Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol

A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery [FESS]. Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 microg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 microg/Kg/h infusion during maintenance [DEX group], or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance [E group] to maintain mean arterial blood pressure [MAP] between [55-65 mmHg]. General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables [MAP and HR]; arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia [Aldrete score >/= 9] were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded. Both DEX group and E group reached the desired MAP [55-65 mmHg] with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP [55-65 mmHg] were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score >/= 9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group. Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect

Can fluid preloading attenuate spinal induced hypotension in the elderly?

Physiologic is aimost associated with progressive loss of reserve in organ function. The objective of this study was to evaluate fluid preloading either by colloid, crystalloid or both on the incidence and frequency of spinal anesthesia induced hypotension in elderly patient. 60 patients scheduled for lower limb orthopedic surgery under spinal anaesthesia were randomly allocated to receive preload with either 6% hydroxyethyl starch 500 ml [Colloid group], 1000 ml lactated Ringer's [Crystalloid group], 500 mI lactated Ringer's plus 250 ml 6% hydroxyethylstarch [Combined group] or received no prehydration [No preload group]. ABP decreased significantly in the four groups after induction of spinal anaesthesia and it was significantly higher in the colloid goup than the other groups. The mean of ephedrine and incidence of hypotension was significantly lower in colloid group 3 of 15 [20%], compared with crystalloid 9 of 15 [60%], combined group 7 of 15 [46%] and no preload group 11 of 15 [73%]. intravascular administration in the four groups resulted in significant increase of CVP then decrease after spinal block. The use of colloid as a pre-emptive infusion is demonstrably effective to attenuate spinal anaesthesia induced hypotension in elderly patient as compared with crystalloid or no fluid preload. However, the incidence of hypotension was only reduced but not completely eliminated

Prospective randomized study of acute normovolaemic haemodilution versus induced hypotension on haemostatic markers and transfusion requirements in major orthopaedic surgery

Thirty patients scheduled for orthopedic surgery of the hip, femur or pelvis for sepsis or malignant tumors, all under general anesthesia, were randomly allocated to one of two groups: Acute normovolemic hemodilution group [ANH group] and hypotensive group [H group]. ANH was started after induction of general anesthesia. In H group, hypotension was induced and maintained using esmolol. Hemoglobin [Hb] and hematocrit [Hct] measures as well as coagulation variables were measured during perioperative period. Total blood loss of each patient was evaluated. The results revealed that homologous transfusion requirements were noted. In ANH group, Hb and Hct values were significantly decreased intra and postoperatively compared to H group. ANH caused significant decrease of platelet count and prolongation of activated partial thromboplastin time [aPTT] intra and postoperatively compared to H group. Significant more volume was infused in ANH group than H group. Patients in H group had significant lower blood loss and needed significant less allogenic blood transfusion