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Effectiveness of Dexmedetomidine to Reduce Bleeding During Tympanoplasty and Functional Endoscopic Sinus Surgery (FESS): An Interventional Study

K. Udaya Bhaskar , Suma KV1 , K Udaya Bhaskar2 , RVR Santosh Naidu3

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Indian Journal of Anesthesia and Analgesia 6(5):p 1569-1574, September-October 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6519.12

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Suma KV, K Udaya Bhaskar, RVR Santosh Naidu. Effectiveness of Dexmedetomidine to Reduce Bleeding During Tympanoplasty and Functional Endoscopic Sinus Surgery (FESS): An Interventional Study. Indian J Anesth Analg. 2019;6(5 Part-1):1569-1574.

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Abstract

Context: Bleeding during the nasal and middle ear surgeries can impair the visibility of the surgical field. Controlled hypotension is a technique used to bring down the Mean Arterial Pressure (MAP) and reduce the bleeding in the surgical field. Aims: To evaluate the effectiveness of dexmedetomidine, a selective α2-adrenoceptor agonist, on reducing the intra-operative bleeding and duration of surgery. Settings and Designs: Randomized, double blind, control study. Materials and Methods: We included sixty patients who were posted for tympanoplasty and FESS under general anesthesia and divided randomly to Group D where dexmedetomidine 1 μg/kg loading dose plus a maintenance of 0.5 to 0.8 μg/kg/hr and Group P in whom normal saline 1 ml/kg loading dose and 1 ml/kg/hr maintenance was administered. Heart rate and MAP was measured at 15,30,45,60 minutes and at extubation. Bleeding severity score and the duration of surgery were noted. Student t-test and chi-square test were used for data analysis, p - value < 0.05 was considered statistically significant. Results: The fall in heart rate, MAP was more in the Group D than in Group P and was significantstatistically (p < 0.05). Bleeding severity score was lower in the Group D than in Group P. (none of the patients had a score of 3 in Group D and in Group P 10 patients had a score of 3). The mean duration of surgery was also less in the Group D (55.55 min ± 2.34) when compared to Group P (68.39 min ± 4.38) which was statistically significant (p < 0.01). Conclusion: Dexmedetomidine infusion started as loading dose along with intra-operative maintenance results in a decrease in the MAP, reduced bleeding and shorter surgical duration.

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Suma KV, K Udaya Bhaskar, RVR Santosh Naidu. Effectiveness of Dexmedetomidine to Reduce Bleeding During Tympanoplasty and Functional Endoscopic Sinus Surgery (FESS): An Interventional Study. Indian J Anesth Analg. 2019;6(5 Part-1):1569-1574.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6519.12

Keywords

Bleeding severity score; Controlled hypotension; Dexmeditomidine; Placebo.

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