Premedication with clonidine before TIVA optimizes surgical field visualization and shortens duration of endoscopic sinus surgery - results of a clinical trial.
BACKGROUND
During functional endoscopic sinus surgery (FESS), intraoperative bleeding can significantly compromise visualization of the surgical field. Clonidine constricts peripheral blood vessels and reduces systemic blood pressure, which in combination decrease nasal mucosa blood flow. This dual effect can potentially reduce bleeding during FESS and stabilize the intraoperative hemodynamic profile of the patient.


OBJECTIVE
The aim of this prospective study was to assess if the quality of the surgical field visualization during FESS was improved when clonidine was used as a premedication agent.


METHODS
A group of 44 patients undergoing FESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded by the operating surgeon using the scale proposed by Boezaart. The evaluations were done during surgery at 15 minutes (K1), 30 minutes (K2), 60 minutes (K3) and 120 minutes (K4) after incision.


RESULTS
The duration of the surgical procedure was significantly shorter in the clonidine group: mean time of surgery: 80 vs. 96 min in the clonidine and midazolam groups, respectively. Also better quality of surgical field was observed at all time points in the clonidine group.


CONCLUSIONS
Premedication with clonidine before FESS results in shortening of the surgical time and a better quality of the surgical field.
Nicolaus Copernicus University of Torun, Poland. kwawrzyniak@wp.pl
K
K
Wawrzyniak
K
K
Kusza
J B
JB
Cywinski
P K
PK
Burduk
W
W
Kazmierczak
D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002908:Chronic Disease; D003000:Clonidine / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D011292:Premedication; D011446:Prospective Studies; D012852:Sinusitis / Q000601:surgery*; D018709:Statistics, Nonparametric
D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D003000:Clonidine; D008874:Midazolam