The Effect Of Oral Clonidine Premedication On blood Loss And The Quality Of The Surgical Field During Endoscopic Sinus Surgery

Document Type : Original Article

Authors

1 Resident of Otorhinolaryngology, Beni-Suef, Egypt.

2 Professor of Otorhinolaryngology Faculty of Medicine- Beni-Suef University

3 Lecturer of Otorhinolaryngology Faculty of Medicine- Beni-Suef University

Abstract

Aim of the study: This study aims to assess the effect of oral clonidine premedication on blood loss and the surgical field quality during endoscopic sinus surgery in individuals with bilateral sinonasal polyposis. Patients and methods: At the Beni- Suef University Hospital, a randomised, controlled, double-blind clinical experiment was done. Approval from research ethics committee of faculty of medicine of Beni-Suef University and an informed consent from patients diagnosed as sinonasal polyposis was obtained, in the duration from June 2019 to February 2020. Forty patients were randomly assigned to equal groups; group 1 (20 patients) received oral clonidine 200 micrograms (the recommended dose) 1 to 1.5 hours before the time of operation and group 2 (20 patients) did not receive clonidine. Surgeries in both groups were done using hypotensive anesthesia in the form of deep general anesthesia and heavy analgesia under general anesthesia. An uncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, and, if necessary, sphenoidectomy were performed as part of endoscopic sinus surgery (ESS). Results: The blood loss in the jar and the total blood loss in group 2 are statistically significant higher than group 1 (P-value<0.05). That there was a statistically significant difference between the two groups regarding the mean Boezart scale and its categories (P-value<0.05). There was a statistically significant increase of the intraoperative time in group 2 than group 1 (P-value<0.05). In conclusion, the pre-medication with clonidine improves hemodynamic status, surgical field, decrease the blood loss inside the jars and the total blood loss and subsequently decrease the intraoperative time.

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  1. Wormald, P. (2005).Endoscopic sinus surgery-Anatomy, three-dimensional reconstruction, and surgical technique. Thieme Medical Publishers.
  2. Riegle, E. V., Gunter, J. B., Lusk, R. P., Muntz, H. R., & Weiss, K. L. (1992). Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. The Laryngoscope, 102(7), 820-823.
  3. Dahmani, S., Brasher, C., Stany, I., Golmard, J., Skhiri, A., Bruneau, B., & Murat, I. (2010). Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta anaesthesiologica scandinavica, 54(4), 397-402.
  4. Demiri, M., Antunes, T., Fletcher, D., & Martinez, V. (2019). Perioperative adverse events attributed to α2-adrenoceptor agonists in patients not at risk of cardiovascular events: systematic review and meta-analysis. British Journal of Anaesthesia, 123(6), 795-807.
  5. Prasad, G. K., Khanna, S., & Jaishree, S. V. (2020). Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends. Saudi Journal of Anaesthesia, 14(1), 77.
  6. Sung, C. S., Lin, S. H., Chan, K. H., Chang, W. K., Chow, L. H., & Lee, T. Y. (2000). Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiologica Sinica, 38, 23-30.
  7. Al-Kadri, H.; Anazi, B. and Tamim, H. (2011). Visual estimation versus gravimetric measurement of postpartum blood loss: A prospective cohort study. Archives of Gynecology and Obstet-rics; 283 (6): 1207-1213.
  8. Boezaart, A.; Johan, V. and Coetzee A. (1995). Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth; 42: 373-376.
  9. Ramakrishnan, V. R. (2012). Kingdom TT, Nayak JV, Hwang PH, Orlandi RR. In Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol (Vol. 2, No. 1, pp. 34-9).
  10. Riegle, E. V., Gunter, J. B., Lusk, R. P., Muntz, H. R., & Weiss, K. L. (1992). Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. The Laryngoscope, 102(7), 820-823.
  11. Maze, M., & Tranquilli, W. (1991). Alpha-2 adrenoceptor agonistsDefining the role in clinical anesthesia. Anesthesiology: The Journal of the American Society of Anesthesiologists, 74(3), 581-605.
  12. Mohseni, M., & Ebneshahidi, A. (2011). 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. Journal of anesthesia, 25(4), 614-617.
  13. Folkow, L. P. (1992). Adrenergic vasomotor responses in nasal mucosa of hooded seals. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 263(6), R1291-R1297.
  14. De Kock, M., Versailles, H., Colinet, B., Karthaeuser, R., & Scholtes, J. L. (2004). Epidemiology of the adverse hemodynamic events occurring during “clonidine anesthesia”: a prospective open trial of intraoperative intravenous clonidine. Journal of clinical anesthesia, 7(5), 403-410.
  15. Fehr, S. B., Zalunardo, M. P., Seifert, B., Rentsch, K. M., Rohling, R. G., Pasch, T., & Spahn, D. R. (2003). Clonidine decreases propofol requirements during anaesthesia: effect on bispectral index. British journal of anaesthesia, 86(5), 627-632.
  16. Dimou, P., Paraskeva, A., Papilas, K., & Fassoulaki, A. (2006). Transdermal clonidine: does it affect pain after abdominal hysterectomy?. Acta Anæsthesiologica Belgica, 54(3), 227-232.
  17. Wawrzyniak, K., Kusza, K., Cywinski, J. B., Burduk, P. K., & Kazmierczak, W. (2013). Premedication with clonidine before TIVA optimizes surgical field visualization and shortens duration of endoscopic sinus surgery: results of a clinical trial. Rhinology, 51(3), 259-64.
  18. JAB, A. M., HASHEMI, J., HASHEMI, M., & SOLTANI, H. (2005). Oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery.
  19. Das, A., Mukherje, A., Chhaule, S., Chattopadhyay, S., Halder, P. S., Mitra, T., ... & Mandal, S. K. (2016). Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study. Saudi journal of anaesthesia, 10(1), 74.