INTRANASAL DEXMEDETOMIDINE IN OPTIMISING SURGICAL FIELD VISUALISATION DURING FUNCTIONAL ENDOSCOPIC SINUS SURGERY: RANDOMIZED CONTROLLED TRIAL

Abstract

Background: FESS a common procedure in the field of ear, nose, throat medicine performed using fibreoptic endoscopy can cause serious adverse events if there is stress response to laryngoscopy and intubation and surgical site bleeding and can affect the postoperative outcome. This study compared the intranasally administered dexmedetomidine and normal saline alone on quality of the surgical field, bleeding and hemodynamic parameters during intubation, intraoperatively and postoperatively during FESS surgeries.

Methods: Eighty four patients undergoing FESS were randomly allocated to receive either intranasal dexmedetomidine (group D)(2 micro gram/kg) or 0.9% normal saline alone(group C) via dripping the drug into both nostrils in equal volume using 2ml syringe 15 mins before Induction. The primary objective was to study the quality of surgical field visualisation through endoscope and the blood loss that occurred. The secondary objective was to study the hemodynamic changes during laryngoscopy and intubation, side effects of intranasal Dexmedetomidine that is bradycardia and hypotension and the incidence of postoperative nausea, vomiting and sore throat.

Results: Surgical field visualisation, blood loss, hemodynamic profile during laryngoscopy and intubation and during surgery and postoperative outcome and satisfaction scores of patients and surgeons were significantly better (p<0.05) in dexmed group than control group.

Conclusion: Patients receiving intranasal dexmedetomidine for FESS had better surgical field and surgeon’s satisfaction and minimal hemodynamic fluctuations with less bleeding with better postoperative outcome and analgesia.