Effect of Controlled Hypotension by Esmolol Versus Remifentanil on Cerebral Oxygen Saturation in Patients Undergoing Endoscopic Sinus Surgery: A Randomized Clinical Trial

Year 2023, , 26 - 32, 22.06.2023

Demet Altun , Serkan Ünsal Levent Aydemir , Hakan Kara , Özlem Turhan , Ali Emre Çamcı

https://doi.org/10.26650/Tr-ENT.2023.1267115

Abstract

Objective: In this prospective, single blind-randomized study, we aimed to investigate the effect of controlled hypotension by esmolol vs. remifentanil on cerebral oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) in patients undergoing functional endoscopic sinus surgery (FESS). Material and Methods: One hundred fifty patients undergoing elective FESS under controlled hypotension were evaluated for study inclusion. Group allocation was performed in a randomized fashion. Controlled hypotension was provided using continuous remifentanil (Group R) or esmolol (Group E) infusion. rSO2 was assessed during controlled hypotension by NIRS monitoring. Demographic data, hemodynamic values, and rSO2 were recorded preoperatively, postinduction 5th min, intraoperatively (10,20,30,45,60,90 minutes), and 5 and 10 minutes after stopping hypotensive agents. The duration of surgery and anesthesia and surgeon satisfaction score were also recorded. Results: 126 patients were included in the study. Among the demographic data, only weight was found significantly different between the groups. The unfortunate fact is that there was no significant difference in the mean of minimum rSO2(p=0.186) and also in the median of the minimum mean arterial blood pressure (MAP) (p=0.312) between Group R and Group E. Surgeon satisfaction score was significantly higher in Group R (p<0.001). rSO2 (p<0.001, R2=0.67) was detected as the best predicting factor by the multiple regression model. While Heart rate (HR), MAP, and preinduction rSO2 added statistically significantly to the prediction(p<0.001), the type of hypotensive drug did not (p=0.979). Conclusion: Esmolol and remifentanil used for controlled hypotension did not cause significant rSO2 changes. Among the factors affecting rSO2 MAP, HR, and pre-induction rSO2 were detected, while the best predictor factor was pre-induction rSO2. Remifentanil provides a better surgical field than esmolol according to the VAS scale.

Keywords

Endoscopic sinus surgery, controlled hypotension, remifentanil, esmolol, monitorization

References

• Alkan A, Honca M, Alkan A, Güleç H, Horasanlı H. The efficacy of esmolol, remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery. Braz J Otorhinolaryngol 2021;87(3):255-9. google scholar
• Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H et al. Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil. Eur Arch Otorhinolaryngol 2017;274(1):239-45. google scholar
• Bayram A, Ulgey A, Gunes I, Ketenci I, Capar A, Esmaoglu A, et al. Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery. Rev Bras Anestesiol 2015;65(1):61-7. google scholar
• Nazir O, Wani MA, Ali N, Sharma T, Khatuja, Misra R, et al. Use of Dexmedetomidine and Esmolol for Hypotension in Lumbar Spine Surgery. Trauma Mon 2016;21(3) e22078. google scholar
• Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol 2016;32(2):192-7. google scholar
• Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database of Systematic Reviews 2018;1(1):CD010947. google scholar
• Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, et al. Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study. Anesth Analg 2007;104(1):51-8. google scholar
• Madsen PL, Secher NH. Near-infrared oximetry of the brain. Prog Neurobiol 1999;58(6):541-60. google scholar
• Madsen P, Pott F, Olsen SB, Nielsen HB, Burcev I, Secher HN. Near-infrared spectrophotometry determined brain oxygenation during fainting. Acta Physiol Scand 1998;162(4):501-8. google scholar
• Farzanegan B, Eraghi MG, Abdollahi S. Evaluation of cerebral oxygen saturation during hypotensive anesthesia in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol 2018;34(4):503. google scholar
• Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S;et al. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol 2007;24(1):59-65 google scholar
• Kim MB, Ward DS, Cartwright CR, J Kolano, S Chlebowski, L C Henson. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput 2000;16(3):191-9. google scholar
• Moka E. Cerebral oximetry and laparoscopic surgery. J Minim Access Surg 2006;2(2):47-8. google scholar
• Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, et al. Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions. Anesth Analg 2010;111(2):496-505. google scholar
• Papadopoulos G, Karanikolas M, Liarmakopoulou A, Berris A. Baseline cerebral oximetry values in elderly patients with hip fractures: a prospective observational study. Injury 2011;42(11):1328-32. google scholar
• Fischer GW, Torrillo TM, Weiner MM, Rosenblatt MA. The use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a patient undergoing shoulder surgery in the beach chair position. Pain Pract 2009;9(4):304-7. google scholar
• Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology 2000;93(4):964-70. google scholar
• Rigamonti A, Scandroglio M, Minicucci F, Magrin S, Carozzo A, Casati A. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy. J Clin Anesth 2005;17(6):426-30. google scholar
• Degoute C-S, Ray M-J, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth 2001;48(1):20-7. google scholar
• Mohseni M, Ebneshahidi A. The effect of oral clonidine premedication on blood loss and the quality of the surgical field dur- ing endoscopic sinus surgery: a placebo- controlled clinical trial. J Anesth 2011;25(4):614-7. google scholar
• Cardesın A, Pontes C, Rosell R, Marco J, Escobar MJ, Bernal-Sprekelsen M. Hypotensive anaesthesia and bleeding dur- ing endoscopic sinus surgery: an observational study. Eur Arch Otorhinolaryngol 2014;271(6):1505-11. google scholar
• Javer AR, Alandejani T. Prevention and management of complications in frontal sinus surgery. Otolaryngol Clin North Am 2010;43(4):827-38. google scholar
• Sarıcaoglu F, Celiker V, Basgul E, Yapakci O, Aypar U. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol 2005;22(2):157-9. google scholar
• Jacobi KE, Böhm BE, Rickauer AJ, Jacobi C. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 2000;12(3):202-7. google scholar
• Heller JA, DeMaria Jr S, Govindaraj S, Lin H-M, Fischer GW, Evans A, et al. Cerebral oximetry monitoring during sinus endoscopy. Laryngoscope 2015;125(4):E127-31. google scholar
• Kussman BD, Wypij D, DiNardo JA, NewBurger J, Jonas RA, Barlett J, et al. An evaluation of bilateral monitoring of cerebral oxygen saturation during pediatric cardiac surgery. Anesth Analg 2005;101(5):1294-300. google scholar