induced Hypotension in Functional Endoscopic Sinus Surgery: A Comparative Study of Dexmedetomidine and Esmolol.
- Author
-
Sahu BP, Nayak LK, Mohapatra PS, and Mishra K
- Abstract
Introduction Functional endoscopic sinus surgery (FESS) is one of the common surgical procedures requiring hypotensive anesthesia; many agents have been tried to reduce the amount of blood loss. This study aims at comparing the efficacy of two agents for providing deliberate hypotension. Objectives The aim of this study was to evaluate the efficacy of esmolol and of dexmedetomidine and compare which one of the two is a better agent to produce induced hypotension during FESS. Materials and methods This was a comparative study conducted in a tertiary care hospital in Odisha, India. There were two study groups with 30 participants each who were given either esmolol or dexmedetomidine (group E and group DEX, respectively). Results Esmolol is an anti-hypertensive agent with better hemodynamic stability. The amount of drug and dose requirement was low in group DEX. The emergence time, sedation score, and time to first analgesic request were found to be highly statistically significant in group DEX. Conclusion Dexmedetomidine was found to be a better agent at controlling intra-operative blood pressure than esmolol and had beneficial effects on recovery from anesthesia and analgesia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sahu et al.)
- Published
- 2021
- Full Text
- View/download PDF
86. Intraoperative blood loss during an osteotomy of the bilateral vertical ramus
- Author
-
Huey-Er Lee, Hong-Sen Chen, Kun-Tsung Lee, Kun-Jung Hsu, and Steven Lai
- Subjects
Related factors ,medicine.medical_specialty ,Blood transfusion ,business.industry ,Dentistry(all) ,medicine.medical_treatment ,hypotensive anesthesia ,Osteotomy ,Surgery ,lcsh:RK1-715 ,bilateral vertical ramus osteotomy ,Mandibular prognathism ,Blood loss ,Hypotensive anesthesia ,autologous transfusion ,lcsh:Dentistry ,Anesthesia ,medicine ,Operative time ,In patient ,blood loss ,business ,General Dentistry ,operative time - Abstract
Background/purpose We studied the correlation between clinical covariates and blood loss under hypotensive anesthesia, in patients undergoing a bilateral vertical ramus osteotomy (BVRO). Materials and methods BVROs were performed on 37 patients with mandibular prognathism. The preoperative and postoperative values of blood constituents were examined and analyzed. Correlations among blood loss, sex, age, operative time, and reduced values of blood constituents were statistically assessed. Results The average operative time was 255.5 ± 42.56 minutes, and blood loss was 105.9 ± 66.83 mL. No patient required a blood transfusion in this study. There were no significant correlations between blood loss and related factors (sex, operative time, and reductions in blood constituents). Comparing sexes, blood loss and reductions in blood constituents exhibited non-significant differences. However, male patients had significantly larger values for presurgical and postsurgical blood constituents than female patients. Conclusion In our study, blood loss was acceptable in patients who underwent a BVRO, and thus, no preoperative autologous blood donation was necessary.
- Published
- 2014
- Full Text
- View/download PDF
87. INDUCED HYPOTENSIVE ANESTHESIA DURING ELECTIVE SURGICAL PROCEDURES
- Author
-
Baljit Singh Bajwa
- Subjects
Blood pressure ,Hypotensive anesthesia ,business.industry ,Anesthesia ,medicine.medical_treatment ,Medicine ,Venous drainage ,Surgical procedures ,business ,Elective Surgical Procedure ,Controlled hypotension ,Reduction (orthopedic surgery) ,Induced Hypotension - Abstract
Medical paradox of induced hypotension has arisen because bleeding during operative interventions has become a problem of increasing importance during the past few years. Certain surgical procedures are now so vastly extensive and that other operations have penetrated so deeply into the vital structure of the body. A number of workers, both on this continent and abroad, have suggested that one effective method of controlling either gross hemorrhage or excessive vascular ooze may be by the reduction of systemic arterial pressure. When such a deliberate hypotension is combined with proper posturing of the patient so that the operative site is superior, permitting gravitational venous drainage away from the wound to the dependent portions of the body, the technique has been called “controlled hypotension,” and has been employed to achieve a relatively ischemic operative field.
- Published
- 2014
88. Effects of Hypotensive Anesthesia on Blood Transfusion Rates in Craniosynostosis Corrections
- Author
-
Jeffrey A. Fearon, T. Kevin Cook, and Morley A. Herbert
- Subjects
Mean arterial pressure ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Blood Loss, Surgical ,Blood Pressure ,Hypotension, Controlled ,Unnecessary Procedures ,Craniosynostosis ,Craniosynostoses ,Postoperative Complications ,medicine ,Humans ,Anesthesia ,Blood Transfusion ,Prospective Studies ,Child ,business.industry ,Significant difference ,Infant ,medicine.disease ,Surgery ,Cerebral blood flow ,Hypotensive anesthesia ,Clinical question ,Child, Preschool ,Preoperative hemoglobin ,Hypotension ,business - Abstract
BACKGROUND Hypotensive anesthesia is routinely used during craniosynostosis corrections to reduce blood loss. Noting that cerebral oxygenation levels often fell below recommended levels, the authors sought to measure the effects of hypotensive versus standard anesthesia on blood transfusion rates. METHODS One hundred children undergoing craniosynostosis corrections were randomized prospectively into two groups: a target mean arterial pressure of either 50 mm Hg or 60 mm Hg. Aside from anesthesiologists, caregivers were blinded and strict transfusion criteria were followed. Multiple variables were analyzed, and appropriate statistical testing was performed. RESULTS The hypotensive and standard groups appeared similar, with no statistically significant differences in mean age (46.5 months versus 46.5 months), weight (19.25 kg versus 19.49 kg), procedure [anterior remodeling (34 versus 31) versus posterior (19 versus 16)], or preoperative hemoglobin level (13 g/dl versus 12.9 g/dl). Intraoperative mean arterial pressures differed significantly (56 mm Hg versus 66 mm Hg; p < 0.001). The captured cell saver amount was lower in the hypotensive group (163 cc versus 204 cc; p = 0.02), yet no significant differences were noted in postoperative hemoglobin levels (8.8 g/dl versus 9.3 g/dl). Fifteen of 100 patients (15 percent) received allogenic transfusions, but no statistically significant differences were noted in transfusion rates between the hypotensive [nine of 53 (17.0 percent)] and standard anesthesia [six of 47 (13 percent)] group (p = 0.056). CONCLUSIONS No significant difference in transfusion requirements was found between hypotensive and standard anesthesia during craniosynostosis corrections. Considering potential benefits of improved cerebral blood flow and total body perfusion, surgeons might consider performing craniosynostosis corrections without hypotension. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
- Published
- 2014
89. Dexmedetomidine used to provide hypotensive anesthesia during middle ear surgery.
- Author
-
Nasreen, Farah, Bano, Shahjahan, Khan, Rashid, and Hasan, Syed
- Subjects
- *
OLD age , *ANESTHESIA , *EAR surgery , *SALINE solutions , *PLACEBOS - Abstract
This study was carried out to assess the hypotensive effect of low dose dexmedetomidine (DEX) infusion during middle ear surgery. 42 ASA grades I and II patients of either sex aged 18-45 years undergoing elective middle ear surgery were randomly divided into two groups of 21 each. Group I received placebo bolus and infusion of saline at a rate similar to DEX in Group II. Group II received 10-15 min prior to induction of anesthesia 1 µg/kg IV bolus DEX diluted in 10 ml of normal saline over 10 min. Immediately thereafter an infusion of 0.4 µg/kg/hr of DEX commenced. Standard anesthetic technique was used. Halothane was titrated to achieve a mean arterial pressure 30% below the control value (value taken just after premedication). We observed that a statistically significant reduction in the percentage of halothane required to reduce MAP 30% below control value occurred in patients receiving DEX infusion (1.3 ± 0.4%) in comparison to those receiving placebo (3.1 ± 0.3%). Patients receiving DEX infusion had a better surgical field. The mean awakening time was significantly reduced in patients of Group II (9.1 ± 2.7 min) when compared to patients of Group I (12.8 ± 2.2 min). We conclude that DEX can be safely used to provide hypotensive anesthesia during middle ear surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
90. Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy
- Author
-
Jehan Mohammad Ezzat Hamed and Walid Mamdouh Ataalla
- Subjects
Mean arterial pressure ,Tourniquet ,Blood transfusion ,business.industry ,medicine.medical_treatment ,Bleeding ,esmolol ,hypotensive anesthesia ,Hydroxyethyl starch ,Esmolol ,fentanyl ,Loading dose ,Fentanyl ,Blood pressure ,hemoglobin deficit ,Anesthesia ,Materials Chemistry ,medicine ,Original Article ,business ,myomectomy ,medicine.drug - Abstract
Objectives: The objective of this study is to evaluate the effect of esmolol-induced hypotensive anesthesia (EIHA) on intra-operative (IO) bleeding during open myomectomy. Patients and Methods: Eighty-eight women were randomly divided into the study group received EIHA without uterine tourniquet and control group who received normotensive anesthesia with uterine tourniquet. EIHA was provided as priming dose of esmolol (0.5 mg.kg-1) before the induction of anesthesia and esmolol infusion (0.05-0.3 mg.kg-1.min-1) to maintain mean arterial pressure at 60–70 mmHg that was stopped on completion of myomectomy. Fentanyl was used as IO analgesia (loading dose: 1.0 μg.kg-1 then infusion of 0.2-0.4 μg.kg-1.h-1). All patients received 6% hydroxyethyl starch (HES; initially, 3 mL.kg-1 over 5-10 minutes and supplemental doses according to requirements) and Lactated Ringer's solution (LR; 5 mL.kg-1.h-1). Trigger for blood transfusion was hemoglobin concentration (HBC)
- Published
- 2019
91. The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty.
- Author
-
Schmidt-Braekling T, Goytizolo E, Waldstein W, Sharrock N, and Boettner F
- Abstract
Introduction: Hypotensive epidural anesthesia (HEA) is used in total joint arthroplasty as a safe and effective blood-saving modality. In order to maintain the blood pressure and heart rate patients, receive 1000 to 1500 mL of lactated Ringer's solution during surgery. While HEA reduces the intraoperative blood loss, the effect of intravenous fluid loading on hemoglobin levels is not fully understood. The current study investigates the effect of HEA on perioperative hemoglobin levels., Materials and Methods: The study included 35 patients operated on by a single surgeon undergoing primary total knee arthroplasty under HEA. Intraoperatively, at least 300 mL of intravenous fluid were given every 15 min over the first 60 min after HEA. Blood samples were drawn before entering the operating room, after HEA, as well as after inflation of the tourniquet, every 15 min thereafter, as well as in the recovery room and on postoperative days one and two. In addition, fluid in- and outtake was recorded., Results: Patients received a mean 1275 mL during the 60 min of tourniquet time. The mean arterial pressure (MAP) 5 min after HEA dropped to 60 mmHg and reached a constant level of around 58 mmHg 15 min after HEA. The average hemoglobin level dropped from 13.9 g/dL prior to HEA, to 12.5 g/dL immediately after HEA ( p < 0.001). Intraoperatively the hemoglobin level dropped further and reached 11.8 g/dL at 60 min in the absence of blood loss., Conclusions: Hypotensive epidural anesthesia and the resulting fluid substitution resulted in an average hemoglobin drop of 2.1 g/dL within the first 60 min. This needs to be taken into account when evaluating the need for blood transfusions after primary joint replacement surgery under HEA.
- Published
- 2020
- Full Text
- View/download PDF
92. The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study.
- Author
-
Bahr MH, Rashwan DAE, and Kasem SA
- Abstract
Objectives: Postoperative cognitive dysfunction (POCD) is multifactorial, which may be caused by anesthetic and surgical causes or cerebral injury. This study aimed to evaluate the effect of dexmedetomidine as a neuroprotective drug compared to esmolol on the prevalence of POCD in adult patients undergoing middle ear surgeries under hypotensive anesthesia., Methods: This study included male and female adult patients, according to American Society of Anesthesiology physical status (ASA) I, the patients who underwent middle ear surgeries under hypotensive anesthesia were randomly assigned to two groups that received esmolol and dexmedetomidine. The demographic data, heart rate, mean arterial blood pressure, duration of the surgery, evaluation of the surgical field, and the Mini-Mental State Examination (MMSE) (preoperatively and at 1, 6 and 24 hours postoperatively) were recorded., Results: There was a significant difference between the numbers of patients who had POCD in MMSE1: 12 cases in the esmolol group (41.37%) compared to three cases in the dexmedetomidine group (10.34%) (P = 0.016), in MMSE6: 10 cases in the esmolol group (34.48%) compared with two cases in the dexmedetomidine group (6.89%) (P = 0.023) and in MMSE24: seven cases in the esmolol group (24.13%) compared with one case in the dexmedetomidine group (3.44%) (P = 0.022), while the median and range of MMSE score were comparable between the two groups (P > 0.05)., Conclusions: This study suggests that intraoperative use of dexmedetomidine as an adjuvant to hypotensive anesthesia reduces the incidence of POCD compared to esmolol., Competing Interests: Conflict of Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2020, Author(s).)
- Published
- 2020
- Full Text
- View/download PDF
93. Hemostasis in Endoscopic Sinus Surgery
- Author
-
Harshita Pant
- Subjects
Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Intraoperative bleeding ,03 medical and health sciences ,0302 clinical medicine ,Paranasal Sinus Diseases ,Medicine ,Humans ,030223 otorhinolaryngology ,Intraoperative Complications ,Sinus (anatomy) ,Surgical approach ,business.industry ,Total intravenous anesthesia ,General surgery ,Logical approach ,General Medicine ,Hemostasis, Surgical ,Surgery ,Endoscopic sinus surgery ,medicine.anatomical_structure ,Otorhinolaryngology ,Hypotensive anesthesia ,030220 oncology & carcinogenesis ,Hemostasis ,Risk Adjustment ,business - Abstract
Intraoperative bleeding during endoscopic sinus surgery poses an additional dimension to an already technically challenging surgical approach because of the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments. Poor visualization is one of the most important factors that increase the risk of intraoperative complications such as inadvertent injury to major vessels and nerves, and incomplete surgery. This article provide a logical approach to improving the surgical field, minimizing risk of inadvertent vascular injury, and managing intraoperative bleeding.
- Published
- 2016
94. Treatment
- Author
-
Olivecrona, H., Ladenheim, J., Olivecrona, H., and Ladenheim, J.
- Published
- 1957
- Full Text
- View/download PDF
95. Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery
- Author
-
Adel Mikhail Fahmy, Mahmoud Hassan Mohammed, and Karim Youssef Kamal Hakim
- Subjects
Hypotensive anesthesia ,medicine.medical_specialty ,biology ,Gabapentin ,Nausea ,business.industry ,Functional endoscopic sinus surgery ,Analgesic ,biology.organism_classification ,Placebo ,Pacu ,Surgery ,Opioids ,Anesthesiology and Pain Medicine ,Opioid ,Anesthesia ,medicine ,Vomiting ,Analgesia ,medicine.symptom ,business ,medicine.drug - Abstract
BackgroundFunctional Endoscopic sinus surgery (FESS) is a delicate and time consuming procedure; it is performed routinely under general anesthesia. Hypotensive techniques should be employed for best visualization of operative field. Gabapentin is a structural analog of gamma amino butyric acid. The aim of this study was to determine the analgesic efficacy of gabapentin and its role in deliberate hypotension during and after FESS.MethodsEighty patients ASA physical status I–II patients were scheduled to undergo elective FESS under general anesthesia. Patients were randomly assigned to one of two groups using a computer-generated table. Patients in the control group (40 patients) received oral placebo capsules and the study group (40 patients) patients received oral gabapentin (Conventin 400mg; Evapharma Egypt) 1.2g 1h before surgery. Intraoperative, mean arterial blood pressure, infusion rates of the hypotensive agent (sodium nitroprusside) were recorded at 15min interval. Assessments of pain, opioid usage, and side effects were performed at 1h interval after arrival in the PACU.ResultsGabapentin group patients required significantly lower (p value
- Published
- 2012
96. Laparoscopic and Robotic Partial Nephrectomy With Controlled Hypotensive Anesthesia to Avoid Hilar Clamping: Feasibility, Safety and Perioperative Functional Outcomes
- Author
-
Michele Gallucci, Mariaconsiglia Ferriero, Giuseppe Simone, Rocco Papalia, Ester Forastiere, Salvatore Guaglianone, and Manuela Costantini
- Subjects
kidney ,medicine.medical_specialty ,Mean arterial pressure ,Urology ,medicine.medical_treatment ,ischemia ,Hypotension, Controlled ,Constriction ,nephrectomy ,medicine ,Humans ,kidney neoplasms ,Prospective Studies ,Prospective cohort study ,Contraindication ,robotics ,business.industry ,Perioperative ,Clamping ,Nephrectomy ,Surgery ,Treatment Outcome ,Hypotensive anesthesia ,Anesthesia ,Feasibility Studies ,Laparoscopy ,business - Abstract
We evaluated the feasibility and safety of laparoscopic and robotic assisted partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping and eliminate renal ischemia.A total of 60 patients with renal tumors who were candidates for nephron sparing surgery and had no contraindication to hypotensive anesthesia underwent partial nephrectomy without hilar clamping and with controlled hypotension during tumor excision. A total of 40 laparoscopic partial nephrectomies and 20 robotic assisted partial nephrectomies were done. All patients who were candidates for laparoscopic or robotic assisted partial nephrectomy regardless of tumor site, size or growth pattern were included in study. The surgical field was assessed for bleeding and visibility using a numerical rating scale.Median tumor size was 3.6 cm (range 1.8 to 10), median operative time was 2 hours (range 1 to 3.5), median blood loss was 200 ml (range 30 to 700 ml) and median hospital stay was 3 days (range 3 to 8). All margins were negative. The median duration of controlled hypotension with a median mean arterial pressure of 65 mm Hg (range 55 to 70) was 14 minutes (range 7 to 16). No patient required intraoperative transfusion but 4 (6.6%) required transfusion postoperatively. Complications developed postoperatively in 3 patients, ie port site bleeding, hemorrhage and hematoma, respectively. Median preoperative and postoperative serum creatinine was 0.9 and 1.10 mg/dl, respectively. The median preoperative and postoperative estimated glomerular filtration rate was 87.20 and 75.60 ml/minute/1.73 m2, respectively.Controlled hypotension allowed laparoscopic and robotic assisted partial nephrectomy to be done without renal hilar clamping. All procedures were completed safely and perioperative outcomes are encouraging.
- Published
- 2012
97. Does tranexamic acid, deliberate hypotension, and anti-Trendelenburg position improve the quality and outcome for functional endoscopic sinus surgery
- Author
-
Khafagy, Ahmed H. and Osman, Sameh M.
- Published
- 2013
- Full Text
- View/download PDF
98. Low-dose but not high-dose prostaglandin E1 improves the histological outcome of severe forebrain ischemia in rats
- Author
-
Shinya Oda, Yoshihide Miura, Kaoru Kanazawa, Noriko Yokoo, Masaki Nakane, Kazue Iizawa, and Masayuki Okada
- Subjects
Male ,Nitroprusside ,Vasodilator Agents ,Hippocampus ,Neuroprotection ,Forebrain ischemia ,Brain Ischemia ,Rats, Sprague-Dawley ,Brain ischemia ,Random Allocation ,chemistry.chemical_compound ,Prosencephalon ,Animals ,Entorhinal Cortex ,Medicine ,Prostaglandin E1 ,Dose-Response Relationship, Drug ,business.industry ,Prostaglandins E ,Low dose ,medicine.disease ,Rats ,Disease Models, Animal ,Neuroprotective Agents ,Anesthesiology and Pain Medicine ,chemistry ,Hypotensive anesthesia ,Anesthesia ,lipids (amino acids, peptides, and proteins) ,Sodium nitroprusside ,Hypotension ,business ,medicine.drug - Abstract
Prostaglandin E(1) (PGE(1)) has been shown to provide short-term neuroprotection against various types of brain ischemia in a dose-dependent manner in mice. However, these findings were obtained from experiments performed without any control over physiological parameters. We performed an outcome study where physiological parameters were controlled in an attempt to confirm the dose-dependant neuroprotective effects of PGE(1).A rat model of severe forebrain ischemia was used. Two doses of PGE(1) were administered during the pre-ischemic period, a low dose (LowPG group) and a high dose (HighPG group). Normotension was maintained in the LowPG group, while hypotension was induced in the HighPG group. In separate groups, normal saline (Control) or sodium nitroprusside (SNP) were infused to compare outcomes under similar blood pressure conditions. Histological outcomes in the hippocampal CA1 and entorhinal cortex were evaluated 5 days post-ischemia.HighPG resulted in hyperglycemia. The percentage of dead neurons in the hippocampal CA1 and entorhinal cortex were similar in the Control, SNP, and HighPG groups, the percentage being significantly attenuated in the LowPG group (CA1: Control = 92.8 +/- 2.4%, LowPG = 85.0 +/- 8.5%, HighPG = 95.3 +/- 2.4%, and SNP = 96.4 +/- 0.7%, P0.01; entorhinal cortex: Control = 73.8 +/- 4.0%, LowPG = 53.2 +/- 12.3%, HighPG = 72.1 +/- 12.6%, and SNP = 76.5 +/- 4.1%, P0.01).Pre-ischemic administration of low-dose PGE(1) in rats provided neuroprotection against severe forebrain ischemia. A dose dependency was not observed with PGE(1) dose and outcome.
- Published
- 2010
99. Effects of remifentanil, nitroglycerin, and sevoflurane on the corrected QT and Tp-e intervals during controlled hypotensive anesthesia
- Author
-
Seyfi Kartal, Safinaz Karabayirli, Bahadır Kösem, Tolga Çimen, Nuran Kavun Çimen, Bunyamin Muslu, Hatice Kılınç, and Muhammet Gözdemir
- Subjects
Adult ,Male ,Methyl Ethers ,Mean arterial pressure ,Adolescent ,Vasodilator Agents ,Remifentanil ,030204 cardiovascular system & hematology ,Hypotension, Controlled ,QT interval ,Sevoflurane ,03 medical and health sciences ,Electrocardiography ,Nitroglycerin ,Young Adult ,0302 clinical medicine ,Double-Blind Method ,Piperidines ,030202 anesthesiology ,medicine ,Repolarization ,Humans ,Anesthesia ,cardiovascular diseases ,Prospective Studies ,Aged ,Inhalation ,business.industry ,Corrected qt ,Arrhythmias, Cardiac ,Middle Aged ,Rhinoplasty ,Analgesics, Opioid ,Long QT Syndrome ,Anesthesiology and Pain Medicine ,Hypotensive anesthesia ,Anesthetics, Inhalation ,Female ,business ,medicine.drug - Abstract
Study objective Controlled hypotension is a preferred method in various surgical operations, but limited data are available for the effects of drug combinations that are used to ensure the desired level of hypotension on cardiac repolarization. Design Randomized, prospective, double-blinded study. Patients The study comprised 65 patients undergoing septorhinoplasty surgery under general anesthesia. Interventions Group S received sevoflurane inhalation alone, group R received sevoflurane and remifentanil, and group N received sevoflurane and nitroglycerine in a way that a mean arterial pressure of 60 ± 5 mm Hg was achieved. Measurements Electrocardiogram was performed before induction (T1), 30 minutes after induction (T2), and 5 minutes after extubation (T3). Corrected QT (QTc), QT dispersion (QTd), and corrected Tp-e (Tp-ec) intervals and Tp-e/corrected QT (Tp-e/QTc) ratio were calculated. Main results QTc prolongation was observed at T2 and T3 in all groups, but only QTc prolongation at T2 was statistically significant in group S ( P > .05). Significant prolongation of QTd interval at T2 and T3 was observed in group S ( P P = .103) and group R ( P = .058). Tp-e/QTc was significantly decreased on T2 in all 3 groups, and it was returned to baseline at T3 ( P Conclusion The present study demonstrated that none of the 3 hypotensive anesthesia methods has an overall negative effect on Tp-e and Tp-e/QTc. Therefore, we conclude that all 3 methods can be used safely in terms of proarrhythmic risk, but increased sevoflurane consumption may require more attention due to significant prolongation of QTc and QTd.
- Published
- 2015
100. Hypotensive Anesthesia and Its Effects on the Cardiovascular System
- Author
-
Hugo Van Aken and James E. Cottrell
- Subjects
Hypotensive anesthesia ,business.industry ,Anesthesia ,Medicine ,business - Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.