Abstract
Background and Aims: Controlled hypotension is required for middle ear surgery to achieve a bloodless operative field. A highly selective alpha2 adrenergic agonist like dexmedetomidine, by virtue of its central sympatholytic, sedative and analgesic-sparing effect may provide such desired operating conditions. The present study was designed to evaluate the clinical effects of dexmedetomidine infusion as an anesthetic adjuvant to provide oligemic surgical field in middle ear surgeries.
Methods: Forty patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-58 years, weighing 45-80 kg, scheduled for elective middle ear surgery, were enrolled for this prospective placebo controlled observational study. After induction of general anaesthesia, Patients of Group A received infusion of dexmedetomidine 0.5 μg/kg/h and patients of Group B received placebo infusion of normal saline during middle ear surgery till 20 min before completion of surgery. All patients were assessed intraoperatively for bleeding at surgical field, haemodynamic changes, awakening time and postoperative recovery.
Results: The mean heart rate was found to be higher in patients of Group B after the extubation while patients of Group A did not show much variation in their mean heart rate values. In Group A, the Bleeding Scores and the Final Opinion on Bleeding Score were significantly lower when compared with Group B. None of the patients of Group B had significant reduction in bleeding at surgical site, thus it is evident that patients receiving dexmedetomidine infusion had a better surgical field as compared to patient of Group B.
Conclusions: Dexmedetomidine was found to significantly reduce intra operative bleeding. This, in turn, improves operative field visibility and increases surgeon’s satisfaction during middle-ear surgery under general anesthesia.
Keywords: Dexmedetomidine, anesthesia oligemic surgical field, Middle ear.
References
- Chiranjib S, Chiranjib B, Rajiv S, Anisha De, Sudeshna B, Arvind KV, Suchismita P. Journal of Society of Anesthesiologists of Nepal (JSAN) 2016;3(2):57-63.
- Jellish WS, Owen K, Edelstein S, Fluder E, Leonetti JP. Standard anesthetic technique for middle ear surgical procedures: A comparison of desflurane and sevoflurane. Otolaryngol Head Neck Surg 2005;133:269‑
- Marchal JM, Gomez‑Luque A, Martos Crespo F, Sánchez De La Cuesta F, Martinez‑Lopez MC, Delgado‑Martinez AD. Clonidine decreases intraoperative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand 2001;45:627‑
- Vishalakshi Patil, Harshavardhan Venkatayogi, Hanni Vinaykumar Karegoud, Mohan, Balaraju Thayappa.C IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 4 Ver. VIII (Apr. 2015), PP 01-05.
- Yung MW. Local anaesthesia in middle ear surgery: survey of patients and surgeons. Clin Otolaryngol Allied Sci 1996;21(5):404–8.
- Caner G, Olgun L, Gultekin G, et al. Local anesthesia for middle ear surgery. Otolaryngol Head Neck Surg 2005;133(2):295–7.
- Busick T, Kussman M, Scheidt T, et al. Preliminary experience with dexmedet-omidine for monitored anesthesia care during ENT surgical procedures. Am J Ther 2008;15(6):520–7.
- Jellish WS, Leonetti JP, Murdoch JR, et al. Propofol-based anesthesia as compared with standard anesthetic techniques for middle ear surgery. J Clin Anesth 1995;7(4):292–6.
- Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth 2009;103(4):490–5.
- Panzer O, Moitra V, Sladen RN. Pharmacology of sedativeanalgesic agents: Dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.
- Jellish WS, Owen K, Edelstein S, Fluder E, Leonetti JP. Standardanesthetic technique for middle ear surgical procedures:A comparison of desflurane and sevoflurane. Otolaryngol Head Neck Surg 2005;133:269-74.
- Marchal JM, Gómez-Luque A, Martos-Crespo F, SánchezDe La Cuesta F, Martínez-López MC, Delgado-Martinez AD.Clonidine decreases intraoperative bleeding in middle earmicrosurgery. ActaAnaesthesiolScand 2001;45:627-33.
- Panzer O, Moitra V, Sladen RN. Pharmacology of sedativeanalgesic agents: exmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.
- Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: A wonder drug? Indian J Anaesth 2011;55:323‑
- Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg 2010;111:1004‑
- Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D. Effects of dexmedetomidine on isoflurane require-ments in healthy volunteers 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999;83: 372‑
- Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991;74:997‑
- Aantaa R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolar conce-ntration of isoflurane by dexmedetomi-dine. Anesthesiology 1997;86:1055‑
- Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg 2008;107:1340‑
- Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedet-omidine in humans. Anesthesiology 2000;93:382‑
- Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth 2008;20;437-41.
- Nasreen F, Bano S, Khan RM, Hasan SA. Dexmedetomidine used to provide hypotensive anesthesia during middle ear surgery. Indian J Otolaryngol Head Neck Surg 2009 61:205-7.
- Durmus M, But AK, Dogan Z, Yucel A, Miman MC, Ersoy MO. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol 2007; 24: 447-53
- Aboushanab OH, El-Shaarawy AM, Omar AM, Abdelwahab HH. A comparative study between magnesium sulphate and dexmedetomidine for deliberate hypotension during middle ear surgery. Egyptian Journal of Anaesthesia 2011;27:227-32.
- Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991;74:997-1002.
- Aho M. Erkola O, Kallio A, Scheinin H, Korttila K. Dexmedetomidine infusion for maintenance of anaesthesia in patients undergoing abdominal hysterectomy. Anesth Analg 1992;75:940-6.
Corresponding Author
Dr Junaida Sarwar
Post Graduate Student, Department of Anesthesiology, Govt. Medical, College, Srinagar 190002
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No: +91-9906263888
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.84
