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Category: Volume 05 Issue 11 November 2017
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Title: Comparative Evaluation of Oral Clonidine and Oral Atenolol as Premedication in Functional Endoscopic Sinus Surgery (FESS) Under General Anaesthesia

Authors: Vijay Patil, Vinaya Kulakarni

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.183

Abstract

Aim and Objectives: To assess the effect of oral clonidine and oral atenolol as premedication on hemodynamic stability, blood loss, quality of the surgical field and side effects in patients undergoing FESS.

Material and Methods: The study included total 100 patients of (age 15 – 50 years) ASA grade I and II were randomly divided into two groups of 50 each. Patients received oral clonidine 5mcg/kg in group C and oral atenolol 1mg/kg in group A, 90 minutes prior to induction. Induction and maintainence of general anaesthesia was performed by the same standard protocol for both groups. Various study parameters i.e. hemodynamic effect (PR, SBP, DBP & MAP), amount of total blood loss, quality of surgical field, sedation score and side effects were recorded and statistically analyzed.

Results: The hemodynamic stability, less amount of blood loss and good quality surgical field was obtained in clonidine group compared to that of atenolol group & there were no serious side effects both in the groups.

Conclusion: We conclude that oral clonidine is better than atenolol in terms of hemodynamic stability, lesser blood loss & quality of surgical field without any side effects.

Keywords: Atenolol, Clonidine, hemodynamic stability, Functional endoscopic sinus surgery (FESS).

References

  1. Nasser A. Fageeh, Edilberto O. Pelausa, Adel Quarrington. Functional endoscopic sinus surgery: University of Ottawa experience and an overview. Annals of Saudi Medicine. 1996;16:( 6): 711-714.
  2. Paul D. Gittelman, Paul B Jacobs, Jane Scorina. Comparison of functional endoscopic sinus surgery under local and general anesthesia. Ann Otol Rhinol Laryngol. 1993;102:289-293.
  3. Masood Mohseni, Amin Ebneshahidi, The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial. J Anesth. 2011;25:614–617.
  4. Engleman E, Lipszyc M, Gilbert E, Van der Linden P, Bellins B, et al. Effect of clonidine on anaesthetic drug requirement and hemodynamic response during aortic surgery. Anesthesiology. 1989;71:178-187.
  5. Andre P. Boezaart. Comparison of sodium nitroprusside and esmolol- induced controlled hypotension for functional endoscopic Sinus surgery. Can J Anesth. 1995;42:(8):373-376.
  6. Joseph MM: Anesthesia for ear, nose and throat surgery. In: Longneeker DE., Tinker JH, Morgan GE. Principles and practice of Anesthesiology, 2 nd ed. st Louis: Mosby, p 2210, 1998.
  7. Wormald PJ. The surgical field in endoscopic sinus surgery. Endoscopic sinus surgery—anatomy, three-dimensio-nal reconstruction, and surgical technique. New York: Thieme. 2005. p. 7–12.
  8. Lindop MJ. Complications and morbidity of controlled hypotension. Br J anaesth. 1975;47:799-803.
  9. Jabalameli MD, M. Hashemi MD, H. Soltani MD, J. Hashemi MD: Oral Cloni-dine Premedication Decreases Intraopera-tive Bleeding in patients undergoing Endoscopic Sinus Surgery. J Research in Medical Sciences. 2005;1:25-30.
  10. Nair S, Collins M, Hung P, Rees G, Close D,Wormald PJ: The effect of B blocker premedication on surgical field during Endoscopic Sinus Surgery. 2004; 114(6): 1042-1046.
  11. Ankichetty SP, Ponniah M, Cherian VT, Thomas S, Kumar K, JeslinL.,Jaysheela K,Malhotra N. Comparison of total intravenous anaesthesia using propofol and inhalational anaesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. Journal of anaesthesiology clinical pharmacology, 2011;27(3): 328-332.
  12. Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B, Nivoche Y, Constant I, Murat I. Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta Anaesthesiol Scand. 2010;54:397–402.
  13. Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin. 2000;38:23–29.
  14. Toivonen J, Kaukinen S. Clonidine premedication: a useful adjunct in produc-ing deliberate hypotension. Acta Anaesthesiol Scand. 1990;34:653–657.
  15. Lee J, Lovell AT, Parry MG, Glaisyer HR, Bromley LM. I.v. clonidine: does it work as a hypotensive agent with inhalation anaesthesia? Br J Anaesth. 1999;82:639–640.
  16. Maze M, Tranquilli W. Alpha-2 adrenoceptor agonist: defining the role in clinical anesthesia. Anesthesiology. 1991;74:581–605.
  17. Folkow LP. Adrenergic vasomotor responses in nasal mucosa of hooded seals. Am J Physiol. 1992;263(6 Pt 2):R1291–7.
  18. Okopski JV.Recent advances in pharmaceutical chemistry review III, A new wave of beta blockers. J  ClinPharm and Ther. 1987; 12:369-388.
  19. Matot I, Sichel JY. The Effect of Clonidine Premedication on Hemody-namic Responses to Microlaryngoscopy and Rigid Bronchoscopy. AnesthAnalg. 2000;91:828–833.
  20. Singh S, Arora K. Effect of oral clonidine premedication on perioperative haemodyn-amic response and posroperative analgesic requirement for patients undergoing laparoscopic choleystectomy. Ind J anaesth. 2011; 55(1): 26-29.
  21. Gupta D,Srivastava S, Dubey RK, Prakash PS, Singh PK, Singh Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double blind, controlled study. Ind J  Anaesth. 2011;55(2):135-140.
  22. Welfringer P,Manel J, Garric J, Clonidine premedication and isofluraneanesthesia to reduce bleeding in otologic surgery. Ann Fr AnesthReanim. 1992;11(2):125-131.
  23. Shukla U, MalhotraK, and Prabhakar T.  Comparative study of  theefffect of clonidine and tramadol in post- spinal anaesthesia  shivering.  Ind J. Anaesth. 2011; 55(3):242-246.

Corresponding Author

Vijay Patil

Assistant Professor, B J Medical College & Sasoon hospital, Pune

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