The effect of blood pressure and cardiac output on the quality of the surgical field and middle cerebral artery blood flow during endoscopic sinus surgery

International Forum of Allergy & Rhinology
Thanh Ngoc HaPeter-John Wormald

Abstract

A clear surgical field is critical during endoscopic sinus surgery (ESS). Hypotensive anesthesia and cardiac output (CO) may optimize the surgical field; however, evidence of their effect on bleeding and cerebral blood flow is conflicting. The aim of this study was to evaluate the effect of blood pressure (BP) and CO on intraoperative bleeding and middle cerebral artery blood flow velocity (Vmca ) during ESS. This was a prospective randomized controlled trial. Patients undergoing ESS for chronic rhinosinusitis at a tertiary institution in 2013 were randomized to receive BP manipulation using target-controlled noradrenaline infusion during surgery to either their left or right sinuses. The contralateral side in each patient served as control. Bleeding was scored using a 0 to 10 point bleeding assessment scale (BAS, 0-10) and Vmca was measured using transcranial Doppler ultrasonography every 10 minutes or when surgically opportune, and time-matched with BP and CO. Data was analyzed using Bland-Altman methods. A total of 105 time points were collected across a mean arterial pressure (MAP) range of 32 to 118 mmHg. Significant correlations were demonstrated between MAP and Vmca (r = 0.7, p < 0.0001), MAP and BAS (r = 0.50, p < 0.000...Continue Reading

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Citations

Jul 9, 2016·International Forum of Allergy & Rhinology·Richard R Orlandi
May 27, 2020·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Suneeta GollapudyMatthias L Riess
Feb 4, 2019·Current Allergy and Asthma Reports·Saad AlsalehAmin Javer
Dec 23, 2016·Current Opinion in Otolaryngology & Head and Neck Surgery·Daniel A Carlton, Satish Govindaraj
Nov 26, 2020·International Forum of Allergy & Rhinology·Richard R OrlandiBing Zhou
Jul 9, 2021·American Journal of Rhinology & Allergy·Lirit LeviEthan Soudry
Jul 17, 2021·Current Opinion in Anaesthesiology·Kamilla Esfahani, Lauren K Dunn

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