A study investigating the use of clonidine preoperatively in FESS surgery. A double blinded trial of 47 patients in Barcelona randomised into receiving clonidine (20 minutes preoperatively) versus Remifentanil (continuous infusion). Propofol and fentanyl were used for induction and then sevofluorane used for maintenance. This study had good randomisation, blindness of the operating assessing surgeon and external rhinologist assessor although low numbers. Bleeding was assessed using the Boezaart and Wormald scales and also a VAS every hour by both surgeons independently. Clonidine is an alpha 2 adrenergic agonist which acts via the CNS to induce peripheral arterial vasodilation and Remifentanil is an opioid which induces hypotension via histamine and nitrous oxide release. The results showed a significant decrease in bleeding scores for Clonidine based anaesthesia during the first two hours of the procedure. Ideally this would have been compared with total intravenous anaesthesia, the preferred choice for many FESS surgeons.
Clonidine based vs Remifentanil based hypotensive anaesthesia in FESS
Reviewed by Suki Ahluwalia
A randomized double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia.
CONTRIBUTOR
Suki Ahluwalia
Cairns Hospital / James Cook University, Queensland, Australia.
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