Used Of Dexmedetomidine In Endoscopic Sinus Surgery Patients During Isoflurane Controlled Hypotension

Background:The aim of this study was to assess the effect of dexmedetomidine in isoflorane controlled hypotension anesthesia in functional endoscopic sinus surgery, and evaluate its effect in perioperative hemodynamics, stress response and postoperative recovery.Methods:Thirty patients,ASA Ⅰ-Ⅱ scheduled for elective functional endoscopic sinus surgery,were randomly divided into tow groups.Dexmedetomidine group (group D) receive dexmedetomidine (1μg/kg) over15min before anesthesia induction followed by (0.4-0.6μg/kg/h) infusion during maintenance, and propofol group (group C) receive propofol (1-2μg/ml) target-controlled infusion during anesthesia.Both groups receive remifentanil0.1μg/kg/min infusion, according to BIS adjust isoflurane inhalation concentration for maintenance of anaesthesia. SBP, DBP, MAP, HR and BIS were recorded before induction, before and after intubation, at1,10,20,30and60min after incision, after finished surgery and after extubation. The concentration of isoflurane and volume of hypotensive agent were recorded at1,10,20,30and60min after incision. Surgical field exposure condition and satisfaction scores were assessed by the surgeon. Results:Homodynamic:both groups compared with T0,MAP was significantly decreased during surgery(P<0.05) at points T3,T4,T5,T6,T7and T8.At recovery both groups compared with T0,MAP was significantly decreased (P<0.05) at point T8.After extubation both groups compared with T0,MAP was no significant difference (P>0.05).Group D compared with group C,MAP was significantly decreased (P<0.05) at points T6,T8and T9.Group D compared with T0,HR was no significant difference (P>0.05) at all points,while HR in group C was significantly increased (P<0.05) at points T2,T5,T6,T7,T8and T9.Group C compared with group D,HR was significantly increased (P<0.05) at points T2,T4,T5,T6,T7, T8and T9.Surgical field exposure condition, blood loss and used of drugs: group D Fromme surgical filed exposure condition (2.3±0.7) was significantly good compared with group C (3±0.01)(P<0.05). Group D blood loss (170±25) was significantly less than group C (286±69)(P<0.05).In used of drugs, group D,3patients (20%) received nitroglycerin was significantly less than group C,7patients (46.66%)(P<0.05).Group D compared with group C, isoflorane minimum alveolar concentration was significantly decreased (P<0.05) at points T3,T4,T5and T6.Group C,5patients (33.33%) received esmolol was significantly more than group D, no patients (P<0.05).Recovery of anesthesia:group D compared with group C, recovery time, spontaneous breathing, opening eyes and extubation time was no significant difference (P>0.05). Group D compared with group C, agitation and chills was significantly reduced (P<0.05).Conclusion:Dexmedetomidine was safe and more effective than propofol in achieving controlled hypotension, good surgical field exposure condition and recovery during isoflorane controlled hypotension.Infusion of demedetomidine, at the doses used in this study, reduced the requirements of isoflorane concentration and amount of nitroglycerin.