Endoscopic Sinus Surgery Clinical Trial
Official title:
Comparative Study of Influence of Different Techniques of Remifentanil Titration During Functional Endoscopic Sinus Surgery Under Total Intravenous Anaesthesia (TIVA)
The aim of this randomized trial is to assess the efficacy of analgesia , compare the utility of Pupillary Dilatation Reflex (PRD), Surgical Pleth Index (SPI) for monitoring pain perception intraoperatively and their influence on intraoperative blood loss, quality of surgical field using Boezaart Bleeding Scale (BBS) in patients undergoing functional sinus surgery (FESS)
Intraoperative blood loss during FESS constitutes a major problem for a surgeon because it
influences quality of surgical field. Each incident of haemorrhage makes the operator stop
the procedure in order to bring back the optimal visualization of the intranasal anatomy. In
the end it prolongs the time of procedure.
Currently, intraoperative blood loss is estimated based on Boezaart Bleeding Scale (BBS) (0 -
no bleeding (cadaveric conditions), 1 - Slight bleeding, no suctioning required, 2 - Slight
bleeding, occasional suctioning required, 3 - Slight bleeding, frequent suctioning required;
bleeding threatens surgical field a few seconds after suction is removed, 4 - Moderate
bleeding, frequent suctioning required, and bleeding threatens surgical field directly after
suction is removed, 5 - Severe bleeding, constant suctioning required; bleeding appears
faster than can be removed by suction; surgical field severely threatened and surgery usually
not possible).
Recently, the Surgical Pleth Index (SPI) and Pupillary Dilatation Reflex (PRD) were added as
a surrogate variable showing the nociception-antinociception balance into above mentioned
parameters constituting a novel approach in monitoring patients intraoperatively, known as
adequacy of anaesthesia (AoA) or tailor-made anaesthesia. PRD value >5% reflects increased
sensitivity to painful stimulus as well as delta SPI>10 or any SPI>50, and they constitute
the indication for administration of rescue analgesia intraoperatively.
This study aims at evaluating utility of SPI-directed analgesia or PRD-directed analgesia or
Boezaart scale-directed analgesia using remifentanil on the intraoperative blood loss,
haemodynamic stability and time duration of surgery.
Currently, FESS is most often performed using total intravenous anaesthesia (TIVA) which is
by majority of anaesthesiologists believed to reduce the intraoperative blood loss compared
to general anaesthesia using volatile anaesthetics, but literature provides conflicting
findings in this area.
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