RESUMO
Three different vasoconstricting agents were evaluated during functional endoscopic sinus surgery (FESS) in 57 children. Oxymetazoline hydrochloride 0.05%, phenylephrine hydrochloride 0.25%, or cocaine 4% was applied to the nasal mucosa in a prospective, randomized, double-blind fashion. Heart rate and blood pressure changes were recorded 5 and 10 minutes after application of the study vasoconstrictor to each nostril. The surgeon's subjective impressions of bleeding and visualization were recorded for each side of the nose, as were total blood loss and anesthesia time. Although all three vasoconstrictors were tolerated well by the children, there was a suggestion that heart rate decreased more at 5 minutes with phenylephrine than with oxymetazoline or cocaine (P = .08) and that blood pressure increased more at 10 minutes with phenylephrine than with oxymetazoline or cocaine (P = .1). No arrhythmias were noted. Subjective scoring for bleeding showed that children receiving oxymetazoline were less likely to receive scores of "more" bleeding than usual (3/38 vs. 10/34 for phenylephrine and 10/35 for cocaine, P less than .02). Subjective scoring for visualization showed that children receiving oxymetazoline were also less likely to receive scores of "worse" visualization than usual (3/38 vs. 12/38 for phenylephrine and 9/35 for cocaine, P less than .01). There was no difference in surgical bleeding or visualization between children receiving phenylephrine and children receiving cocaine. In our institution, 0.05% oxymetazoline is the preferred vasoconstrictor for FESS in children.
Assuntos
Sinusite/cirurgia , Vasoconstritores/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Doença Crônica , Cocaína/administração & dosagem , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Hemostasia Cirúrgica/métodos , Humanos , Monitorização Intraoperatória , Oximetazolina/administração & dosagem , Fenilefrina/administração & dosagem , Estudos ProspectivosRESUMO
Anesthetic records for the first 71 children who underwent selective dorsal rhizotomy (SDR) at our hospital were reviewed. Anesthesia during SDR must preserve muscle contraction in response to direct electrical stimulation of the dorsal nerve rootlets. In our experience, halothane, isoflurane, and narcotics do not interfere with electrophysiologic monitoring, even though relatively large doses are required during SDR. Propofol proved to be unacceptable as an anesthetic because of severe muscle spasms during electrical stimulation of the nerve rootlets. The body temperature rises predictably during the stimulation phase of SDR and active warming measures should be avoided.
