Endoscopic Sinus surgery usually associated by bleeding, despite using of local vasopressor injection, head up position- controlled hypotension is generally used for control of this purpose. Propofol has been reported as a good agent for controlled hypotension by decreasing systemic vascular resistance secondary to arterial and venous vasodilation and a decrease in myocardial contractility with a dose-dependent property. Magnesium Sulfate also has been reported as an agent of hypotensive anaesthesia by inhibition of the release of norepinephrine by blocking N-type calcium channel at the nerve ending beside acting as a vasodilator. The well known pharmacodynamic effects of the intravenous infusion of propofol or Magnesium Sulfate may prove the advantage of this group in controlling intraoperative blood pressure thus reducing surgical field bleeding.
The aim of the work to compare the efficacy of propofol and magnesium sulfate to control blood pressure during endoscopic sinus surgery and the resultant effects on the quality of the surgical field including bleeding and visibility.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
50
Following induction of anaesthesia, propofol infusion will be started 75 mcg/kg/min for the first 10-15 minutes, then a maintenance infusion of propofol (50 mcg/kg /min)
Before induction of anaesthesia, Magnesium Sulfate infusion will be started at 40 mg/kg in 100 ml saline over 10 minutes as the loading dose then Magnesium sulfate infusion 10-15 mg/kg/hr started immediately after induction of anaesthesia
Patients will receive iv lidocaine 1.5 mg/kg before induction of anaesthesia
Patients will receive fentanyl 1-2 mcg/kg before induction of anaesthesia
Patients will receive propofol in a dose of 1-2 mg /kg
Patients will receive 0.6 mg /kg iv atracurium over 60 sec, to facilitate tracheal intubation
Patients lungs will be ventilated using the volume controlled mechanically ventilated with 40% oxygen in the air with positive end-expiratory pressure (PEEP) of 5 cmH2O, tidal volume 500 ml and Respiratory Rate of 12 per minute
Nabil A Abd El-Mageed
Al Mansurah, DK, Egypt
Mean arterial blood pressure (MAP)
automatically non invasive measured every 3 minutes , recorded every 15 minutes till the end and 15 minutes after extubation the end and 15 minutes after extubation
Time frame: 15 minutes after the induction of the hypotensive agent
The blood loss
The blood loss would be calculated using the following formula Blood Loss = Blood Volume. In )Hct 1 / Hct2)
Time frame: at the end of the surgery
The number of patients will need nitroglycerine and dose
The number of patients will need nitroglycerine
Time frame: at the end of the surgery
Use of Ephedrine
The number of patients will need ephedrine
Time frame: at the end of the surgery
Need for blood transfusion
The number of patient need for blood transfusion
Time frame: at the end of the surgery
Postoperative Ramsey sedation
patient awake, anxious, agitated or restless 2 patient awake -1co operative, oriented and tranquil 3 patient drowsy with respond to command 4 patient asleep brisk response to glabella tap or loud auditory sound 5 patient asleep with sluggish response to stimulus 6 patient hasno response to nail bed pressure or othernoxious stimuli
Time frame: for the first hour postoperative
Simplified post operative nausea and vomiting score
using impact scale score evaluation
Time frame: for the first 24 hour postoperative
Recovery time
time needed to reach modified aldrete score\> or=9)
Time frame: one hour after extubation
Heart rate (HR)
Time frame: 15 minutes after the start of the hypotensive agent
surgical field assessment
By the surgeon interms of bleeding and visibility using a 6-option Liker-scale scale adapted from Fromme el al. (26): 0 = no bleeding; 1 = minor bleeding, but no aspiration required; 2 = minor bleeding, aspiration required; 3 = minor bleeding, frequent aspiration required; 4 = moderate bleeding, visible� only with aspiration; 5 = severe bleeding, continuous aspiration required
Time frame: 2 hours intraoperative
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.